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Ersan V, Usta S, Aydin C, Carr BI, Karatoprak S, Yilmaz S. Critical overview of resection for Bismuth-Corlette type IV perihilar cholangiocarcinoma. Acta Chir Belg 2023; 123:489-496. [PMID: 35549649 DOI: 10.1080/00015458.2022.2078030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/18/2021] [Accepted: 05/11/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Current standard treatment for perihilar cholangiocarcinoma (pCCA) is surgical resection. Bismuth-Corlette (BC) type IV pCCA is accepted as an unresectable disease. In the present study, the results of non-transplant surgical approaches in patients with BC type IV pCCA were examined. METHODS Medical records of consecutive patients with BC type IV pCCA between 2010 and 2021 were retrospectively reviewed. Patients were subdivided according to operation type. Postoperative survival rates were compared. RESULTS Hemihepatectomy with caudate lobe and extrahepatic bile duct (EHBD) resection was performed in 15 patients and only EHBD resection was performed in 10 patients. Ten of the cases were found to be unresectable at the stage of laparotomy. Median follow-up was 41.3 (24.8-57.9) months. Overall survival rate for all 35 patients was 56.4% at 1 year, 32.2% at 2 years, and 16.1% at 3 years. When survivals were compared according to operation type, 1, 2, and 3-year survivals were 80%, 57.1% and 42.9% for the hepatectomy group; 55.6%, 44.4% and 11.1% for the EHBD resection group; 75%, 0% and 0% in laparotomy-only group, respectively (p = 0.13). The best survival rates were obtained in patients with pCCA who underwent hepatectomy and were lymph node negative, 100% for 1 year, 66.7 for 2 years and 50% for 3 years. CONCLUSION It is difficult to achieve high survival rates in BC type IV pCCA. However, these patients mostly benefit from resective treatments. Acceptable survival rates can be achieved, especially in the R0N0 patient group.
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Affiliation(s)
- Veysel Ersan
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Sertac Usta
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Cemalettin Aydin
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Brian I Carr
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Sinan Karatoprak
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Sezai Yilmaz
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
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2
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Kayhan B, Karaca ZM, Canpolat E, Ersan V, Gül M, Yologlu S, Yılmaz S. Is hepatitis-B immunization effective during chronic liver fibrosis? Investigation of secretory and cellular immune responses on an experimental model. Immunopharmacol Immunotoxicol 2023; 45:102-113. [PMID: 36066099 DOI: 10.1080/08923973.2022.2121925] [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] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Adults with end-stage of chronic liver diseases have lower antibody titers after hepatitis-B vaccination. We have less amount of knowledge about the effect of non-viral cause chronic liver fibrosis on vaccination. In this study, we investigated the effect of non-viral chronic liver fibrosis on hepatitis B vaccine and the effect of tetanous toxoid co-administration at the level of humoral and cellular immune responses in an experimental model. METHODS Hepatitis B vaccine was administered either alone or in combination with tetanus toxoid in thioacetamide-induced fibrotic BALB/c mice. Fibrosis level was determined by Knodell scoring. Anti-HBsAg, biochemical parameters, inflammatory (IL-1β, TNF-α), and anti-inflammatory (IL-10) cytokine levels were investigated in serum samples by automated systems and ELISA; respectively. Frequencies of activated lymphocytes were determined in flow cytometer. RESULTS Antibody titers significantly decreased after immunization of fibrotic mice. However, co-administration of toxoid significantly elevated antibody titer. The percentage of CD19+CD69+ B lymphocytes was found to be lower in vaccinated fibrotic group compared to vaccinated naive group. Simultaneous administration of toxoid significantly increased the frequencies of CD4+ and CD8+ T cells expressing CD69 and CD127. Interestingly, CD19+CD5+CD1high Breg cells were significantly reduced in the group vaccinated with hepatitis B vaccine and toxoid, simultaneously. The reduction in Breg percentage did not expose a significant decrease in the level of IL-10. CONCLUSION Non-viral chronic liver fibrosis causes a reduction on specific antibody level after vaccination. Reduction on Breg cell frequency may have an effect on elevation of antibody level after co-administration of tetanus toxoid.
