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Ozsoy M, Unalp O, Sozbilen M, Alper M, Kilic M, Zeytunlu M. Results of Surgery-Related Complications in Donors of Right Lobe Liver Graft: Analysis of 272 Cases. Transplant Proc 2014; 46:1377-83. [DOI: 10.1016/j.transproceed.2013.12.065] [Citation(s) in RCA: 6] [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] [Received: 05/31/2013] [Revised: 10/19/2013] [Accepted: 12/16/2013] [Indexed: 02/09/2023]
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Kazimi M, Ibis C, Alper I, Ulas M, Baran M, Arikan C, Aydogdu S, Ulukaya S, Zeytunlu M, Kilic M. Right-sided diaphragmatic hernia after orthotopic liver transplantation: report of two cases. Pediatr Transplant 2010; 14:e62-4. [PMID: 19344340 DOI: 10.1111/j.1399-3046.2009.01168.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diaphragmatic hernia after OLT is a rare surgical complication. We here report successful diagnosis and treatment of two cases with right-sided diaphragmatic hernia developed after OLT both utilizing left-sided allografts. Combination of factors related to the surgical techniques and patient characteristics might explain the pathophysiology behind the diaphragmatic hernias following liver transplantation. Respiratory as well as non-specific gastrointestinal symptoms may be hints for an overlooked diaphragmatic hernia after liver transplantation. Diaphragmatic hernia should be added to the list of potential complications of liver transplantation for prompt diagnosis and appropriate treatment.
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Affiliation(s)
- M Kazimi
- Ege University Organ Transplantation Center, Izmir, Turkey
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Demirci S, Ozkok S, Yalman D, Zeytunlu M, Nart D, Yuzer Y, Coker A, Uslu R, Goker E. Postoperative gemcitabine alone and concurrent with radiation therapy in locally advanced pancreatic carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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4
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Nart D, Ertan Y, Pala E, Zeytunlu M, Kilic M, Yilmaz F. Intrahepatic Cholangiocarcinoma Arising in Chronic Viral Hepatitis–Associated Cirrhosis: Two Transplant Cases. Transplant Proc 2008; 40:3813-5. [DOI: 10.1016/j.transproceed.2008.06.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/23/2008] [Indexed: 11/29/2022]
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Aydin U, Yazici P, Kazimi C, Bozoklar A, Sozbilen M, Zeytunlu M, Kilic M. Simultaneous Air Transportation of the Harvested Heart and Visceral Organs for Transplantation. Transplant Proc 2008; 40:44-6. [DOI: 10.1016/j.transproceed.2007.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Samancilar O, Cakan A, Cetin Y, Cagirici U, Veral A, Zeytunlu M, Turhan K, Kilic M, Askar F. Comparison of the Harmonic Scalpel and the Ultrasonic Surgical Aspirator in Subsegmental Lung Resections: An Experimental Study. Thorac Cardiovasc Surg 2007; 55:509-11. [DOI: 10.1055/s-2007-965483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Orguc S, Aydin U, Unalp OV, Kirdok O, Gurgan U, Kazimi M, Ozsoy M, Kilic M, Zeytunlu M. Preoperative Helical Computerized Tomography Estimation of Donor Liver Volume. Transplant Proc 2006; 38:2941-7. [PMID: 17112870 DOI: 10.1016/j.transproceed.2006.08.106] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the accuracy of spiral computed tomography (CT) and 3-D imaging models in measuring total and segmental liver volume in potential living donors. METHODS A prospective study was undertaken to assess the correlation between the volumes of potential donor livers determined via helical CT and the actual volumes measured during operation in 150 donor candidates. Left-lateral segment (S2,3) or left-lobe (S2,3,4) transplantation was performed in 36 cases with 96 right-lobe liver transplants (S5,6,7,8). Ten donor candidates were refused owing to inadequate liver volumes, and 8 for other reasons. RESULTS The regression analysis model showed a significant correlation between the preoperative CT estimates of graft volume and intraoperative weight measurement of harvested grafts in living liver donors (F: 5525.37; P < .05); 97.7% of changes in CT volume were explained by differences in graft mass (R2: 0.977). CONCLUSION Preoperative estimation of segmental volumes of the donor liver is necessary to avoid donor-recipient size disparity, thereby preventing hepatic failure of donors after harvesting. It has a major impact on donor selection and type of surgical management. The accuracy of helical CT was high to determine total and segmental liver volumes.
