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Akbulut S, Yagin FH, Sahin TT, Garzali IU, Tuncer A, Akyuz M, Bagci N, Barut B, Unsal S, Sarici KB, Saritas S, Ozer A, Bentli R, Colak C, Bayindir Y, Yilmaz S. Effect of COVID-19 Pandemic on Patients Who Have Undergone Liver Transplantation: Retrospective Cohort Study. J Clin Med 2023; 12:4466. [PMID: 37445501 DOI: 10.3390/jcm12134466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In liver transplant (LT) recipients, immunosuppressive therapy may potentially increase the risk of severe COVID-19 and may increase the mortality in patients. However, studies have shown conflicting results, with various studies reporting poor outcomes while the others show no difference between the LT recipients and healthy population. The aim of this study is to determine the impact of the COVID-19 pandemic on survival of LT recipients. METHODS This is a retrospective cohort study analyzing the data from 387 LT recipients diagnosed with COVID-19. LT recipients were divided into two groups: survival (n = 359) and non-survival (n = 28) groups. A logistic regression model was used to determine the independent risk factors for mortality. Machine learning models were used to analyze the contribution of independent variables to the mortality in LT recipients. RESULTS The COVID-19-related mortality rate in LT recipients was 7.2%. Multivariate analysis showed that everolimus use (p = 0.012; OR = 6.2), need for intubation (p = 0.001; OR = 38.4) and discontinuation of immunosuppressive therapy (p = 0.047; OR = 7.3) were independent risk factors for mortality. Furthermore, COVID-19 vaccination reduced the risk of mortality by 100 fold and was the single independent factor determining the survival of the LT recipients. CONCLUSION The effect of COVID-19 infection on LT recipients is slightly different from the effect of the disease on the general population. The COVID-19-related mortality is lower than the general population and vaccination for COVID-19 significantly reduces the risk of mortality.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Ibrahim Umar Garzali
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Musap Akyuz
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Nazlican Bagci
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Bora Barut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Serdar Saritas
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya 44280, Turkey
| | - Ali Ozer
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Recep Bentli
- Department of Internal Medicine, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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Sarici KB, Akbulut S, Uremis MM, Garzali IU, Kucukakcali Z, Koc C, Turkoz Y, Usta S, Baskiran A, Aloun A, Yilmaz S. Evaluation of Bone Mineral Metabolism After Liver Transplantation by Bone Mineral Densitometry and Biochemical Markers. Transplant Proc 2023; 55:1239-1244. [PMID: 37127514 DOI: 10.1016/j.transproceed.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
AIM This study aimed to evaluate the course of bone and mineral metabolism after liver transplantation (LT) in patients with chronic liver disease. METHODS One hundred four patients who had undergone LT and had a minimum of 6 months of follow-up after LT were included in this prospective cohort study. The following parameters were evaluated for each patient: preoperative and postoperative (postoperative day [POD]30, POD90, POD180) osteocalcin, bone-specific alkaline phosphatase (BALP), type 1 collagen, beta-C-terminal end telopeptide (β-CTx), vitamin D, parathyroid hormone (PTH), ALP, calcium, phosphate, sedimentation, and bone mineral densitometer scores (L2, L4, L total, and F total). The parameters were compared in terms of sex, presence of liver tumor (hepatocellular carcinoma [HCC; n = 19] vs non-HCC [n = 85]), and presence of autoimmune liver disease (autoimmune liver disease [ALD; n = 8] vs non-ALD [n = 96]). RESULTS The median age of the patients (n = 81 men and n = 23 women) was 52 years (95% CI, 50-56). There was a significant change in the defined time intervals in parameters such as osteocalcin (P < .001), BALP (P < .001), β-CTx (P < .001), vitamin D (P < .001), PTH (P < .001), ALP (P = .001), calcium (P < .001), phosphate (P = .001), L2 (P = .038), L total (P = .026), and F total (P < .001) scores. There was a significant difference in POD90 ALP (P = .033), POD180 calcium (P = .011), POD180 phosphate (P = .011), preoperative sedimentation (P = .032), and POD180 F total (P = .013) scores between both sexes. There was a significant difference in POD180 osteocalcin (P = .023), POD180 β-CTx (P = .017), and preOP calcium (P = .003) among the HCC and non-HCC groups. Furthermore, we found significant differences in preoperative ALP (P = .008), preoperative sedimentation (P = .019), POD90 (P = .037) and POD180 L2 (P = .005) scores, preoperative (P = .049) and POD180 L4 (P = .017), and POD180 L total (P = .010) and F total (P = .022) scores between the patients with and without ALD. CONCLUSION This study shows that the bone and mineral metabolism of the LT recipients was negatively affected after LT. In addition, we showed that bone and mineral metabolism was more prominent in patients with HCC, and bone mineral density scores were higher in patients with ALD.