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Affiliation(s)
- Başak Kayhan
- Transplantation Immunology Laboratory, Department of General Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey.,Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Anadolu University, Eskişehir, Turkey
| | - Zeynal Mete Karaca
- Transplantation Immunology Laboratory, Department of General Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey.,Department of Medical Biology and Genetics, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Esra Canpolat
- Transplantation Immunology Laboratory, Department of General Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
| | - Veysel Ersan
- Department of General Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
| | - Mehmet Gül
- Department of Histology and Embryology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Saim Yologlu
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Sezai Yılmaz
- Department of General Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
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İnce V, Carr BI, Usta S, Ersan V, Gözükara Bağ H, Yılmaz S. The Effect of Pre-transplant Lipid Profile on Post-transplant Hepatocellular Carcinoma Recurrence: Retrospective Single-Center Analysis. Turk J Gastroenterol 2022; 33:434-442. [PMID: 35678802 DOI: 10.5152/tjg.2022.21413] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Plasma lipids have been shown to relate to tumor biology. We aimed to analyze the effect of pre-transplant plasma lipid profiles on post-transplant tumor recurrence in patients with hepatocellular carcinoma and to identify any possible relationship between the pre-transplant lipid profile with maximum tumor diameter, number of tumor nodules, tumor differentiation, portal vein invasion, or serum biomarker levels. METHODS Patients with hepatocellular carcinoma who underwent liver transplants between 2006 and 2021 had data collected pro- spectively and were analyzed retrospectively. Patients who did not have lipid profile data before transplant and whose post-transplant follow-up period was <90 days were excluded. Patients who had pre-transplant plasma lipid data and whose post-transplant follow-up period was >90 days were included in this study (n = 254). RESULTS Lower high-density lipoprotein cholesterol levels were found to be significantly associated with post-Tx recurrence (38 vs 29.5, P < .001) and were also significantly associated with macroscopic portal vein thrombosis (39 vs 30.4, P < .021). There was no significant association between plasma lipids and tumor differentiation. Higher high-density lipoprotein cholesterol levels were significantly asso- ciated with good overall and disease-free survivals (P = .024 and P = .001). CONCLUSION Pre-transplant low plasma high-density lipoprotein cholesterol levels were significantly associated with portal vein throm- bosis and poor post-transplant overall and disease-free survivals.
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Affiliation(s)
- Volkan İnce
- Department of Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
| | - Brian I Carr
- Department of Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
| | - Sertaç Usta
- Department of Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
| | - Veysel Ersan
- Department of Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
| | - Harika Gözükara Bağ
- Department of Biostatistics, Medical School, İnönü University, Malatya, Turkey
| | - Sezai Yılmaz
- Department of Surgery, Liver Transplantation Institute, İnönü University, Malatya, Turkey
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Ince V, Carr BI, Bag HG, Ersan V, Usta S, Koc C, Karakas S, Sarici B, Gonultas F, Yilmaz S. Liver transplantation for hepatocellular carcinoma: Extended Malatya criteria. Int J Surg 2022. [DOI: 10.1016/j.ijsu.2022.106488] [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: 12/01/2022]
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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]
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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Carr BI, Bag HG, Ince V, Ogut Z, Tuncer A, Akbulut S, Ersan V, Usta S, Isik B, Yilmaz S. A simple 2-parameter blood test alert for the presence of small hepatocellular carcinomas. Clin Pract (Lond) 2021; 18:1804-1809. [PMID: 34966540] [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] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Objectives The majority of HCCs present at an advanced stage in which potentially curative therapies cannot be used. Surveillance ultrasound has been found to increase the numbers of patients diagnosed with small tumors, but it is often not used. We aimed to try to identify widely-available and cheap potential serum markers for use in patients at risk for HCC. Material and Methods A comparison was made of the complete blood count and liver function tests in a group of patients (n=114) with proven small HCCs (≤ 2 cm) and patients without HCC (n=506), all of whom were treated by liver transplantation in our Liver Transplantation Institute. Results Significant differences were found for blood levels of WBC, lymphocytes, total bilirubin and transaminases. Several 2-parameter combinations were assessed, but only the combination of total bilirubin and lymphocytes was found to be significantly different between patients with small HCCs and no HCC. Multivariate regression analysis showed significance only for total bilirubin levels and lymphocyte counts. The results were confirmed using a separate small cohort of non-transplant patients. Conclusion The combination of elevated levels of total bilirubin and lymphocyte counts holds promise for identification of patients with chronic liver disease who are at risk for HCC.
