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Yilmaz S, Sönmez T, Ünver MU, Ince V, Akbulut S, Isik B, Emre S. The first 4-way liver paired exchange from an interdisciplinary collaboration between health care professionals and design economists. Am J Transplant 2023; 23:1612-1621. [PMID: 37419452 DOI: 10.1016/j.ajt.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] [Imported: 08/29/2023]
Abstract
We report initial results of a liver paired exchange (LPE) program established at the Liver Transplant Institute at Inonu University through collaboration with design economists. Since June 2022, the program has been using a matching procedure that maximizes the number of living donor liver transplants (LDLTs) to the patients in the pool subject to the ethical framework and the logistical constraints of the program. In 1 4-way and 4 2-way exchanges, 12 LDLTs have been performed via LPE in 2022. The 4-way exchange, generated in the same match run with a 2-way exchange, is a first worldwide. This match run generated LDLTs for 6 patients, revealing the value of the capacity to carry out larger than 2-way exchanges. With only 2-way exchanges, only 4 of these patients would receive a LDLT. The number of LDLTs from LPE can be increased by developing the capacity to perform larger than 2-way exchanges in either high-volume centers or multicenter programs.
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Affiliation(s)
- Sezai Yilmaz
- Inonu University Liver Transplant Institute, Malatya, Turkey.
| | - Tayfun Sönmez
- Boston College, Department of Economics, Chestnut Hill, Massachusetts, USA
| | - M Utku Ünver
- Boston College, Department of Economics, Chestnut Hill, Massachusetts, USA; Deakin University, Professorial Research Fellow, Burwood, Victoria, Australia
| | - Volkan Ince
- Inonu University Liver Transplant Institute, Malatya, Turkey
| | - Sami Akbulut
- Inonu University Liver Transplant Institute, Malatya, Turkey
| | - Burak Isik
- Inonu University Liver Transplant Institute, Malatya, Turkey
| | - Sukru Emre
- Inonu University Liver Transplant Institute, Malatya, Turkey
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Kılcı BM, İnce V, Carr BI, Usta S, Bağ HG, Şamdancı E, Işık B, Yılmaz S. Parameters Predicting Microvascular Invasion and Poor Differentiation in Hepatocellular Carcinoma Patients with Normal Alpha-fetoprotein Level Before Liver Transplantation. Turk J Gastroenterol 2023; 34:753-759. [PMID: 37326153 PMCID: PMC10441150 DOI: 10.5152/tjg.2023.22538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/28/2022] [Indexed: 06/17/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND/AIMS The aim of this study is to evaluate the parameters that might be associated with pathologically diagnosed microvascular invasion and poor differentiation, using complete blood count and routine clinical biochemistry test results, in hepatocellular carcinoma patients before liver transplantation. MATERIALS AND METHODS The data of patients who underwent liver transplantation for hepatocellular carcinoma at our institute, between March 2006 and November 2021, was researched retrospectively. RESULTS The incidence of microvascular invasion was 28.6%, poor differentiation rate was 9.3%, hepatocellular carcinoma recurrence rate after liver transplantation was 12.1%, and median time to recurrence was 13 months, in the patients with normal alpha-fetoprotein levels. After univariate and multivariate analysis, maximum tumor diameter >4.5 cm and the number of nodules (n > 5) were found to be independent risk factors for microvascular invasion, and number of nodules >4 and mean platelet volume ≤8.6 fL were found to be independent risk factors for poor differentiation. Serum alpha-fetoprotein levels were still within the normal range at the recurrence time, in 53% of the patients who had recurrence after liver transplantation, but surprisingly were elevated in 47% of the patients at time of hepatocellular carcinoma recurrence. CONCLUSIONS In hepatocellular carcinoma patients with normal alpha-fetoprotein levels before liver transplantation, independent risk factors of the presence of microvascular invasion were maximum tumor diameter and number of nodules, and independent risk factors of poor differentiation were mean platelet volume and number of nodules. Furthermore, serum alpha-fetoprotein levels were still normal at time of recurrence in 53% of hepatocellular carcinoma patients whose alpha-fetoprotein levels were normal before liver transplantation but were elevated in 47% of the patients at recurrence time, despite having normal levels before liver transplantation.