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Affiliation(s)
- Kemal Baris Sarici
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Muhammed Mehdi Uremis
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, Malatya, Turkey
| | | | - Zeynep Kucukakcali
- Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemalettin Koc
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yusuf Turkoz
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Baskiran
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ali Aloun
- King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Akbulut S, Barut B, Garzali IU, Sarici KB, Tamer M, Unsal S, Karabulut E, Baskiran A, Bayindir Y, Yilmaz S. Effect of Pre-Transplant COVID-19 Exposure On Post-Liver Transplant Clinical Outcomes. Transplant Proc 2023:S0041-1345(23)00089-1. [PMID: 36973149 PMCID: PMC9968604 DOI: 10.1016/j.transproceed.2023.01.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 03/01/2023]
Abstract
Background and Aim COVID-19 has led to an unprecedented global health crisis. This situation caused an immediate reduction in solid organ transplantation activity. The aim of this study was to present the follow-up results of patients with chronic liver disease (CLD) who underwent LT after a previous history of COVID-19 infection. Methods Socio-demographic characteristics and clinicopathological data of 474 patients who underwent LT at Inonu University Liver Transplant Institute between March 11, 2020, and March 17, 2022, were prospectively recorded and analyzed retrospectively. Among these, the data of 35 patients with CLD who were found to be exposed to COVID-19 infection in the pre-LT period were analyzed for this study. Results The median BMI, Child, and MELD/PELD scores of the 35 patients were calculated as 25.1 kg/m2 (IQR: 7.4), 9 (IQR: 4) and 16 (IQR: 10), respectively. Graft rejection occurred in four patients at a median of 25 days post-transplant. Five patients underwent retransplantation at median 25 days post-transplant. The most common cause of retransplantation is early hepatic artery thrombosis. There were 5 deaths during postoperative follow up. Mortality developed in 5 (14.3%) of the patients who were exposed to COVID-19 infection in the pre-transplant period, while mortality occurred in 56 (12.8%) of the patients who were not exposed to COVID-19 infection. There was no statistically significant difference in mortality between the groups (p=0.79). Conclusion The results of this study showed that exposure to COVID-19 before LT does not affect post-transplant patients and graft survival.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Bora Barut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | | | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Murat Tamer
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Selver Unsal
- Department of Nursing Service, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yasar Bayindir
- and Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Gonultas F, Akbulut S, Sarici KB, Toprak S, Kilci B, Bilgic Y, Kose A, Yakupogullari Y, Garzali IU, Yilmaz S. Management of wet ascitic type of peritoneal tuberculosis: single center experience. Eur Rev Med Pharmacol Sci 2023; 27:980-987. [PMID: 36808343 DOI: 10.26355/eurrev_202302_31192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). PATIENTS AND METHODS Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. RESULTS Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures. However, seven were converted to open laparotomy. CONCLUSIONS Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.
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Affiliation(s)
- F Gonultas
- Department of Surgery, Department of Pathology, Department of Gastroenterology, Department of Infectious Diseases and Clinical Microbiology, Department of Medical Microbiology, Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey.