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Affiliation(s)
- Brian I Carr
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Harika Gozukara Bag
- Department of Biostatistics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Volkan Ince
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.,Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Zeki Ogut
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adem Tuncer
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.,Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.,Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Burak Isik
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.,Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.,Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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Carr BI, Bag HG, Ince V, Akbulut S, Ersan V, Usta S, Isik B, Ogut Z, Tuncer A, Yilmaz S. A Combination of Blood Lymphocytes and AST Levels Distinguishes Patients with Small Hepatocellular Carcinomas from Non-cancer Patients. J Gastrointest Cancer 2021; 52:1211-1216. [PMID: 34762264 PMCID: PMC8799503 DOI: 10.1007/s12029-021-00740-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE HCC patients typically present at an advanced tumor stage, in which surgical therapies cannot be used. Screening ultrasound exams can increase the numbers of patients diagnosed with small tumors, but are often not used in patients at risk for HCC. We evaluated clinically available and cheap potential blood tests as biomarkers for screening patients at risk for HCC. METHODS A comparison was made of commonly used blood count and liver function parameters in a group of patients (n = 101) with small HCCs (≤ 3 cm) or without HCC (n = 275), who presented for liver transplantation in our institute. RESULTS Significant differences were found for blood lymphocytes and AST levels. This 2-parameter combination was found to be significantly different between patients with small HCCs versus no HCC. Using the combination of lymphocytes and AST levels to dichotomize the HCC patients, only blood levels of alpha-fetoprotein among the tumor characteristics were found to be significantly different among the 2 HCC groups, as well as levels of blood total bilirubin, ALKP, and PLR ratio. The results were confirmed using a separate smaller cohort of non-transplanted small size HCC patients. CONCLUSION The combination of elevated blood levels of lymphocyte counts and AST levels holds promise for screening of patients with chronic liver disease who are at risk for HCC.
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Affiliation(s)
- Brian I Carr
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey.
| | - Harika Gozukara Bag
- Department of Biostatistics, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Volkan Ince
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Burak Isik
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Zeki Ogut
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Adem Tuncer
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Faculty of Medicine, Inonu University, Bulgurlu Mah, Elazig Yolu 15 km, 44280, Malatya, Turkey
- Department of Surgery, Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
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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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Novruzov N, Ersan V, Bayramov N, Otlu B, Aliyev E, Ince V, Isik B, Yilmaz S, Karipkiz Y. Extracellular Histones H3 as a Prognostic Blood Marker for Delayed Liver Function Recovery After Donor Hepatectomy. Transplant Proc 2021; 53:2305-2311. [PMID: 34452737 DOI: 10.1016/j.transproceed.2021.07.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Early prediction of liver dysfunction after liver resection remains a challenge. We hypothesized that extracellular histone concentrations are a promising new biomarker for the detection of liver injury after donor hepatectomy. METHODS This prospective study considered 93 living donors who underwent hepatectomy. Blood samples of donors were collected on postoperative day 1, and histone levels in the plasma samples of the patients were measured with total histone H3 sandwich ELISA kits. Among 86 right lobe donors, 23 (26.7%) were deemed to have a delayed liver function recovery according to the International Study Group of Liver Surgery's definition of posthepatectomy liver failure, whereas 63 (73.3%) were considered to have an adequate liver function recovery. RESULTS The area under the receiver operating characteristic (ROC) curve for circulating histones in predicting persistent liver dysfunction was 0.618 ± 0.06 (95% confidence interval [CI], 0.501-0.735; P = .091). The cutoff point value obtained from the analysis of ROC curves was 0.895, with a sensitivity of 95.7% and a specificity of 32.9%, respectively, for examining a delayed liver function recovery (P = .015). The Fisher analysis significantly verified these results empirical influence function % 7.90 (95% CI, 3.91-11.90; P = .006). The univariate analysis determined that postoperative histones were identified as an independent risk factor of delayed liver function recovery (odds ratio, 10.8; 95% CI, 1.4-84.9; P = .024). CONCLUSIONS The circulating histone negatively correlates with liver dysfunctions after donor hepatectomy and had the best value in predicting liver dysfunction within 24 hours after liver resection.
