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Öğe Aborted donor hepatectomy in living donor liver transplantation: lessons learned(Sa Medical Assoc, 2020) Kutluturk, K.; Akbulut, S.; Baskiran, A.; Gonultas, F.; Dirican, A.; Isik, B.; Yilmaz, S.Background: Aborted donor hepatectomy (ADH) during any stage of living donor hepatectomy (LDH) is a rare event. We describe our experience and discuss the lessons from these events. Methods: From September 2005 to January 2019, 77 of 2 031 (3.79%) LDH were aborted at various stages of surgical procedure due to donor or recipient related reasons. Demographic and clinical data of aborted donor candidates and the clinical course of their potential recipients were analysed. Results: LDH of 77 donor candidates was aborted due to donor (n = 53) or recipient (n = 24) related reasons. The most common donor related reason was the quality of liver parenchyma (n = 31). The most common recipient related reason was haemodynamic instability (n = 11). Twenty-three recipients underwent either living donor liver transplantation (LDLT) (n = 21) or deceased donor liver transplantation (DDLT) (n = 2) at a median of 6 days following ADH. In one aborted due to a donor reason and two aborted for recipient reasons, LDLT was performed using the same donor candidates. Thirty-six recipients had no liver transplantation (LT) and died a median of 17.5 days following ADH. Conclusions: We believe that ADH will decrease with experience and meticulous preoperative clinical and radiological evaluations. Abandoning the donor hepatectomy is always a valid option at any stage of the surgery when the unexpected is encountered.Öğe Acinetobacter Infection in a Liver Transplantation Intensive Care Unit(Elsevier Science Inc, 2013) Otan, E.; Aydin, C.; Usta, S.; Kutluturk, K.; Kayaalp, C.; Yilmaz, S.Objective. Despite the advances in surgical technique and postoperative care, infectious complications are associated with high mortality rates. Acinetobacter species are emerging as a leading worldwide nosocomial pathogen in intensive care unit (ICU) patients. This study was designed to evaluate the results of the patients who developed Acinetobacter infection in the ICU after liver transplantation. Methods. We retrospectively analyzed 220 patients who had undergone liver transplantation between August 2011 and August 2012. Among the 55 positive culture results with clinical signs of infection, Acinetobacter was the single infectious agent for 10 of them, who were included in the study. Results. The mean age of the patients was 43.1 +/- 11.79 years with a male dominance (70%, n = 7). Eighty percent of the patients underwent living donor liver transplantations (n = 8). Mean Model for End-stage Liver Disease score was 28.5 +/- 14.99. Graft dysfunction was present in 50% (n = 5), all of whom had a history of preoperative hospitalization (100%, n = 10). Forty percent (n = 4) of patients had a history of diabetes mellitus and 60% were subject to extended mechanical ventilation. Mean platelet count was 20.32 +/- 8.1 x 10(9)/mL. The majority of the patients had multiple culture-positive sites (90%, n = 9). Positive culture results for Acinetobacter species included bloodstream (n = 8), drain fluid (n = 5), sputum (n = 3), paracenthesis material (n = 3), and catheter (n = 1). The mean period of postoperative positive culture results was 12.7 +/- 9.5 days. Mortality was 90% (n = 9). Conclusion. Acinetobacter infections in the ICU after liver transplantation were asociated with a high mortality presenting with thrombocytopenia.Öğe Analysis of risk factors affecting the development of infection in artificial vascular grafts used for reconstruction of middle hepatic vein tributaries in LDLT(Lippincott Williams & Wilkins, 2018) Koc, C.; Akbulut, S.; Isik, B.; Yologlu, S.; Yilmaz, S.[Abstract Not Available]Öğe Chronic Graft-Versus-Host Disease After Liver Transplantation: A Case Report(Elsevier Science Inc, 2012) Yilmaz, M.; Ozdemir, F.; Akbulut, S.; Ersan, V.; Koc, C.; Koc, S.; Yilmaz, S.Graft-versus-host disease (GVHD) after orthotopic liver transplantation pun is a rare but significant complication, occuring in 1%-2% of cases with a mortality rate of 85%-90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the host's histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.