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Affiliation(s)
- Burak M. Kılcı
- Department of Surgery, İnönü University, Liver Transplantation Institute, Malatya, Turkey
| | - Volkan İnce
- Department of Surgery, İnönü University, Liver Transplantation Institute, Malatya, Turkey
| | - Brian I. Carr
- Department of Surgery, İnönü University, Liver Transplantation Institute, Malatya, Turkey
| | - Sertaç Usta
- Department of Surgery, İnönü University, Liver Transplantation Institute, Malatya, Turkey
| | - Harika G. Bağ
- Department of Biostatistics, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Emine Şamdancı
- Department of Pathology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Burak Işık
- Department of Surgery, İnönü University, Liver Transplantation Institute, Malatya, Turkey
| | - Sezai Yılmaz
- Department of Surgery, İnönü University, Liver Transplantation Institute, Malatya, Turkey
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Ince V, Sahin TT, Akbulut S, Yilmaz S. Liver transplantation for hepatocellular carcinoma: Historical evolution of transplantation criteria. World J Clin Cases 2022; 10:10413-10427. [PMID: 36312504 PMCID: PMC9602233 DOI: 10.12998/wjcc.v10.i29.10413] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] [Imported: 08/29/2023] Open
Abstract
Liver transplantation (LT) for hepatocellular carcinoma is still a hot topic, and the main factor that is associated with the success of treatment is to determine the patients who will benefit from LT. Milan criteria have been defined 25 years ago and still is being used for patient selection for LT. However, in living donor LT, the Milan criteria is being extended. Current criteria for patient selection do not only consider morphologic characteristics such as tumor size and number of tumor nodules but also biologic markers that show tumor aggressiveness is also being considered. In the present review article, we have summarized all the criteria and scoring systems regarding LT for hepatocellular carcinoma. All criteria have 5-year overall survival rates that were comparable to the Milan Criteria and ranged between 60%-85%. On the other hand, it was seen that the recurrence rates had increased as the Milan criteria were exceeded; the 5-year recurrence rates ranged between 4.9% to 39.9%. Treatment of hepatocellular carcinoma needs a multidisciplinary approach. Ideal selection criteria are yet to be discovered. The same is true for treatment modalities. The goal will be achieved by a harmonic interplay between basic science researchers and clinicians.
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Affiliation(s)
- Volkan Ince
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sami Akbulut
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Akbulut S, Sahin TT, Ince V, Yilmaz S. Impact of COVID-19 pandemic on clinicopathological features of transplant recipients with hepatocellular carcinoma: A case-control study. World J Clin Cases 2022; 10:4785-4798. [PMID: 35801031 PMCID: PMC9198872 DOI: 10.12998/wjcc.v10.i15.4785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/17/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on the management of all diseases. Various diseases such as cancer have a higher risk of COVID-19-related death. Despite this fact, any delay or alteration in treatment of cancer may have fatal consequences. Hepatocellular carcinoma (HCC) is an aggressive liver cancer that requires multimodality treatment to improve survival.
AIM To evaluate the impact of COVID-19 on the management of patients with HCC by determining changes in demographic, clinical and histopathological variables.
METHODS Demographic, clinical and pathological variables of patients with HCC who had undergone liver transplantation between March 2020 and June 2021 (Pandemic group, n = 48) were retrospectively compared with that of the patients with HCC transplanted between November 2018 and March 2020 (Pre-pandemic group, n = 61).
RESULTS The median age of the patients in the study was 56 (interquartile range = 15). Ninety-seven patients (89%) were male and 12 were female (11%). The most common etiology of liver disease was hepatitis B virus (n = 52, 47.7%). According to our results, there was a 21.3% drop in the number of patients transplanted for HCC. There was no difference in the demographic, clinical and pathological characteristics of the patients except blood alkaline phosphatase levels (P = 0.029), lymphovascular invasion (P = 0.019) and type of the liver graft that was transplanted (P = 0.017).
CONCLUSION It is important to develop a surveillance strategy for liver transplant centers. The liver transplantation for HCC is justified and safe provided that strict surveillance protocols are applied.