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Affiliation(s)
- Namig Novruzov
- Department of Surgery, Central Customs Hospital, Baku, Azerbaijan.
| | - Veysel Ersan
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | | | - Baris Otlu
- Department of Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | | | - Volkan Ince
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Burak Isik
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Sezai Yilmaz
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Yunus Karipkiz
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
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Yilmaz S, Akbulut S, Kutluturk K, Dogan SM, Baskiran A, Ersan V, Koc C, Aydin C, Kayaalp C. Splenic Artery Transposition for Hepatic Artery Reconstruction During Liver Transplantation: Is It the Best Choice for Adequate Arterial Inflow in Extraordinary Conditions? Liver Transpl 2021; 27:595-599. [PMID: 37160046 DOI: 10.1002/lt.25884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/03/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Koray Kutluturk
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sait Murat Dogan
- 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
| | - Veysel Ersan
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemalettin Koc
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemalattin Aydin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Carr BI, Ince V, Bag HG, Usta S, Ersan V, Isik B, Yilmaz S. CRP is a superior and prognostically significant inflammation biomarker for hepatocellular cancer patients treated by liver transplantation. Clin Pract (Lond) 2021; 18:1626-1632. [PMID: 33972830 PMCID: PMC8106696] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inflammation and its markers are considered prognostically important for many cancers, including Hepatocellular Carcinoma (HCC). However, it is not really clear which markers are the best. AIMS To assess in a cohort of prospectively-evaluated HCC patients who were treated with liver transplant and whose survival was known, multiple commonly used inflammatory markers in relation to survival and to both clinical and tumor aggressiveness parameters. RESULTS Amongst 330 transplanted HCC patients, CRP was found to be the only significant inflammatory marker for survival, on multivariate Cox regression analysis. NLR, PLR, GGT, AST, ALT and the Glasgow inflammation score were also found to be significant, but on univariate analysis only. CRP was significant in patients with both small (< 5 cm) and large HCCs and in patients with elevated or low Alpha-Fetoprotein (AFP) levels. Comparison of HCC patients with high (>2.5 mg/ dL) compared low serum CRP levels showed significant differences for blood levels of NLR, LMR, Hb, total bilirubin and liver transaminases, as well as Maximum Tumor Diameter (MTD) and percent of patients with Portal Vein Thrombosis (PVT). CONCLUSIONS Elevated serum CRP levels were associated with significantly increased MTD and percent of patients with PVT and significantly worse overall survival in HCC patients who were treated by liver transplantation.
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Affiliation(s)
- Brian I Carr
- Department of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | | | - Sertac Usta
- Department of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Veysel Ersan
- Department of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Burak Isik
- Department of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, Turkey
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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] 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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Gundogan E, Karabulut E, Ersan V, Kayaalp C. Dieulafoy lesion in a Hartmann stump. Asian J Endosc Surg 2020; 13:560-563. [PMID: 31943868 DOI: 10.1111/ases.12781] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/07/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022]
Abstract
A 70-year-old man underwent laparoscopic anterior resection for sigmoid carcinoma, and on postoperative day 4, he required an emergency Hartmann procedure for bowel ischemia and anastomotic leakage. Five days after the emergency procedure, there was a massive hemorrhage through the anus that appeared in the abdominal drain. During exploration, the origin of the bleeding could not be found, and the rectal stump was closed over a urinary Foley catheter (with an inflated balloon) with the help of a purse-string suture. In the intensive care unit, massive hematochezia continued. Emergency transanal colonoscopy to the Hartmann stump found the rectum full of clotted blood. Active pulsatile arterial bleeding of a rectal Dieulafoy lesion was detected. After endoscopic hemostasis efforts failed, bleeding was stopped successfully by transanal suturing. The patient was discharged without any other problems, and no recurrent bleeding occurred during the 18-month follow-up. Here, we report a rectal Dieulafoy lesion in a Hartmann stump for the first time.
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Affiliation(s)
- Ersin Gundogan
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, 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. 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]
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]
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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Ince V, Carr BI, Bag HG, Koc C, Usta S, Ersan V, Baskiran A, Sahin TT, Yilmaz S. Gamma glutamyl transpeptidase as a prognostic biomarker in hepatocellular cancer patients especially with >5 cm tumors, treated by liver transplantation. Int J Biol Markers 2020; 35:91-95. [PMID: 32436751 DOI: 10.1177/1724600820921869] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BackgroundSerum AFP levels are typically elevated in less than 50% of hepatocellular cancer (HCC) patients. Gamma-glutamyl transpeptidase (GGT) levels have been suggested to be a potentially useful HCC biomarker.AimsTo assess in a cohort of prospectively evaluated HCC patients who underwent liver transplant and whose survival was known; the occurrence, prognosis, and clinical characteristics of patients with elevated serum GGT levels.ResultsSerum GGT levels were found to be elevated in a higher proportion in patients with either small or large HCC than alpha-fetoprotein (AFP) levels, and were significantly related to prognosis in patients with large size HCCs. There was no clear correlation between GGT and AFP levels, likely reflecting different HCC characteristics or HCC cell lineages associated with these two markers. Furthermore, elevated GGT was found in 24% of low-AFP patients with small tumors and 46% with large tumors. Elevated GGT levels were also significantly associated with microvascular invasion and tumor diameter.ConclusionsElevated serum GGT levels were associated with HCC size and worse survival, and were unrelated to AFP levels. GGT may be a useful prognostic tumor marker, especially for low-AFP HCC patients.