Öğe Clinical Outcomes of Donor Hepatic Artery to Recipient Replaced Right Hepatic Artery Anastomosis in Living-Donor Liver Transplantation(Elsevier Science Inc, 2015) Koc, O.; Yaylak, F.; Sarici, B.; Soyer, V.; Yilmaz, S.Objective. The aim of this work was to evaluate the clinical outcomes of donor hepatic artery to recipient replaced right hepatic artery anastomosis in living-donor liver transplantation. Methods. A retrospective analysis of 12 patients with donor hepatic artery to recipient replaced right hepatic artery anastomosis in living-donor liver transplantation from January 2012 to July 2014 was performed. Age, sex, clinical diagnosis of the liver disease, ABO mismatch, hepatic artery thrombosis, biliary strictures and leakage, graft loss, and mortality rates were evaluated. Results. Female-to-male ratio was 4:8. Right lobe was transplanted in 11(91.7%) of the patients. In 1 patient, left lobe was transplanted. In 9 patients, single duct-to-duct biliary anastomosis was performed with cystic duct catheterization. In 2 patients, double duct-to-duct biliary anastomosis was performed. In 1 patient, double biliary duct-to-duct anastomosis was performed after ductoplasty to achieve a single ductal orifice. No hepatic artery thrombosis was observed. Biliary complications were observed in 6 patients (50%: biliary leaks in 2 patients, biliary stricture in 3 patients, and both in 1 patient). ABO mismatch was not observed. No graft loss due to hepatic artery thrombosis was observed. Mortality was observed in 2 patients (16.6%). Conclusions. Donor hepatic artery to recipient replaced right hepatic artery anastomosis in living-donor liver transplantation is somewhat related to biliary complications, but not associated with increased rates of hepatic artery thrombosis.Öğe Comment on: Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial(Oxford Univ Press, 2020) Akbulut, S.; Sahin, T. T.; Yilmaz, S.[Abstract Not Available]Öğe Comparison of Harmonic Scalpel Versus Conventional Knot Tying for Transection of Short Hepatic Veins at Liver Transplantation: Prospective Randomized Study(Elsevier Science Inc, 2012) Olmez, A.; Karabulut, K.; Aydin, C.; Kayaalp, C.; Yilmaz, S.The objective of this study was to compare harmonic scalpel for short hepatic vein transection with conventional ligation during recipient hepatectomy with caval preservation. Sixteen patients undergoing elective living donor liver transplantation were randomized into 2 groups. We recorded number, diameter, and location of each short hepatic vein, procedure time, central venous pressure, and degree of liver failure (Child-Pugh and Model for End stage Liver Disease scores). As an end point, we observed the intraoperalive and postoperative bleeding rates of the transected veins. We transected 144 veins of mean diameter of 2.6 +/- 1.8 mm (range, 1-12 mm). Mean number of short hepatic veins in each person was 9 (range, 5-16). Harmonic scalpel was safe for veins with a diameter <= 2 mm; these veins were more prone to bleeding with conventional ligation. Bleeding rate was higher after ligation of veins in the upper half than the lower half of the cava (37% vs 21%; P = .04). Both total and per vessel procedure time did not differ between the groups. No postoperative bleeding complications occurred. Transection of veins with a diameter <= 2 mm by harmonic scalpel was as safe as conventional ligation. Harmonic scalpel transection of small hepatic veins (<= 2 mm) can be even safer than conventional control by knot tying, particularly in narrow areas.Öğe Comparison of hemoglobin levels via measured with pulse co-oximeter and with lab test during living donor hepatectomy(Lippincott Williams & Wilkins, 2018) Colak, Y. Z.; Bicakcioglu, M.; Erdogan, M. A.; Toprak, H. I.; Yilmaz, S.[Abstract Not Available]Öğe Comparison of Plasmapheresis and Molecular Adsorbent Recirculating System Efficacy in Graft Failure After Living Donor Liver Transplantation(Elsevier Science Inc, 2013) Ince, V.; Aydin, C.; Otan, E.; Karabulut, K.; Koc, S.; Kayaalp, C.; Yilmaz, S.Introduction. Liver transplantation may result in graft failure, requiring time and supportive treatment for regeneration of the graft. The aim of this study was to compare the laboratory parameter changes after single-session molecular adsorbent recirculating system (MARS) and plasmapheresis procedures among living donor liver transplantation patients experiencing graft failure. Patients and Method. We analyzed retrospectively the results in 45 liver transplantation patients treated with plasmapheresis and/or MARS between June 2011 and July 2012: (plasmapheresis, n = 17; MARS, n = 15; MARS + plasmapheresis, n = 13). When cadaveric donor cases (n = 11) were excluded, the remaining 34 included patients, underwent. MARS (n = 18) or plasmapheresis (n = 16) at the first session. Findings. Both groups were similar in age, sex, and body mass index features. The MARS group displayed significantly higher levels of international normalized ratio, blood urea nitrogen, and Model for End-stage Liver Disease score. The plasmapheresis cohort, displayed significantly higher levels of initial direct bilirubin and gamma glutamyl transferase (P < .05). The plasmapheresis group showed a significant decrease in GGT after treatment (P < .05). Results. An initial MARS session provided significantly greater decrease in renal function associated with graft failure after living donor liver transplantation.