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Affiliation(s)
- S Orguc
- Ege Universitesi Tip Fakultesi, Genel Cerrahi Anabilim Dali Bornova, Izmir, Turkey
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Yilmaz F, Aydin U, Nart D, Zeytunlu M, Karasu Z, Kaya T, Ozer I, Yuce G, Aydogdu S, Kilic M. The incidence and management of acute and chronic rejection after living donor liver transplantation. Transplant Proc 2006; 38:1435-7. [PMID: 16797325 DOI: 10.1016/j.transproceed.2006.02.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 10/28/2005] [Indexed: 10/24/2022]
Abstract
Living donor liver transplantation (LDLT) is a good alternative to cadaveric liver transplantation for end-stage liver disease. Herein we report the outcome of 132 LDLTs performed between 1999 and 2005, with special emphasis on the incidence and management of acute and chronic rejection. Among the LDLT population a first acute rejection episode (ARE) was clinically suspected in 24% and proven by liver biopsy in 11%. According to the Banff classification, 50% of AREs were grade 1, and 50%, grade 2. There was no grade 3 AREs. The first ARE occurred between 7 days and 23 months posttransplantation (mean 97 days, median 70 days). Ninety-seven percent (31/32) of the AREs occurred within the first year after transplantation and 3% (1/32) in the second year. Among the patients with ARE, 23% developed a second ARE between 4 and 11 months. A third ARE was detected in 8% of patients after month 18. All AREs responded to adjustment of immunosuppressive doses or steroid boluses. Chronic rejection (CR) was detected in 2%. In conclusion, the incidences of ARE and CR are consistent with the previously reported data. Acute and chronic rejections seem to be mild and easily manageable clinical conditions. Our results also showed a significant difference between clinically suspected and biopsy-proven ARE emphasizing the importance of indicated liver biopsies in the management of the LDLT population.
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Affiliation(s)
- F Yilmaz
- Ege Universitesi Tip Fakultesi, Izmir, Turkey
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Nart D, Ertan Y, Yilmaz F, Yüce G, Zeytunlu M, Kilic M. Primary hepatic marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type in a liver transplant patient with hepatitis B cirrhosis. Transplant Proc 2006; 37:4408-12. [PMID: 16387133 DOI: 10.1016/j.transproceed.2005.10.109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 06/17/2005] [Indexed: 11/29/2022]
Abstract
We describe the clinical, histological, and immunohistochemical features of primary hepatic low grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) in a liver transplant recipient with hepatitis B cirrhosis. MALT lymphomas arise in organs normally devoid of lymphoid tissue, which accumulates as a consequence of chronic antigenic stimulation associated with chronic infection or autoimmune disease. Primary hepatic MALT lymphoma is extremely rare; 13 cases have been reported worldwide to date. Our patient is the first case of primary hepatic MALT lymphoma associated with hepatitis B cirrhosis who was treated with orthotopic liver transplantation.
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Affiliation(s)
- D Nart
- Department of Pathology, Ege University Medical Faculty, Izmir, Turkey
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Orguc S, Tercan M, Bozoklar A, Akyildiz M, Gurgan U, Celebi A, Nart D, Karasu Z, Icoz G, Zeytunlu M, Yuzer Y, Tokat Y, Kilic M. Variations of hepatic veins: helical computerized tomography experience in 100 consecutive living liver donors with emphasis on right lobe. Transplant Proc 2005; 36:2727-32. [PMID: 15621134 DOI: 10.1016/j.transproceed.2004.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anatomical variations in the venous system of liver are not a rarity. A prospective helical computerized tomography (CT) study was undertaken to determine the prevalence of surgically significant hepatic venous anatomic variations among 100 consecutive living liver donors. The studies evaluated the ramification pattern of hepatic veins, the presence of accessory hepatic veins, and of segment 5 or 8 veins (or both) draining into middle hepatic vein. These data obtained by CT influenced surgical planning. Sixty-four donors donated their right lobes and 24 donors, left lateral segments. Only one donor candidate was refused due to combined hepatic and portal venous variations accompanied by multiple bile ducts. Eleven donors were also refused due to reasons other than anatomical variations. Seventeen segment 5 and 17 segment 8 veins draining into middle hepatic vein were anastomosed to inferior vena cava in 23 (36%) of the right lobe liver transplantations. The middle hepatic vein was harvested in only one of the donors. Among the 100 cases, 47 had accessory right inferior hepatic veins, 13 of which were multiple. Twenty-two of the right lobe grafts required surgical anastomoses of these accessory hepatic veins (34%). An isolated hepatic vein anomaly or the presence of accessory hepatic veins are not contraindications to be a living liver donor candidate. However, preoperative knowledge of vascular variations alters surgical management. Helical CT is a valuable tool to delineate the hepatic venous anatomy for surgical planning in living liver donors.