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Affiliation(s)
- Sami Akbulut
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Volkan Ince
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Carr BI, Guerra V, Donghia R, Ince V, Akbulut S, Ersan V, Usta S, Isik B, Samdanci E, Yilmaz S. Microscopic Portal Vein Invasion in Relation to Tumor Focality and Dimension in Patients with Hepatocellular Carcinoma. J Gastrointest Surg 2022; 26:333-340. [PMID: 34506030 DOI: 10.1007/s11605-021-05126-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/13/2021] [Indexed: 02/07/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND Microscopic portal vein invasion (microPVI) and tumor multifocality are hepatocellular carcinoma (HCC) prognosis factors. To investigate whether microPVI and multifocality are directly related to each other. METHODS We retrospectively analyzed the relationships between microPVI, multifocality, and maximum tumor diameter (MTD) in prospectively collected transplanted HCC patients. RESULTS HCCs with 1, 2, or ≥ 3 foci had more microPVI in larger than in smaller HCCs, with microPVI being present in 52.24% of single large foci. Conversely, microPVI patients had similar percentages of single and multifocal lesions. A linear regression model of MTD, showed microPVI best associated with MTD, with 2.49 as coefficient, whereas multifocality had a 0.83 coefficient. A logistic regression model of microPVI showed significant association with tumor multifocality, especially for small HCCs. Trends for microPVI and multifocality in relation to MTD revealed that both increased with MTD but more significantly for microPVI. Survival was similar in patients with small HCCs, with or without microPVI, but was significantly worse in microPVI patients with larger HCCs. No patient survival differences were found in relation to focality. CONCLUSIONS MTD had stronger associations with microPVI than with multifocality. microPVI was associated with worse survival in patients with large HCCs, but survival was not impacted by number of tumor foci. microPVI and multifocality appear weakly related, having different behavior in relation to MTD and survival.
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Affiliation(s)
- Brian I Carr
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Vito Guerra
- National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy
| | - Rossella Donghia
- National Institute of Digestive Diseases. IRCCS S. de Bellis Research Hospital, Castellana Grotte, Italy
| | - Volkan Ince
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Veysel Ersan
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Burak Isik
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Emine Samdanci
- Department of Pathology, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
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Ince V, Tasolar H, Yilmaz S. Attention for insertion of temporary cardiac pacemaker in liver transplant patients. North Clin Istanb 2021; 8:543-4. [PMID: 34909597 DOI: 10.14744/nci.2020.59354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] [Imported: 08/29/2023] Open
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Yilmaz S, Ince V. The Importance of the Immunosuppressive Regime on Hepatocellular Carcinoma Recurrence After Liver Transplantation. J Gastrointest Cancer 2021; 52:1350-1355. [PMID: 34611833 DOI: 10.1007/s12029-021-00716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/26/2022] [Imported: 08/29/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) occurs in approximately 20% of recipients and these patients have median about one year survival after diagnosis. Some immunosuppressive drugs can cause development of HCC recurrence, on the other hand some immunosuppressive drugs may have a positive effect for preventing HCC recurrence. Thus, immunosuppression (IS) modification may play a role in preventing HCC recurrence. METHODS In this review, we analyzed IS treatment strategy in two parts: before HCC recurrence following LT and after HCC recurrence following LT, and after HCC recurrence following LT. RESULTS There is no proven, optimal IS protocol to prevent HCC recurrence after transplantation. Therefore, individualized immunosuppressive treatments should be tailored to the biological behaviour of HCC. Forcing the immune tolerance in terms of recurrence can probably be expressed as the most appropriate post LT period. Once HCC recurrence has developed after transplantation, again, there is no commonly accepted, optimal IS treatment, but there is a tendency to switch to IS modifications that include mTORi by minimizing CNIs and MMF. CONCLUSION There is a need for well-designed, randomized, controlled clinical studies with larger numbers of patients on this subject.
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Affiliation(s)
- Sezai Yilmaz
- Department of Surgery, Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Volkan Ince
- Department of Surgery, Liver Transplant Institute, Inonu University, Malatya, Turkey.