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Sarici KB, Akbulut S, Karabulut E, Sahin TT, Kucukakcali Z, Garzali IU, Aloun A, Yilmaz S. Histopathological Features of Gallbladder Specimens Obtained From Liver Recipients. Transplant Proc 2023:S0041-1345(22)00869-7. [PMID: 36604252 DOI: 10.1016/j.transproceed.2022.11.011] [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] [Received: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the histopathological features of gallbladder specimens obtained from liver transplantation (LT) recipients and to find the correlation between these findings with the clinical features of patients. METHODS The 1985 patients who underwent LT in our institute between March 2002 and January 2021 and whose data regarding pathologic analysis of gallbladder could retrospectively be obtained were included in the study. The data of the patients including age, gender, the reason for LT (fulminant or nonfulminant), presence of ascites, macroscopic characteristics of gallbladder (the length, diameter, and wall thickness), and microscopic findings were all obtained and analyzed in the present study. RESULTS A total of 1985 patients (men = 1300 and women = 685) with a median age of 39.4 years were included in this study. LT was performed in 249 patients because of fulminant liver failure, and abdominal ascites were detected in 933 patients during LT. There were statistical differences in terms of age (P < .001), gallbladder length (P < .001). and width (P < .001) among the both gender, but there was no difference in terms of histopathologic characteristics and presence of gallstones. On the other hand, there were significant differences in terms of age (P < .001), gallbladder length (P < .001), width (P < .001), wall thickness (P = .021), presence of gallstones (P < .001), and histopathologic characteristics (P < .001) between the patients with fulminant and nonfulminant liver failure etiologies. Similar results were obtained when characteristics of patients with and without ascites were compared. CONCLUSIONS This the first study analyzing the histopathological analysis of gallbladder specimens in LT recipients. Chronic liver disease, presence of ascites and gender are the factors affecting the macroscopic and microscopic features of the gallbladder.
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Affiliation(s)
- Kemal Baris Sarici
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Ertuğrul Karabulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Zeynep Kucukakcali
- Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ibrahim Umar Garzali
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ali Aloun
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Akbulut S, Sarici KB, Toprak S, Tuncer A, Ciftci F, Karadag N, Gurluler E, Karabulut E, Colak C, Yilmaz S. Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors. Transplant Proc 2023:S0041-1345(22)00868-5. [PMID: 36604250 DOI: 10.1016/j.transproceed.2022.11.010] [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] [Received: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). METHODS Data from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. RESULTS A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P = .001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P = .015). CONCLUSIONS The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Serhat Toprak
- Department of Pathology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Felat Ciftci
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Nese Karadag
- Department of Pathology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ercument Gurluler
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Koc C, Akbulut S, Sarici KB, Uremis MM, Dogan UG, Kucukakcali Z, Garzali IU, Karabulut E, Turkoz Y, Yilmaz S. Measurement of Heavy Metal and Antioxidant-Oxidant Levels in Tissues Obtained From Three Different Localizations of Explant Hepatectomy of Patients With Hepatocellular Carcinoma. Transplant Proc 2023:S0041-1345(22)00867-3. [PMID: 36604253 DOI: 10.1016/j.transproceed.2022.11.013] [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] [Received: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND To reveal any difference in terms of heavy metal and antioxidant/oxidant levels of liver tissues obtained from 3 different locations of hepatectomy specimens of patients with hepatocellular carcinoma (HCC). METHODS Total hepatectomy materials of patients who underwent liver transplantation for HCC were objects of this study. Three liver tissue samples were obtained from each material, one from HCC tissue, one adjacent from the border of HCC, and one at least 3 cm distant from HCC, each 10 × 10 mm in diameter. Samples are preserved at -70°C. Levels of heavy metals (As, Cd, Cu, Mn, Pb, Se, and Zn) and oxidant-antioxidant parameters (catalase, glutathione peroxidase [GSHPx], superoxide dismutase [SOD], nitric oxide, prolidase, glutathione, malondialdehyde, total oxidant status, antioxidant status, oxidative stress index, total-thiol, native thiol, and disulphid) are measured. RESULTS This study included 22 patients (18 men, 4 women with an age range of 3 to 66 years. There were significant differences in terms of Cd, Pb, Zn, GSHPx, SOD, nitric oxide, and native thiol levels between liver tissues derived from 3 different locations. Cd, Pb, and Zn levels were significantly different in tumor tissues, whereas GSHPx and SOD levels were significantly different in tumor and neighboring tissues. Nitric oxide levels were relatively different in tumor tissues compared with tumor-neighboring tissues. Native thiol levels differed significantly in tumor tissues compared with tissues distant from tumor. CONCLUSIONS The aim of this study is unique in medical literature, which reveals that the amount of heavy metals and antioxidant/oxidant accumulation are variable in the same liver tissue in different locations because of multiple and yet unknown factors.