Öğe Comparison of standard and modified standart organ procurement technique for deceased donors(Lippincott Williams & Wilkins, 2018) Koc, C.; Akbulut, S.; Yilmaz, S.[Abstract Not Available]Öğe Damages to unreinforced masonry buildings by the Van earthquakes of 23 October and 9 November 2011(Copernicus Gesellschaft Mbh, 2013) Tama, Y. S.; Solak, A.; Cetinkaya, N.; Sen, G.; Yilmaz, S.; Kaplan, H.Van, a city in Eastern Anatolian Turkey, was hit by two earthquakes with magnitudes of M-w = 7.2 and M-w = 5.6 in October and November 2011. Both earthquakes caused extensive damage to many buildings. Unreinforced masonry buildings, especially in rural areas, suffered from those earthquakes extensively as in many other cases observed in Turkey during other previous earthquakes. This paper presents a site survey of damaged masonry buildings. Reasons for the wide spread damages are discussed in the paper.Öğe A descriptive analysis of 188 liver transplant patient visits to an Emergency Department(Verduci Publisher, 2012) Turtay, M. G.; Oguzturk, H.; Aydin, C.; Colak, C.; Isik, B.; Yilmaz, S.Background: The aim of the study is to seek the causes of application, the demographic and clinical characteristics of liver transplant patients and to share the experiences of our Emergency Department. Materials and Methods: One hundred eighty-eight Emergency Department visits of ninety patients who underwent liver transplant operations between 2002 and 2009 were evaluated retrospectively. Results: The patients applied to the Emergency Department with the complaints of fever 28.2% and abdominal pain 30.9%. It was detected that the final diagnosis of 52.4% of the patient visits was associated with the gastrointestinal system. It was observed that the most common treatment was drug therapy by 45.2% and that antibiotics treatment was the most applied method in drug treatment. Alanine aminotransferase (ALT) median value of hospitalized patients (45.5 U/L) is significantly higher than that of discharged patients (35 U/L) (p = 0.04). From the records of the patients, positive correlations between the length of hospitalization and levels of total bilirubin, direct bilirubin, ALT and fever during the visit were detected (p = 0.001, p < 0.001, p = 0.01, p = 0.01, respectively). Conclusions: Most frequently liver transplant recipients visited the Emergency Departments with the complaints of fever and abdominal pain. The diagnosis was generally associated with gastrointestinal system disorders. The percentage of hospitalization was high and the length of stay at the hospital was long. The treatment of these patients required a multidisciplinary approach and antibiotics constituted the most used drug treatment. Also, fever and liver function tests examined at the time of admittance to the Emergency Department affected the length of hospitalization.Öğe Diffusion-weighted imaging of the liver in assessing chronic liver disease: effects of fat and iron deposition on ADC values(Verduci Publisher, 2022) Kahraman, A. S.; Kahraman, B.; Ozdemir, Z. M.; Karaca, L.; Sahin, N.; Yilmaz, S.OBJECTIVE: This study was de-signed to evaluate whether fat and iron affect the apparent diffusion coefficient (ADC) values of the liver parenchyma in the settings of fibro-sis and inflammation.PATIENTS AND METHODS: We evaluated the diffusion-weighted images (DWIs) of 58 pa-tients with chronic liver disease and 48 con-trol subjects. Liver specimens of patients were assessed for fibrosis, necroinflammation, iron, and steatosis. Liver ADCs, spleen ADCs, and normalized liver ADCs (defined as the ratio of the liver ADC to spleen ADC) values were an-alyzed after stratifying patients with either fi-brosis stages or histology activity index (HAI) scores. The relationship between ADC values and histopathological findings was studied us-ing multiple linear regression analysis.RESULTS: The median liver and normalized liver ADC values were significantly lower in higher stages of fibrosis and HAI scores. Com-pared to the control group, patients with the highest stages of fibrosis and inflammation had significantly higher spleen ADCs. The ef-fect of the fibrosis stage on liver ADC and nor-malized liver ADC values was significant in the setting of inflammation, whereas the degree of steatosis and iron grade did not affect these ADC values.CONCLUSIONS: ADC values can distinguish both later stages of liver fibrosis and inflam-mation. There is no significant effect of fat and iron on ADC values. Therefore, DWI may be re-liable in evaluating liver fibrosis and inflamma-tion.