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Ogut Z, Kilci B, Ince V, Koc C, Isik B, Yilmaz S. Very Rare Recurrence Site of Hepatocellular Carcinoma After Living Donor Liver Transplantation: Subcutaneous Abdominal Drain Tract. J Gastrointest Cancer 2021; 52:310-312. [PMID: 32495110 DOI: 10.1007/s12029-020-00429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] [Imported: 08/29/2023]
Affiliation(s)
- Zeki Ogut
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Burak Kilci
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Volkan Ince
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey.
| | - Cemalettin Koc
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Burak Isik
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
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Abstract
PURPOSE Liver transplantation is a curative treatment option for hepatocellular carcinoma. In this review, we aimed to review liver transplantation criteria for hepatocellular carcinoma and patient survivals. METHODS We reviewed literature in terms of liver transplant criteria for hepatocellular carcinoma. Patient eligibility criteria, post-transplant survivals, tumor recurrence and expansion of Milan criteria rates were analyzed. RESULTS The Milan criteria, after being published in 1996, have become for deceased donor liver transplantation in hepatocellular carcinoma worldwide. Later, many transplant centers published their own liver transplant criteria. Most of the criteria consisted of morphological tumor characteristics based on tumor size and number. The newest published one is Malatya criteria. The 5-year overall survival according the all of the criteria is greater than 50%. There were just one paper which compare criteria according to survival and Malatya criteria were the best amongst extended criteria with 5-year OS 79.7% in that study. CONCLUSION It is clear that morphological criteria consisting only of tumor size and number are insufficient in patient selection for liver transplantation and should thus be combined with biological, inflammatory, radiological, pathological and genetic markers that predict the biological behavior of the tumor. Efforts to find the best criteria are still ongoing and 5-year overall survival should be greater than 60%.
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Affiliation(s)
- Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.
| | - Cengiz Ara
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
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Barut B, Ince V, Usta S, Gonultas F, Yilmaz S. Incidentally Detected Gastric Gastrointestinal Stromal Tumor during Living Donor Liver Transplant Surgery for Hepatocellular Carcinoma: The First Two Cases. Int J Organ Transplant Med 2021; 12:48-52. [PMID: 35509722 PMCID: PMC9013499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] [Imported: 08/29/2023] Open
Abstract
Coexistence of hepatocellular carcinoma and gastrointestinal stromal tumor is rare. In this case series, we aimed to present an unusual coincidence of a gastrointestinal stromal tumor and hepatocellular carcinoma in patients who underwent living donor liver transplantation for hepatocellular carcinoma who had an incidental gastric gastrointestinal tumor which was detected intraoperatively.
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Affiliation(s)
| | - V. Ince
- Correspondence: Volkan Ince, MD, FEBS, Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.ORCID: 0000-0002-0714-490X,Tel: +90-422-3410660,E-mail:
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Ince V, Carr BI, Bag HG, Ersan V, Usta S, Koc C, Gonultas F, Sarici BK, Karakas S, Kutluturk K, Baskiran A, Yilmaz S. Liver transplant for large hepatocellular carcinoma in Malatya: The role of gamma glutamyl transferase and alpha-fetoprotein, a retrospective cohort study. World J Gastrointest Surg 2020; 12:520-533. [PMID: 33437403 PMCID: PMC7769743 DOI: 10.4240/wjgs.v12.i12.520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND There is increasing interest in transplanting patients with hepatocellular carcinoma (HCC) with tumors greater than 5 cm (Milan criteria).
AIM To investigate possible prognostically-useful factors for liver transplantation in HCC patients with large tumors.
METHODS In this clinical study, 50 patients with HCC who were transplanted at our Liver Transplant Center between April 2006 and August 2019 and had tumors greater than 6 cm maximum diameter were retrospectively analyzed. Their survival and full clinical characteristics were examined, with respect to serum alpha-fetoprotein (AFP) and gamma glutamyl transpeptidase (GGT) levels. Kaplan-Meier survival estimates were used to determine overall survival and disease-free survival in these patients. The inclusion criterion was evidence of HCC. Exclusion criteria were the presence of macroscopic portal vein thrombosis or metastasis and a follow-up period of less than 90 d.
RESULTS Using receiver operating characteristic curve (ROC) analysis, cutoff values of AFP 200 ng/mL and GGT 104 IU/L were identified and used in this study. Significantly longer overall survival (OS) and disease-free-survival (DFS) were found in patients who had lower values of either parameter, compared with higher values. Even greater differences in survival were found when the 2 parameters were combined. Two tumor size bands were identified, in searching for the limits of this approach with larger tumors, namely 6-10 cm and > 10 cm. Combination parameters in the 6-10 cm band reflected 5-year OS of 76.2% in patients with low AFP plus low GGT vs 0% for all other groups. Patients with tumors greater than 10 cm, did not have low AFP plus low GGT. The most consistent clinical correlates for longer survival were degree of tumor differentiation and absence of microscopic portal venous invasion.
