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Öğe Karaciğer Nakli Sonuçları Üzerinde Kan Transfüzyonlarının Etkisi ve Transfüzyon Gereksinimini Etkileyen Faktörler(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2008) Yaprak, Onur; Dayangac, Murat; Balcı, Deniz; Duran, Cihan; Uraz, Süleyman; Ayanoğlu, Ömer; Yüzer, Yıldıray; Tokat, Yamanİntraoperatif kan transfüzyon ihtiyacı üzerindeki preoperatif hasta karekteristiklerinin etkisini araştırmak ve aynı zamanda kan transfüzyonunun postoperatif mortalite ve morbiditeye etkilerini değerlendirmek. MATERYAL ve METOD: Haziran 2004 ile Mayıs 2006 tarihleri arasında kliniğimizde son evre karaciğer hastalığı olan 16’sı kadaverik ve 65’i canlıdan olmak üzere toplam 81 hastaya karaciğer transplantasyonu uygulandı. Hastalar daha önceki çalışmalarda olduğu gibi 2 gruba ayrıldı). Yüksek transfüzyon yapılmış gurup (YTG) (>4 ünite eritrosit süspansiyonu) ve düşük transfüzyon yapılmış gurup (DTG) (<4 ünite eritrosit süspansiyonu). Dataların kategorizasyonu ve hesaplanmasından sonra kantitatif parametreler independent student’s t- test, kalitatif parametreler ise chi-squared test ile değerlendirildi. BULGULAR: Ortalama transfüze edilen eritrosit süspansiyonu 5.4 ünite idi. İntraoperatif kan transfüzyonu gereksinimi üzerinde hasta yaşı, primer hastalık olarak HCV, hastanın Child skoru anlamlı parametreler olarak saptandı. YTG hastalarda postoperatif reoperasyon ve mortalite oranı anlamlı düzeyde daha yüksek bulundu. Ayrıca YTG hastalarda postoperatif enfeksiyon gelişimi daha fazla idi. SONUÇ: Bu araştırmada yüksek kan transfüzyonunun posttransplant komplikasyonlar ve mortalite üzerinde önemli bir etken olduğu sonucuna varılmıştır.Öğe Recipient Splenic Artery Utilization for Arterial Re-Anastomosis in Living Donor Liver Transplantation: Single-Center Experience(H G E Update Medical Publishing S A, 2012) Piskin, Turgut; Demirbas, Tolga; Yalcin, Levent; Yaprak, Onur; Dayangac, Murat; Guler, Necdet; Bulutcu, FusunThrombosis of recipient hepatic artery is a life threatening complication for liver transplantation. The etiology of hepatic arterial thrombosis is multi-factorial and can be caused by intimal dissection, poor surgical technique and coagulopathies. The patency of hepatic arterial flow is very important for both graft survival and patient survival. Intraoperative diagnosis of inadequate hepatic arterial flow found with Doppler ultrasonography is essential in order to achieve good results after liver transplantation. Urgent re-anastomosis is necessary when the arterial blood flow is insufficient. We performed 317 living donor liver transplantations from July 2004 to July 2011. We used recipient splenic artery for hepatic artery reconstruction in six patients. These six patients were included in this study. Using the recipient splenic artery is a simple, safe and practical alternative for hepatic artery re-anastomosis in living donor liver transplantations.Öğe Right Lobe Liver Transplantation Using Hyperbilirubinemic Donors(John Wiley & Sons Inc, 2010) Demirbas, Baha Tolga; Piskin, Turgut; Orug, Taner; Dayangac, Murat; Yaprak, Onur; Yuzer, Yildiray; Tokat, Yaman[Abstract Not Available]Öğe Right-lobe Liver Transplant From Donors With Gilbert Syndrome(Baskent Univ, 2012) Demirbas, Tolga; Piskin, Turgut; Dayangac, Murat; Yaprak, Onur; Akyildiz, Murat; Tokat, Yaman; Yuzer, YildirayObjectives: Donor safety is one of the most important aspects of living-donor liver transplant. The preoperative evaluation of candidates for such transplants essentially starts with serologic and biochemical analyses. However, some potential liver donors with normal liver function test results may have isolated mild hyperbilirubinemia (serum indirect bilirubin level > 20.5 mu mol/L [1.2 mg/dL]). Gilbert syndrome is an autosomal recessive condition that is a common cause of nonhemolytic unconjugated hyperbilirubinemia, and its prevalence is 3% to 10% in the healthy US population. Mild hyperbilirubinemia episodes are expected in people with Gilbert syndrome when they are exposed to physical stress, such as operative intervention or low energy intake. The liver morphologic findings of these individuals are normal; however, there is a debate on the use of people with Gilbert syndrome as living-liver donors. The purpose of this study was to assess the results of right-lobe living-donor hepatectomy of liver donors with Gilbert syndrome. Materials and Methods: Between 2004 and 2010, two hundred twenty-five living-donor liver transplants using right-lobe grafts were performed in our hospital. Donors with Gilbert syndrome were defined as those whose serum bilirubin level was greater than 20.5 mu mol/L (1.2 mg/dL). Six of 225 right-lobe living-donor liver transplants were performed using donors with Gilbert syndrome. Results: The median follow-up after transplant was 34 months (range, 18 to 51 mo). One week after the operation, the median bilirubin level for rightlobe liver donors was 34.5 mu mol/L (2.02 mg/dL) (range, 17.1 to 51.3 mu mol/L [1 to 3 mg/dL]), and the median prothrombin time (international normalized ratio) was 1.36 (range, 1.1 to 1.7). The median bilirubin level of the donors after 6 months was 29 mu mol/L (1.7 mg/dL) (range, 20.5 to 41 mu mol/L [1.2 to 2.4 mg/dL]). Conclusions: Living-donor liver transplant from Gilbert syndrome donors can be safely performed.Öğe Successful Treatment of Severe Hepatorenal Syndrome with Living Donor Liver Transplantation(H G E Update Medical Publishing S A, 2012) Demirbas, Baha Tolga; Piskin, Turgut; Dayangac, Murat; Yaprak, Onur; Oklu, Levent; Yuzer, Yildiray; Tokat, YamanHepatorenal syndrome is defined as renal failure caused by acute or chronic liver failure without any laboratory or histological reasons. The exact etiology of this syndrome is unknown. However, vasodilatation in the splanchnic area as a result of cirrhosis and portal hypertension, reflex systemic and splanchnic vasoconstriction are the basic pathophysiological reasons of this syndrome. The decrease of renal perfusion, decrease in glomerular filtration rate, sodium retention and deterioration of excretion of free water are the major renal problems and these remain progressive according to the stage of liver disease. The treatment of this syndrome is correction of the underlying problem. Here, we report a patient who was having hemodialysis, due to renal failure as a consequence of liver cirrhosis for three months and returned back to his normal life without a need for dialysis after liver transplantation.