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Affiliation(s)
- Volkan Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Brian I. Carr
- Department of Surgery, Liver Transplantation Institute, 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, Malatya, Turkey
| | - Sertac Usta
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Adil Baskiran
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
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Ince V, Barut B, Baskiran A, Ersan V, Gonultas F, Ozdemir F, Otan E, Koc C, Sahin TT, Kutlu R, Kayaalp C, Yilmaz S. Liver transplantation for combined hepatocellular-cholangiocarcinoma. Int J Surg 2020. [DOI: 10.1016/j.ijsu.2020.01.096] [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: 11/28/2022]
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Carr BI, Ince V, Bag HG, Ersan V, Usta S, Yilmaz S. Microscopic vascular invasion by hepatocellular carcinoma in liver transplant patients. Clin Pract (Lond) 2020; 17:1497-1505. [PMID: 33343877 PMCID: PMC7746034] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND A characteristic of Hepatocellular Carcinoma (HCC) is to invade the portal venous system in the liver as a means of spread within the liver and systemically. The ensuing Portal Vein Thrombosis (PVT) is a poor prognosis parameter and often diagnosed radiologically pre-treatment. More limited Microvascular Portal Invasion (microPVI) is typically diagnosed on examination of tumors removed after treatment by resection or transplant. The biological characteristics and subsets of PVI are incompletely characterized. AIMS To examine HCC patients with and without microPVI to understand the clinical relationships to other tumor and clinical characteristics and to survival. METHODS A cohort of 270 liver transplant patients with HCC without macroscopic PVT that were available to us was examined. Patients with (165) and without (105) microPVI were compared for survival and clinical features. RESULTS The mean survival of patients with and without microPVI was significantly different: 86.6 versus 110.5 months, p=0.007.The microPVI+ patients differed from microPVI- patients in having a significantly larger number of tumor nodules, tumor size and higher serum levels of both Alpha-Fetoprotein (AFP) and almost significant for higher Gamma-Glutamyl Transpeptidase (GGT, p=0.053). Survival in microPVI+ patients related significantly to serum GGT (p=0.006) but not to AFP levels. The incidence of microPVI increased with increase in tumor size and survival decreased significantly with increase in tumor size for microPVI patients. Increase in tumor size was also associated with significantly higher serum GGT levels in patients who were microPVI+, but not in those who were microPVI. Furthermore, patients with microPVI who had prolonged survival significantly differed from those with shorter survival in respect only to tumor size and serum GGT levels. CONCLUSION These findings draw attention to a group of patients with microPVI who have long survival and to the usefulness of serum GGT levels in their evaluation and prognosis.
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Affiliation(s)
- Brian I Carr
- Deptment of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Volkan Ince
- Deptment of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | | | - Veysel Ersan
- Deptment of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Sertac Usta
- Deptment of Surgery, Liver Transplantation Institute, Inonu University, Turkey
| | - Sezai Yilmaz
- Deptment of Surgery, Liver Transplantation Institute, Inonu University, Turkey
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Abstract
The application of laparoscopic surgery via the vagina has been introduced at the beginning of this millennium. Here, we report a case of transvaginal extraction of a laparoscopic hepatectomy specimen. An exophytic liver mass originated from segment VI in a 24-year-old female was excised with laparoscopic technique using four trocars (0.5–1.2 cm sizes). The specimen (11 × 8.5 cm) was removed transvaginally instead of an abdominal incision. To the best of our knowledge, only six similar cases have been previously reported, with a patient age range of 32–74 years. Our case, due to younger age, had high cosmetic expectations. Specific to this case, we aimed a better aesthetic outcomes and better convalescence period and, we achieved these objectives. We believe that patient selection and experience on natural orifice specimen extraction were the keys to the success of the operation. We shared this technique with a video presentation.