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Affiliation(s)
| | - Sami Akbulut
- Liver Transplant Institute, Malatya, Turkey; Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | | | - Muhammed Mehdi Uremis
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ufuk Gunay Dogan
- Fuel-Oil Analysis Laboratory, Inonu University Rectorate, Malatya, Turkey
| | - Zeynep Kucukakcali
- Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ibrahim Umar Garzali
- Liver Transplant Institute, Malatya, Turkey; Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Yusuf Turkoz
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, Malatya, Turkey
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Ates M, Akbulut S, Tuncer A, Sahin E, Karabulut E, Sarici KB. Squamous Cell Carcinoma Arising from Perianal Buschke-Lowenstein Tumor (Giant Condyloma Acuminatum): Comprehensive Literature Review. J Gastrointest Cancer 2022; 53:1083-1092. [PMID: 34694593 DOI: 10.1007/s12029-021-00713-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/13/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to provide an overview of the literature on carcinoma arising from giant perianal condyloma acuminatum. METHODS We present a new case of squamous cell carcinoma arising from giant perianal condyloma acuminatum. We also conducted a systematic search of the medical literature using PubMed, Medline, Google, and Google Scholar related to carcinoma arising from giant perianal condyloma acuminatum. The following search terms were used in various combinations: condyloma acuminatum, giant condyloma acuminatum, Buschke-Lowenstein tumor, squamous cell carcinoma, and verrucous carcinoma. The search included articles published before in the English language November 2020. RESULTS A total of 55 article concerning 97 patients with carcinoma (squamous cell carcinoma, verrucous carcinoma, basaloid cell carcinoma, carcinoma insitu) arising from giant perianal condyloma acuminatum meeting the aforementioned criteria were included. The patients were aged from 24 to 82 years (median: 49.6, IQR: 21); 20 were female (median age: 52.5, IQR: 20.5), and 75 were male (median age: 53, IQR: 17.5). The gender data of the remaining two patients could not be obtained. The histopathological features of tumors arising from giant condyloma acuminatum are as follows: squamous cell carcinoma (n = 56), squamous cell carcinoma in situ (n = 16), verrucous carcinoma (n = 19) and basaloid cell carcinoma (n = 1), squamous cell carcinoma + verrucous carcinoma (n = 1), squamous cell carcinoma + squamous cell carcinoma in situ (n = 1), squamous cell carcinoma + basaloid cell carcinoma (n = 1) and malignant behavior (n = 2). CONCLUSION Giant condyloma acuminatum is a rare variant of anogenital warts. It is known that this tumor, which is mostly thought to be benign, has a high potential for local recurrence and transformation into invasive cancer. Therefore, it is vital that the tumor is resected with clean surgical margins, even if it looks benign, and that aggressive treatment options are not avoided when necessary.
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Affiliation(s)
- Mustafa Ates
- Department of Surger, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surger, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey.
- Department of Surgery and Liver Transplant Institute, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey.
| | - Adem Tuncer
- Department of Surger, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Emrah Sahin
- Department of Surger, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Surger, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Kemal Baris Sarici
- Department of Surger, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
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Akbulut S, Uremis MM, Sarici KB, Uremis N, Hargura AS, Karakas S, Dogan UG, Turkoz Y, Yilmaz S. Measurement of oxidant and antioxidant levels in liver tissue obtained from patients with liver transplantation: A case-control study. Transpl Immunol 2022; 75:101697. [PMID: 35985614 DOI: 10.1016/j.trim.2022.101697] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This study aimed to compare oxidant and antioxidant substance accumulation in the liver tissues of patients with chronic liver disease (recipients) who underwent liver transplantation (LT) with living liver donors (LLDs) who underwent living donor hepatectomy (LDH). METHODS This prospective study included 160 recipients (LT group) and 40 LLDs (LLD group). During surgery, a piece of liver tissue measuring a minimum of 10 × 10 mm was obtained from the edge of the right lobe of the liver of recipients and LLDs, incubated for 10 min in saline to remove blood, and stored at -70 °C until biochemical analysis was performed. Catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), myeloperoxidase (MPO), prolidase, reduced glutathione (GSH), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), total thiol, native thiol, and disulfide levels were measured in stored liver tissues. RESULTS There was a statistically significant difference between LT and LLD groups in terms of age (p < 0.001), body mass index (p = 0.019), GSH-Px (p < 0.001), SOD (p = 0.001), MPO (p < 0.001), prolidase (p < 0.001), GSH (p < 0.001), and MDA (p = 0.003) values in favor of the LT group. Furthermore, there was a statistically significant difference between LT and LLD groups in terms of CAT (p < 0.001), TAS (p < 0.001), TOS (p < 0.001), OSI (p < 0.001), total thiol (p < 0.001), native thiol (p < 0.001), and disulfide (p < 0.001) values in favor of the LLD group. There were no differences between the groups in terms of sex. CONCLUSION This study demonstrated that it is possible to assess the extent of oxidative stress in liver tissues by measuring the levels of antioxidant enzymes, oxidants, or the end-products of oxidative stress. With the use of optimum and minimally invasive methods, quantifying these molecules will potentially help evaluate the extent of liver disease and prognostication of liver cirrhosis.