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Affiliation(s)
- S Orguc
- Genel Cerrahi Anabilim Dali Bornova, Ege Universitesi Tip Fakultesi, Izmir 35100, Turkey
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Akyildiz M, Karasu Z, Arikan C, Kilic M, Zeytunlu M, Gunsar F, Ersoz G, Akarca U, Batur Y, Tokat Y. Impact of pretransplant MELD score on posttransplant outcome in living donor liver transplantation. Transplant Proc 2005; 36:1442-4. [PMID: 15251354 DOI: 10.1016/j.transproceed.2004.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is not clear whether pretransplantation MELD (model for End-Stage Liver Disease) score can foresee posttransplant outcome. We retrospectively evaluated 80 adult patients (55 men, 25 women) who underwent living donor liver transplantation between September 1998 and March 2003. Five other patients with fulminant hepatitis were excluded. The UNOS-modified MELD scores were calculated to stratify patients into three groups: group 1) MELD score less than 15 (n = 13); group 2) MELD score 15 to 24 (n = 36); and group 3) MELD score 25 and higher (n = 26). The patients were predominantly men (n = 52, 69.3%) with overall mean age of 43.9 years (range, 17-62 years). The mean follow-up was 15.7 months (range, 1-47; median = 14 months). The mean MELD score was 22.7 (range, 9-50; median = 21). The overall 1- and 2-year patient survivals were 87% and 78.7%, respectively. The 1-year patient survivals for groups 1, 2, and 3 were 100%, 87%, and 79%; respectively. 2-year survivals, 100%, 79%, and 61%, respectively. Survivals stratified by MELD showed no statistically remarkable differences in 1-year and 2-year patient survival (P = .08). In contrast, 1-year and 2-year patient survival rates for UNOS status 2A, 2B, and 3 were 73%-50%, 95%-91%, and 91%-91%, statistically significant difference (P = .002). Finally, to date preoperative MELD score showed no significant impact on 1- and 2-year posttransplant outcomes in adult-to-adult living donor liver transplantation recipients, but we await longer-term follow-up with greater numbers of patients.
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Affiliation(s)
- M Akyildiz
- Edge University Medical School, Izmir, Turkey.
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Unalp O, Celebi A, Akyldz M, Karasu Z, Tanil V, Zeytunlu M, Yuzer Y, Tokat Y, Kilic M. SIROLIMUS RESCUE THERAPY FOR NEUROTOXICITY AND NEPHROTOXICITY SECONDARY TO THE USE OF CALCINEURIN INHIBITORS AFTER THE ORTHOTOPIC LIVER TRANSPLANTATION. Transplantation 2004. [DOI: 10.1097/00007890-200407271-01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Nart D, Arikan C, Akyildiz M, Yuce G, Demirpolat G, Zeytunlu M, Karasu Z, Aydogdu S, Killi R, Yuzer Y, Tokat Y, Kilic M. Hepatocellular carcinoma in liver transplant era: a clinicopathologic analysis. Transplant Proc 2003; 35:2986-90. [PMID: 14697957 DOI: 10.1016/j.transproceed.2003.10.076] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common tumors in the world, and the prognosis is usually poor. Today, liver transplantation (LT) is a radical but frequently curative treatment modality for HCC. In selected patients, it cures HCC and the underlying cirrhosis at the same time. The present clinicopathological study examined the importance of tumor characteristics for their effects on recurrence and survival rates after LT for HCC. Forty-two native hepatectomy specimens among 250 consecutive orthotopic liver transplantations contained HCC. Patients were predominantly men (30 men, 12 women), ranging in age from 1 to 61 years (median 51). While 20 patients received cadaveric organs, 22 were transplanted from living donors. In 14 patients (33%) HCC presented as a solitary nodule, 5 (12%) as two nodules; 2 (5%) as three nodules; and 21 patients (50%) as more than three nodules. The maximal diameter of the largest tumor not larger than 3 cm in 28 patients (66%), exceeding this size in 14 patients (34%). There was a significant correlation between nodule number and tumor size (r = 0.36, P = 0.05). While 23 patients had no sign of vascular involvement, 17 tumors showed microscopic invasion and two large vessel involvement. There was a positive correlation between vascular invasion and nodule number (r = 0.41, P = 0.05). The histopathological grade of differentiation of the tumors was assessed as "well" in seven patients (14%), moderate in 28 (72%), and poor in 7 (14%). The differentiation was significantly poorer when vascular invasion was observed (r = 0.43, P =.01). According to the TNM classification, 11 patients (26%) were stage I, 6 (14%) stage II, 13 (31%) stage III, and 12 (29%) stage IV. After a median follow-up of 10 months (1-50 months), the overall mortality was 18% (n = 8). Patient survival at 6 month, 1, and 4 years was 88%, 80%, and 60%, respectively. The outcome was significantly poorer for TNM stage IV versus stage I,II, and III tumors to (P =.02). Tumor recurred in three patients at 4,6, and 50 months after liver transplantation. The sites of recurrence were bone, lung, and adrenal glands. In conclusion, liver transplantation represents a safe and feasible treatment for hepatocellular carcinoma with excellent outcomes compared with other treatment modalities. Liver transplantation offers excellent survival rates and chance for cure in stages I, II, and III hepatocellular carcinoma in cirrhotic patients.