Öğe Donor Complications Among 500 Living Donor Liver Transplantations at a Single Center(Elsevier Science Inc, 2012) Ozgor, D.; Dirican, A.; Ates, M.; Gonultas, F.; Ara, C.; Yilmaz, S.Introduction. Living donor liver transplantation (LDLT) has become necessary because of the shortage of cadaveric organs. We retrospectively analyzed 500 living donor hepatectomies using the Clavien classification system for complications to grade their severity. Materials and methods. We retrospectively identified and applied the Clavien clasification to 500 consecutive donors who underwent right for LDLT left hepatectomy between January 2007 and August 2011. Results. The 149 complications were observed in 93 of 500 (18.6%) donors who were followed for a mean 30 months. There wan no donor mortality. Complications developed in 85 (18.6%) right 5 (35.7%) left, and 3 (10%) left lateral segment hepatectomy donors. The overall incidence of reoperations was 7.2%. Seventy-seven of 149 complications were grade I (51.6%) or 9 grade II (6%). The major complications consisted of 27 (18.1%) grade IIIa, 35 (23.4%) grade IIIb, and 1 (0.6%) grade IVa. Grade IVb and grade V complications did not occur. The most common problems were biliary complications in 14 of 181 donors (7.7%). Conclusion. Donors for LDLT experienced a range of complications.Öğe Donor Risk and Predictive Factors of Outcome of Living Donor Liver Transplantation (LDLT) for Adults in Europe: A Report from the European Liver Transplant Registry (ELTR).(Wiley-Blackwell, 2013) Adam, R.; Karam, V.; Delvart, V.; Coker, A.; Yilmaz, S.; Tokat, Y.; Astarcioglu, I.[Abstract Not Available]Öğe Economic Analysis and Economic Leakage Level in Water Loss Management and Paths for Future Evaluation: A Review(Univ Tehran, Coll Engineering, 2022) Firat, M.; Ates, A.; Yilmaz, S.; Ozdemir, O.Operational and investment costs increase due to aging of the network, increasing the failure rate, leakage and the water demand, new investments and energy consumption. Several methods and tools with different initial investment and operating costs are proposed for reducing water losses in the related literature. The aim of this study is to make detailed evaluations within the framework of economic components for effective and sustainable water loss management and provide a reference for further studies. The most important advantage is that there has not been a detailed assessment and discussion in this context within the framework of economic analysis and the economic leakage level. The methods and tools for reducing the water losses such as district metered areas, passive leakage control, active leakage control, pressure management, pipe management and network renewal methods, were evaluated economically and discussed. The most important issues in water loss management are the definition of the economic leakage level and the cost components that are the maintenance and break repair, methods applied to detect and control the leaks and automation systems for monitoring, control and data transfer. Moreover, the priority, suitability, applicability and economic impact of the methods should be considered to decide the methods for more efficient use of resources.Öğe Effect of Mammalian Target of Rapamycin Inhibitors on Hepatocellular Carcinoma Recurrence in Liver Transplant Patients: Malatya Experience(Lippincott Williams & Wilkins, 2017) Veysel, E.; Ince, V.; Otan, E.; Kayaalp, C.; Yilmaz, S.[Abstract Not Available]Öğe Effect of resveratrol and melatonin on oxidative stress enzymes, regeneration, and hepatocyte ultrastructure in rats subjected to 70% partial hepatectomy(Elsevier Science Inc, 2008) Kirimlioglu, H.; Ecevit, A.; Yilmaz, S.; Kirimlioglu, V.; Karabulut, A. BayAim. We sought to compare the antioxidant effects of resveratrol (R) and melatonin (M) after 70% partial hepatectomy (PH) as evidenced by ultrastructural alterations and effects on hepatocyte proliferation and apoptosis. Methods. Twenty-six male Wistar albino rats were randomized into four groups: group A (n = 8) resveratrol (R); group B (n = 8) melatonin (M); group C (n = 5) control PH; group D (n = 5) sham operated animals. The rats that received either R or M were sacrificed a week after PH. The malondialdehyde, glutathione, glutathione S-transferase, and nitric oxide levels were estimated in liver homogenates. The morphological changes were investigated using light and electron microscopy (EM). Cell proliferation was detected by immunohistochemical staining with monoclonal antibodies to Ki-67. Apoptosis was detected by the transferase-mediated dUTP nick end-labeling method. Results. PH induced hepatic LP, decreased GSH and NO, and inhibited GST activity (P < .05). R and M completely prevented PH-induced lipid peroxidation, decreased hepatic GSH and NO levels (P < .05). The inhibition of GST activity was prevented by R (P < .05), but not with M (P > .05). In the PH group EM showed severe morphological changes: mitochondrial degeneration, vacuoles, lipid droplets, and myelin-like figures. In both the R and M groups, morphological alterations repaired protective effects more prominently in the R group. Ki-67 indices (KI) were increased in the PH group and decreased in both R and M groups (P < .001). In the M group, KI was the lowest, but the difference compared with R was not significant (P > .05). Apoptosis was slightly increased in PH, but in either the R or M groups, apoptosis was intensively increased (P < .001). Increased apoptosis was greatest in the M group and the difference compared with the R group was statistically significant (P < .05). Conclusion. R and M suppressed PH-induced oxidative damage, attenuated proliferation, and stimulated apoptosis. When we compared R and M, R showed more potent antioxidative effects and was morphologically more protective to hepatocytes. Antiproliferative effects of M were more potent. Because of their potent antioxidative effects, R and M can be effective for oxidative damage like ischemia-reperfusion injury; however, because of the adverse effects on proliferation and apoptosis more studies are needed in states in which regeneration is critical.Öğe Effects of Different Positive End-Expiratory Pressure Values on Liver Function and Indocyanine Green Clearance Test in Liver Transplantation Donors: A Prospective, Randomized, Double-Blind Study(Elsevier Science Inc, 2015) Bicakcioglu, M.; Aydogan, M. S.; Sayan, H.; Toprak, H. I.; Isik, B.; Yilmaz, S.; Yologlu, S.Introduction. The aim of this study was demonstrate the influence of different positive end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green (ICG) clearance test in donor patients. Methods. ICG clearance tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute retention rate after administration of ICG (ICG-R15%). This study was performed in 40 patients who underwent right hepatectomy. Results. The positive end-expiratory pressure (PEEP) was 0 cm H2O in the first (control) group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15 minutes after administration, significant difference was not observed between groups. PT and INR values were different within comparisons groups (P < .05). There were significant differences in Hgb and Hct values compared with the baseline values (T0) within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous pressure were significantly different between the groups (P <.05). Conclusions. Given the small magnitude and limited clinical significance of these changes, we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery.Öğe Effects of Thoracic Epidural Anesthesia on Liver Blood Flow and Indocyanine Green Clearance Test in Living-Donor Liver Transplantation: A Prospective, Randomized, Double-Blind Study(Elsevier Science Inc, 2015) Sayan, H.; Aydogan, M. S.; Bicakcioglu, M.; Toprak, H. I.; Isik, B.; Yilmaz, S.Background. Donors are volunteers without any health problems. Therefore, the anesthetic management of donor safety is an important issue. Our aim in this study was to compare thoracic epidural anesthesia and general anesthesia effects on liver blood flow by means of liver function tests and indocyanine green and compared with living-donor liver transplantation. Methods. Subjects were divided into 2 equal groups: the control group (group I) and the epidural block group (group II, closed envelope method). In group II patients, the epidural catheter was inserted at the T6-8 level. In all patients, anesthesia was standardized with the use of lidocaine, fentanyl, and thiopental. Indocyanine green clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), and at postoperative 24 and 72 hours were recorded. Simultaneously, hemoglobin, hematocrit, platelet count, prothrombin time (PT), international normalized ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate transaminase, and alanine transaminase values were analyzed. Results. Plasma disappearance rate (PDR) and retention at 15 minutes (R15) of indocyanine green were not statistically significant difference between groups (P > .05). Intragroup comparison of PDR and R15 values at times T1, T2, T3, and T4 showed that the values at T0 were statistically significant (P < .05). PT and INR values were significantly different for all times within each group (P < .05). It was concluded that the use of thoracic epidural anesthesia has no effect on global liver function and liver-related liability tests in patients undergoing elective liver donor surgery.