CONCLUSION Serum levels of AFP and GGT, both alone and combined, represent a simple prognostic identifier in patients with large HCCs undergoing liver transplant-ation.
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Affiliation(s)
- Volkan Ince
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Brian I Carr
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Harika Gozukara Bag
- Department of Biostatistics, Inonu University, School of Medicine, Malatya 44280, Turkey
| | - Veysel Ersan
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Sertac Usta
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Cemalettin Koc
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Fatih Gonultas
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Baris Kemal Sarici
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Serdar Karakas
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Koray Kutluturk
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Adil Baskiran
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Department of General Surgery, Inonu University, Liver Transplantation Institute, Malatya 44280, Turkey
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Ince V, Akbulut S, Otan E, Ersan V, Karakas S, Sahin TT, Carr BI, Baskiran A, Samdanci E, Bag HG, Koc C, Usta S, Ozdemir F, Barut B, Gonultas F, Sarici B, Kutluturk K, Dogan MS, Ozgor D, Dikilitas M, Harputluoglu M, Aladag M, Kutlu R, Varol I, Dirican A, Aydin C, Isik B, Ara C, Kayaalp C, Emre S, Yilmaz S. Author Correction: Liver Transplantation for Hepatocellular Carcinoma: Malatya Experience and Proposals for Expanded Criteria. J Gastrointest Cancer 2020; 51:1006. [PMID: 32643114 DOI: 10.1007/s12029-020-00451-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] [Imported: 08/29/2023]
Abstract
The original version of this article unfortunately contained a mistake in the author group section.
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Affiliation(s)
- Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.
| | - Sami Akbulut
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Emrah Otan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Veysel Ersan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Serdar Karakas
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Tolga Tevfik Sahin
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Brian I Carr
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Emine Samdanci
- Department of Pathology, Medical School, Inonu University, Malatya, Turkey
| | - Harika Gozukara Bag
- Department of Biostatistics, Medical School, Inonu University, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Fatih Ozdemir
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Bora Barut
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Fatih Gonultas
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Baris Sarici
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Koray Kutluturk
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Murat Sait Dogan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Dincer Ozgor
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Mustafa Dikilitas
- Department of Medical Oncology, Medical School, Inonu University, Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey
| | - Murat Aladag
- Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Medical School, Inonu University, Malatya, Turkey
| | - Ilknur Varol
- Department of Pediatric Gastroenterolgy, Medical School, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cemalettin Aydin
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Burak Isik
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cengiz Ara
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sukru Emre
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
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Ince V, Akbulut S, Otan E, Ersan V, Karakas S, Sahin TT, Carr BI, Baskiran A, Samdanci E, Bag HG, Koc C, Usta S, Ozdemir F, Barut B, Gonultas F, Sarici B, Kutluturk K, Dogan MS, Ozgor D, Dikilitas M, Harputluoglu M, Aladag M, Kutlu R, Varol I, Dirican A, Aydin C, Isik B, Ara C, Kayaalp C, Emre S, Yilmaz S. Liver Transplantation for Hepatocellular Carcinoma: Malatya Experience and Proposals for Expanded Criteria. J Gastrointest Cancer 2020; 51:998-1005. [PMID: 32519232 DOI: 10.1007/s12029-020-00424-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] [Imported: 08/29/2023]
Abstract
Survival was examined from a Turkish liver transplant center of patients with HCC, to identify prognostic factors. Data from 215 patients who underwent predominantly live donor liver transplant for HCC at our institute over 12 years were included in the study and prospectively recorded. They were 152 patients within and 63 patients beyond Milan criteria. Patients beyond Milan criteria were divided into two groups according to presence or absence of tumor recurrence. Recurrence-associated factors were analyzed. These factors were then applied to the total cohort for survival analysis. We identified four factors, using multivariate analysis, that were significantly associated with tumor recurrence. These were maximum tumor diameter, degree of tumor differentiation, and serum AFP and GGT levels. A model that included all four of these factors was constructed, the 'Malatya criteria.' Using these Malatya criteria, we estimated DFS and cumulative survival, for patients within and beyond these criteria, and found statistically significant differences with improved survival in patients within Malatya criteria of 1, 5, and 10-year overall survival rates of 90.1%, 79.7%, and 72.8% respectively, which compared favorably with other extra-Milan extended criteria. Survival of our patients within the newly defined Malatya criteria compared favorably with other extra-Milan extended criteria and highlight the usefulness of serum AFP and GGT levels in decision-making.