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Affiliation(s)
- Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
| | - Muhammed Mehdi Uremis
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Kemal Baris Sarici
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Nuray Uremis
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Abdirahman Sakulen Hargura
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey; Department of Surgery, Kenyatta University Teaching, Referral and Research Hospital, 00100 Nairobi, Kenya
| | - Serdar Karakas
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Ufuk Gunay Dogan
- Fuel-Oil Analysis Laboratory, Inonu University Rectorate, 44280 Malatya, Turkey
| | - Yusuf Turkoz
- Department of Medical Biochemistry, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
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10
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Yilmaz S, Akbulut S, Usta S, Ozsay O, Sahin TT, Sarici KB, Karabulut E, Baskiran A, Gonultas F, Ozdemir F, Ersan V, Isik B, Kutlu R, Dirican A, Harputluoglu M. Diagnostic and therapeutic management algorithm for biliary complications in living liver donors. Transpl Int 2021; 34:2226-2237. [PMID: 34510566 DOI: 10.1111/tri.14104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/19/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy ± stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.
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Affiliation(s)
- Sezai Yilmaz
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Oguzhan Ozsay
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kemal Baris Sarici
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ertugrul Karabulut
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adil Baskiran
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Fatih Gonultas
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Fatih Ozdemir
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Isik
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Inonu University, Malatya, Turkey
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11
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Kose A, Altunisik Toplu S, Akbulut S, Yasar S, Sarici KB, Duman Y, Kutlu R, Isik B, Colak YZ, Yilmaz S, Bayindir Y. Evaluation of clinical characteristics and outcomes of postoperative ınfections in living liver donors. Int J Clin Pract 2021; 75:e14324. [PMID: 33960083 DOI: 10.1111/ijcp.14324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
AIM To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). METHODS Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. RESULTS The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum β-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 ± 2 (min 1-max 30, IQR:1) and hospitalization days was 14 ± 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. CONCLUSION Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.
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Affiliation(s)
- Adem Kose
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sibel Altunisik Toplu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Seyma Yasar
- Department of Biostatistics, and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kemal Baris Sarici
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yucel Duman
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Isik
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yusuf Ziya Colak
- Department of Anesthesiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
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12
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Karakas S, Sahin TT, Kutluturk K, Otan E, Baskiran A, Sarici KB, Varol I, Aydin C, Kayaalp C, Yilmaz S. Diaphragmatic hernias after pediatric liver transplantation: Experience of a high-volume transplant center. Pediatr Transplant 2020; 24:e13684. [PMID: 32166863 DOI: 10.1111/petr.13684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/05/2020] [Indexed: 02/05/2023]
Abstract
Diaphragmatic hernias (DHs) are rare complications after pediatric liver transplantation (PLT). It is now widely accepted that DHs after liver transplantation (LT) is a pediatric related condition. PLTs (under of age 18) performed between January 2013 and June 2019 at Malatya Inonu University Institute of Liver Transplantation were retrospectively scanned. Study group consisting DHs and a control group were compared. Among 280 PLTs, 8 of them were complicated with DHs (%2.9). Median age of the patients with DH was 3.0 (0.8-9.5) years. Median graft recipient weight ratio was 2.5 (0.9-4.4). Five patients were below 5th percentiles in terms of pediatric weight growth chart at the time of LT. Also, 6 patients were below 5th percentiles in terms of pediatric height growth chart. There was no statistical difference between study and control groups. There are many risk factors mentioned in literature that may be primarily responsible for DHs after PLT. These factors are left lobe and large-for-size grafts, malnutrition, trauma or diathermy of diaphragmatic nerve and vessels and immunosuppressants. In our study, we could not specify any reason that differs in DHs. In our aspect, narrow diaphragma and thorax are exposed to high intra-abdominal pressure from abdomen. Large-for-size grafts, which are specific to children, also may contribute to this affect. Excessive diathermy and trauma to diaphragmatic collaterals may aggravate the risk of DH. More patients are needed to make an exact conclusion, in order to evaluate with comparable study on this aspect.