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Affiliation(s)
- D Nart
- Department of Pathology, Ege University Medical School, 35100 Bornova, Izmir, Turkey.
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Icoz G, Kilic M, Zeytunlu M, Yaprak O, Arikan C, Yuzer Y, Tokat Y. Roux-en-Y bleeding after living donor liver transplantation: a novel technique for surgical treatment. Transplant Proc 2003; 35:1463-5. [PMID: 12826193 DOI: 10.1016/s0041-1345(03)00484-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Upper gastrointestinal bleeding (GIB) is one of the most common gastroenterologic complications following liver transplantation. The aim of this study is to define the prevalence of GIB due to Roux- en Y (R-Y) enteral anastomoses after living donor liver transplantation (LDLT) and recommend an anastomotic technique for easy surgical intervention. Ninety-five patients underwent 96 LDLT from June 1999 through January 2003. R-Y biliary reconstruction was employed in 43 patients. Anastomoses were end-to-side (ES) in the first 25 patients and side-to-side (SS) type in the last 18 patients. GIB occurred in 13 patients (30%). The R-Y anastomotic line was shown to be the bleeding site in 10 patients. Anastomoses were in ES fashion in 7 of 10 patients (70%). In other words 28% of ES and 17% of SS anastomoses displayed a bleeding episode after LDLT. Four patients required surgical intervention (Three ES, one SS), namely an operative rate of 9%. The type of the jejunojejunostomy, the UNOS or Child-Pugh scores, the presence of preexisting portal hypertension, the duration of portal vein clamping, the GRWR of patients, revealed no statistical significant difference between bleeding and non- bleeding patients. Although statistical analyses did not reveal any significant difference (P =.47), GIB was higher among patients with an ES type of anastomoses. As a result we recommend a jejunojejunostomy in SS fashion on the antimesenteric borders of the jejunal segments with a 3-4 cm blind intestinal segment. The surgical procedure for R-Y bleeding may then be performed without disrupting the jejunojejunostomy.
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Affiliation(s)
- G Icoz
- Ege University Medical School, Department of Organ Transplantation and Research Center, Izmir, Turkey.
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Affiliation(s)
- M Zeytunlu
- Department of Organ Transplantation and Research Center and Hepatopancreatobiliary Unit of Ege University Medical School, Izmir, Turkey.
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Affiliation(s)
- M Zeytunlu
- Department of Organ Transplantation and Research Center and Hepatopancreatobiliary Unit of Ege University Medical School, Izmir, Turkey.
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Tokat Y, Yuzer Y, Karasu Z, Alper M, Killi R, Zeytunlu M, Yilmaz F. New frontiers: adult to adult living donor liver transplantation, single center experience from Turkey. Transplant Proc 2001; 33:3458-60. [PMID: 11750480 DOI: 10.1016/s0041-1345(01)02490-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Y Tokat
- Department of Surgery, Ege University School of Medicine, Bornova, Izmir, Turkey
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Tokat Y, Zeytunlu M, Kilic M, Kaplan H, Yararbaş O. Gastrointestinal complications in renal transplantation. Transplant Proc 1996; 28:2351-2. [PMID: 8769250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Y Tokat
- Organ Transplantation and Research Center, Ege University, Izmir, Turkey
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