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Affiliation(s)
- Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey.
| | - Sami Akbulut
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Emrah Otan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Veysel Ersan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Serdar Karakas
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Tolga Tevfik Sahin
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Brian I Carr
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Emine Samdanci
- Department of Pathology, Medical School, Inonu University, Malatya, Turkey
| | - Harika Gozukara Bag
- Department of Bioistatistics, Medical School, Inonu University, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Fatih Ozdemir
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Bora Barut
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Fatih Gonultas
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Baris Sarici
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Koray Kutluturk
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Murat Sait Dogan
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Dincer Ozgor
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Mustafa Dikilitas
- Department of Medical Oncology, Medical School, Inonu University, Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey
| | - Murat Aladag
- Department of Gastroenterology, Medical School, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Medical School, Inonu University, Malatya, Turkey
| | - Ilknur Varol
- Department of Pediatric Gastroenterolgy, Medical School, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cemalettin Aydin
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Burak Isik
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cengiz Ara
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sukru Emre
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, 44315, Malatya, Turkey
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Baskiran A, Akbulut S, Sahin TT, Koc C, Karakas S, Ince V, Yurdaydin C, Yilmaz S. Effect of HBV-HDV co-infection on HBV-HCC co-recurrence in patients undergoing living donor liver transplantation. Hepatol Int 2020; 14:869-880. [PMID: 32895876 DOI: 10.1007/s12072-020-10085-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023] [Imported: 08/29/2023]
Abstract
PURPOSE To evaluate the effect of hepatitis D virus (HDV) on hepatitis B virus-hepatocellular carcinoma (HBV-HCC) co-recurrence in patients undergoing living donor liver transplantation (LDLT) for HBV alone or HBV-HDV coinfection. METHODS Between 2002 and 2019, 254 HBV-HCC patients underwent LDLT. The patients were divided into two groups after the application of the exclusion criteria: HBV-HCC (Group B; n = 163) and HBV-HDV-HCC (Group D; n = 31). First, the B and D groups were compared in terms of demographic and clinical parameters. Second, patients with (n = 16) and without (n = 178) post-transplant HBV-HCC co-recurrences were grouped and compared in terms of the same parameters. RESULTS Although the risk of HBV-HCC co-recurrence in group D was 4.99-fold higher than in group B, the risk of HBV recurrence alone in group D was 12.5-fold lower than in group B. The AFP (OR = 4.4), Milan criteria (beyond; OR = 18.8), and HDV (OR = 8.1) were identified as the independent risk factors affecting post-transplant HBV-HCC co-recurrence. The Milan criteria (OR = 2.1) and HBV-HCC co-recurrence (OR = 10.9) were identified as the risk factors affecting post-transplant mortality. HBV-HCC co-recurrence developed in 26.5% of patients in Group B and 100% in Group D (OR = 40; p = 0.001). HCC recurrence alone developed in 10% of patients without HBV recurrence in group B and 0% of patients without HBV recurrence in group D (OR = 5.7). CONCLUSION This study showed that the risk of HBV recurrence alone was reduced by 12.5-fold in the presence of HDV; however, the HCC recurrence occurred in all patients with HDV when HBV recurrence developed.