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Affiliation(s)
- Serdar Karakas
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
| | | | - Koray Kutluturk
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
| | - Emrah Otan
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
| | - Adil Baskiran
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
| | | | - Ilknur Varol
- Department of Pediatric Gastroenterology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Cemalettin Aydin
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
| | - Sezai Yilmaz
- Institute of Liver Transplantation, Inonu University, Malatya, Turkey
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13
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Sahin TT, Sarici KB, Kilci B, Koc C, Otan E, Karakas S, Kutluturk K, Aydin C, Kayaalp C, Yilmaz S. Factors Influencing Mortality Following Liver Transplant in Acute Liver Failure: A Single Center Experience. EXP CLIN TRANSPLANT 2019. [PMID: 31070565 DOI: 10.6002/ect.2019.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In irreversible acute liver failure, liver transplant is the only viable treatment option. In this study, our aim was to evaluate and determine the factors related to mortality in patients who received liver transplants in accordance with King's College criteria for acute liver failure in order to prevent futile operations. MATERIALS AND METHODS Our study included 65 adult patients with acute liver failure who received liver transplant according to King's College criteria. Factors related to mortality, including demographic and operative data, causes of acute liver failure, severity of encephalopathy, and laboratory data, were retrospectively analyzed. Patients who received living-donor liver grafts had donations from first-degree to fourth-degree relatives. RESULTS Of 65 patients analyzed, 55.3% were women. Ninety-day mortality rate was 36.9%. Preoperative bilirubin levels in survivor and nonsurvivor groups were 16.3 ± 9.6 and 21.3 ± 10.7 mg/dL, respectively (P = .03). Mortality rates of patients with bilirubin above and below 9 mg/dL were 31.8% and 8.3%, respectively (P = .03). Of patients who died, 75% were women (significantly more women than men, P = .015). Patients who had deceased-donor liver transplants had a significantly higher mortality rate than those who had living-donor liver transplants (52% vs 27.5% ; P = .046). At 3 days posttransplant, bilirubin, creatinine, aspartate aminotransferase, phosphorus, sodium, and ammonia levels were significantly different between survivor and nonsurvivor groups (P < .05). CONCLUSIONS We found living-donor liver transplant to be superior versus deceased-donor liver transplant with regard to development of acute liver failure. Reasons could include the long wait period for deceased donors and liver grafts coming from marginal donors. Bilirubin level and presence of grade 4 encephalopathy had predictive values for poor prognosis of patients.