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Affiliation(s)
- Adil Baskiran
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Serdar Karakas
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Volkan Ince
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
| | - Cihan Yurdaydin
- Department of Gastroenterology, Faculty of Medicine, Koc University, 34450, Istanbul, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, 44280, Malatya, Turkey
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Ince V, Gundogan E, Tolan K, Kayaalp C, Yilmaz S. Resection of Adrenal Metastasis Invading Left Renal Vein Following Living Donor Liver Transplantation for Hepatocellular Carcinoma. J Gastrointest Cancer 2019; 51:311-313. [PMID: 31098842 DOI: 10.1007/s12029-019-00252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] [Imported: 08/29/2023]
Affiliation(s)
- Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University School of Medicine, 44280, Malatya, Turkey.
| | - Ersin Gundogan
- Department of Surgery, Liver Transplantation Institute, Inonu University School of Medicine, 44280, Malatya, Turkey
| | - Kerem Tolan
- Department of Surgery, Liver Transplantation Institute, Inonu University School of Medicine, 44280, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Liver Transplantation Institute, Inonu University School of Medicine, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University School of Medicine, 44280, Malatya, Turkey
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Ince V, Kayaalp C, Otan E, Ozdemir F, Dirican A, Toprak HI, Aydin C, Ara C, Yilmaz S. Living Donor Re-transplantation for Repeated Acute Liver Failure. Int J Organ Transplant Med 2018; 9. [PMID: 29531648 PMCID: PMC5839631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] [Imported: 08/29/2023] Open
Abstract
Emergency liver transplantation (LT) for acute liver failure (ALF) is a life-saving treatment. Occurrence of this situation in the same patient twice is very rare. Herein, we describe a patient who underwent two emergency LTs for ALF, both from living donors. When she was 26 years old, she underwent a right lobe living donor LT (LDLT) from her sister for ALF due to use of herbal weight loss medications. The next 3 years were uneventful but another ALF developed during a terminal stage pregnancy (37th week). Despite medical treatment, her liver functions worsened, and the baby was delivered by caesarean section. The second time, her brother was the donor and she recovered after the emergency right lobe re-LDLT. Both patient and baby were well at the 2-month follow-up. As far as we know, there is no reported similar case, and we concluded that LDLT is a paramount treatment option for both primary and secondary ALFs.
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Affiliation(s)
- V. Ince
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey,Correspondence: Volkan Ince, Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey ,E-mail:
| | - C. Kayaalp
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
| | - E. Otan
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
| | - F. Ozdemir
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
| | - A. Dirican
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
| | - H. I. Toprak
- Inonu University, Liver Transplantation Institute, Department of Anesthesiology, Turkey
| | - C. Aydin
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
| | - C. Ara
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
| | - S. Yilmaz
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Turkey
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Ince V, Ersan V, Ozdemir F, Barut B, Koc C, Isik B, Kayaalp C, Yilmaz S. Deceased donor liver transplantation from donors with central nervous system malignancy: Experience of the Inonu University. North Clin Istanb 2017; 4:213-7. [PMID: 29270568 DOI: 10.14744/nci.2017.74436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/07/2017] [Indexed: 11/20/2022] [Imported: 08/29/2023] Open
Abstract
OBJECTIVE Liver transplantation from deceased donors with a central nervous system (CNS) malignancy has some risk of tumor transmission to the recipient. Though the risk is small, this group of donors is regarded as marginal. The use of marginal grafts may be an acceptable alternative practice in order to expand the donor pool in countries where there is a shortage of donated organs. The aim of this study was to examine and present the outcomes of liver transplantations performed using donors with a CNS tumor. METHODS Between March 2002 and July 2017, 1990 (deceased donor: n=399, 20%; living donor: n=1591, 80%) liver transplantations were performed at the center. Of the 399 deceased donors, 17 (4.2%) had a CNS tumor. The data of donors with a CNS tumor and of recipients who survived for more than 1 month (n=11) were retrospectively reviewed. Demographic data, the grade of the CNS tumor, tumor transmission to recipient data, and survival rates were analyzed. RESULTS Only 2 (18%) grafts were provided locally, 6 (54%) were offered to the transplantation center after all of the national centers had declined them, and 3 (37%) were made available to us by the national coordination center for patients with a documented notification of urgency. High-grade (grade III-IV) brain tumors were detected in 7 (64%) donors, while low-grade (grade I-II) tumors were found in 2 patients. The remaining 2 donors were not pathologically graded because the diagnosis was made radiologically. The 1-, 3-, and 5-year overall and tumor-free survival of the patients was estimated at 100%, 70%, and 45%, respectively. CONCLUSION A median survival of 40 months (range: 13-62 months) was achieved in recipients of grafts from a donor with a CNS tumor and no donor-related malignant transformation was observed.
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Ince V, Barut B, Ozdemir F, Ersan V, Kutluturk K, Gonultas F, Onur A, Isik B, Kutlu R, Yilmaz S. The management of acute appendicitis in liver transplant patients: How effective is the Alvarado score? North Clin Istanb 2017; 4:262-6. [PMID: 29270576 DOI: 10.14744/nci.2017.24381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/16/2017] [Indexed: 11/20/2022] [Imported: 08/29/2023] Open
Abstract
OBJECTIVE The incidence of acute appendicitis after liver transplantation (LT) is extremely low, reported to be 0.09% to 0.49%, but the efficacy of the Alvarado score in this patient group has not been studied. This study was an investigation of the clinical management of patients who developed acute appendicitis after LT and the usefulness of the Alvarado score in the diagnosis. METHODS The study was performed using the data of 7 patients treated for acute appendicitis who were among 1990 patients who underwent LT between March 2002 and July 2017. The Alvarado score of the patients was calculated and reliability was analyzed. RESULTS In this study, the incidence of acute appendicitis in LT patients was 0.35%. All of the patients were in the adult age group; 86% were male. The mean age was 46.4±10.7 years and the timeframe for the development of appendicitis after transplantation was a median of 12 months (range: 4-101 months). The median Alvarado score was 7 (range: 5-9). All of the patients had an Alvarado score above 5 and 71% had a score of 7 or more. CONCLUSION Acute appendicitis is very rare in LT patients. As with non-transplant patients, Alvarado scoring can be safely performed in LT patients.
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Ozdemir F, Ince V, Baskiran A, Ozdemir Z, Bayindir Y, Otlu B, Yilmaz S. Progressive Multifocal Leukoencephalopathy after Three Consecutive Liver Transplantations. Int J Organ Transplant Med 2015; 6:126-30. [PMID: 26306159 PMCID: PMC4545307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] [Imported: 08/29/2023] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a lytic infection of the central nervous system caused by the reactivation of John Cunningham Virus (JCV) in severely immunosuppressed patients. Occurrence of PML after solid organ transplantations, especially after liver transplantation, is rare. If a patient has poor prognostic factors such as atypical radiological involvements or high viral load in cerebrospinal fluid (CSF), overall survival rates could be poor. Herein, we report on a patients who underwent liver transplantation three times and developed PML with unexpected radiological findings; he was also positive for JCV DNA with a high viral load. Although there are limited data about efficacy of cytarabine against JCV, it was given to the patient for five days. Despite the initiation of cytarabine and complete cessation of the immunosuppressive therapy, we lost the patient, unfortunately.
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Affiliation(s)
- F. Ozdemir
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Malatya, Turkey
| | - V. Ince
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Malatya, Turkey,Correspondence: Volkan INCE, MD, Inonu University, Liver Transplantation Institute, Department of General Surgery, 44280, Malatya, Turkey ,Tel: +90-422-341-0660 to 3730, E-mail:
| | - A. Baskiran
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Malatya, Turkey
| | - Z. Ozdemir
- Inonu University, Liver Transplantation Institute, Department of Radiology, Malatya, Turkey
| | - Y. Bayindir
- Inonu University, Liver Transplantation Institute, Department of Infectious Diseases, Malatya, Turkey
| | - B. Otlu
- Inonu University, Faculty of Medicine, Department of Medical Microbiology, Malatya, Turkey
| | - S. Yilmaz
- Inonu University, Liver Transplantation Institute, Department of General Surgery, Malatya, Turkey
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Ince V, Aydin C, Otan E, Karabulut K, Koc S, Kayaalp C, Yilmaz S. Comparison of Plasmapheresis and Molecular Adsorbent Recirculating System Efficacy in Graft Failure After Living Donor Liver Transplantation. Transplant Proc 2013; 45:971-3. [DOI: 10.1016/j.transproceed.2013.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] [Imported: 08/29/2023]
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Ince V, Isik B, Koc C, Baskiran A, Onur A. Barolith, a rare cause of acute appendicitis: a case report. ULUS TRAVMA ACIL CER 2013; 19:86-88. [PMID: 23588989 DOI: 10.5505/tjtes.2013.39327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] [Imported: 08/29/2023]
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