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Affiliation(s)
- Tevfik Tolga Sahin
- From the Inonu University Institute of Liver Transplantation, Malatya, Turkey
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14
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Sarici KB, Karakas S, Otan E, Ince V, Koc C, Koc S, Bayraktar H, Aydin C, Kayaalp C, Gungor S, Kablan Y, Yilmaz S. Can Patients Who Develop Cerebral Death in Fulminant Liver Failure Despite Liver Transplantation Be Previously Forseen? Transplant Proc 2017; 49:571-574. [PMID: 28340835 DOI: 10.1016/j.transproceed.2017.01.036] [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: 10/19/2022]
Abstract
BACKGROUND The outcome of medical treatment is worse in fulminant liver failure (FLF) developing on acute or chronic ground. Recently, liver transplantations with the use of living and cadaveric donors have been performed in these diseases and good results obtained. In this study, we aimed to present the factors affecting the recovery of cerebral functions after liver transplantation in hepatic encephalopathy (HE) developing in FLF, to identify irreversible patient groups and to prevent unnecessary liver transplantation. METHODS In Inonu University's Liver Transplant Institute, 69 patients who made an emergency notice to the National Coordination Center for liver transplantation owing to FLF from January 2012 to December 2015 were included in the study. Patients were divided into 2 groups. Group 1 consisted of 52 patients who underwent liver transplantation and recovered normal brain function, and group 2 had 17 patients who underwent liver transplantation and did not recover normal brain function and had cerebral death. All patients were evaluated before surgery for clinical encephalopathy stage, light reflex, and convulsions. Groups were compared and assessed according to age (>40, 10-40 and <10 years), body mass index, etiologic factor, preoperative laboratory values, transplantation type, mortality, and encephalopathy level. Multivariate analysis was done for specific parameters. RESULTS Prothrombin time (PT), international normalized ratio (INR), and total bilirubin values were significantly different between the groups. There was no significant difference between the groups regarding ammonia and lactate levels. There was a statistically significant difference between the groups regarding sodium and potassium levels from serum electrolytes. However, the averages of both groups were within normal limits. pH and total bilirubin levels were meaningful for multivariate analysis. CONCLUSIONS HE reversibility, mortality, and morbidity are important in patients with HE who undergo liver transplantation. Therefore, West Haven clinical staging and serum INR, PT, and total bilirubin level may be helpful in predicting the reversibility of FLF patients with HE before liver transplantation. It was determined that West Haven encephalopathy grading is important in determining the reversibility of HE after transplantation in FLF; especially the probability of reversibility of stage 4 HE decreases significantly. High PT and INR levels, hyperbilirubinemia, and serum sodium and potassium concentrations were risk factors for the reversibility of HE in this study.
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Affiliation(s)
- K B Sarici
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey.
| | - S Karakas
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - E Otan
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - V Ince
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - C Koc
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - S Koc
- Department of Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - H Bayraktar
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - C Aydin
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - C Kayaalp
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
| | - S Gungor
- Department of Pediatric Neurology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Y Kablan
- Department of Neurology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - S Yilmaz
- Department of Surgery, Inonu University, Institute of Liver Transplantation, Malatya, Turkey
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15
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Yilmaz M, Olmez A, Piskin T, Unal B, Ersan V, Sarici KB, Dirican A, Yilmaz S. Incidental appendectomy in donors undergoing hepatectomy for living-donor liver transplantation. Transplant Proc 2013; 44:1630-4. [PMID: 22841232 DOI: 10.1016/j.transproceed.2012.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to investigate the morbidity associated with appendectomy in living liver donors undergoing hepatectomy. METHODS The medical records of 338 donors who underwent hepatectomies for living-donor liver transplantation between 2008 and 2010 were reviewed retrospectively. The patients were divided into 2 groups on the basis of appendectomy: patients in group A (n = 126) received incidental appendectomies in conjunction with donor hepatectomy, and those in group B (n = 212) underwent hepatectomy alone. RESULTS No significant difference in age, gender, or body mass index was found between groups. The wound infection rate (P = .037) and length of hospital stay (P = .0038) were higher in group A than in group B. Intraoperative findings in 126 donors in group A were subserosal (n = 4), retrocecal (n = 6), or hard nodular (n = 11) appendix; hyperemic appendix with edema (n = 9); appendix length ≥ 8 cm (n = 18); and palpable fecalith (n = 78). Histopathologic examination of appendix specimens revealed lymphoid hyperplasia with a fecalith (n = 32), fecalith only (n = 32), acute appendicitis (n = 20), normal anatomy (n = 18), fibrous obliteration (n = 9), lymphoid hyperplasia (n = 9), Enterobius vermicularis (n = 3), appendiceal neuroma (n = 1), carcinoid tumor (n = 1), and mucoceles (n = 1). CONCLUSION Although incidental appendectomy increased the wound infection rate and length of hospital stay, this procedure is necessary for the prevention of potential complications due to appendicitis when the exploration of the ileocecal region in patients undergoing donor hepatectomy reveals one or more of the following: appendix length ≥ 8 cm; dropsical, hyperemic, subserosal, nodular, and/or retrocecal appendix; and/or palpable fecaloma.
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Affiliation(s)
- M Yilmaz
- Department of Surgery, Inonu University Faculty of Medicine, Division of Liver Transplantation, Malatya, Turkey
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