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Affiliation(s)
- Veysel Ersan
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Aydin Aktas
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Ersin Gundogan
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Uygar Teomete
- Department of Radiology, Miami University, Coral Gables, FL, USA
| | - Fatih Sumer
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Servet Karagul
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
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Gür A, Oguzturk H, Köse A, Turtay MG, Ersan V, Bayindir Y, Ince V, Gurbuz S, Yucel N. Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection. ACTA ACUST UNITED AC 2018; 31:1179-1185. [PMID: 29102943 DOI: 10.21873/invivo.11187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/26/2017] [Revised: 08/14/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM Infections are one of the most important causes of mortality and morbidity after liver transplantation as in all transplantations. Infectious complications are known to be among the preventable causes with appropriate diagnosis and treatment. So early prediction of the risk of infections will provide an effective approach to determine the local antimicrobial resistance and prevention of specific risk factors. The aim of this study was to deterimne whether specific markers are useful or not to deterimne a suspected infection in patients that have undergone liver transplantation. PATIENTS AND METHODS The study included 65 patients with liver transplantation admitted to emergency room with suspicion of infection. These patient's CRP, procalsitonin (PCT), lactate, SAA and IL-6 levels were initially measured in the emergency department. The patients were classified to three categories according to culture results; culture-negative, culture-positive and control group. Studying parameters were investigated according to whether the culture was positive or negative in these patients. RESULTS CRP, PCT, lactate, SAA and IL-6 levels were significanlty high in patients with suspected infeciton when compared to the control group (p<0.05). CRP, PCT and IL-6 levels were higher in the culture-positive group than in the culture-negative group and there was a significant variation (p<0.05). When suspecting an infection evaluating the parameters CRP, PCT and IL-6 was very meaningfull (p<0.05). CONCLUSION We can use CRP, PCT, lactate, SAA and IL-6 parameters to identify presence of infection at the liver transplantation patients admitted to the emergency department with suspected infection. If CRP, PCT and IL-6 levels are significantly high we can guess the patient's positive culture.
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Affiliation(s)
- Ali Gür
- Van Education and Research Hospital, Van, Turkey
| | - Hakan Oguzturk
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adem Köse
- Infection Diseases Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - M Gökhan Turtay
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Yaşar Bayindir
- Infection Diseases Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Volkan Ince
- Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey
| | - Sukru Gurbuz
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Neslihan Yucel
- Emergency Medicine Department, Faculty of Medicine, Inonu University, Malatya, Turkey
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Ince V, Ersan V, Karakas S, Kutluturk K, Karadag N, Kutlu R, Yilmaz S. Does Preoperative Transarterial Chemoembolization for Hepatocellular Carcinoma Increase the Incidence of Hepatic Artery Thrombosis After Living-Donor Liver Transplant? EXP CLIN TRANSPLANT 2017; 15:21-24. [PMID: 28301994 DOI: 10.6002/ect.tond16.l7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Transarterial chemoembolization is a potential risk factor for hepatic artery damage, which may lead to severe consequences. We aimed to investigate this controversial issue in our population of liver transplant patients with hepatocellular carcinoma. MATERIALS AND METHODS Between March 2006 and December 2016, a total of 262 patients with hepatocellular carcinoma underwent liver transplant at our institution. Of these, 22 (8.4%) had preoperative transarterial chemoembolization. We retrospectively reviewed the data of all patients, comparing those who did and did not undergo transarterial chemoembolization. RESULTS The groups were similar in terms of patient sex, mean age, mean alpha-fetoprotein levels, and Milan criteria. The nontransarterial chemoembolization group had a significantly higher mean Model for End-Stage Liver Disease score. Hepatic artery thrombosis after liver transplantation was diagnosed in 6 of 22 patients (27%) in the transarterial chemoembolization group and in 12 of 240 patients (5%) in the nontransarterial chemoembolization group (P = .002). Retransplant was performed in 5 of the 6 patients with hepatic artery thrombosis in the transarterial chemoembolization group and 3 of the 12 patients in the nontransarterial chemoembolization group (P = .04). CONCLUSIONS In patients who undergo transarterial chemoembolization before liver transplantation, the incidence of hepatic artery thrombosis and retransplantation is significantly higher than in those who do not undergo this intervention. The tissues should be carefully handled at the time of transplantation to prevent trauma that may cause intimal dissection in the fragile vessels.
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Affiliation(s)
- Volkan Ince
- Inonu University Liver Transplantation Institute, Malatya, Turkey
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Baskiran A, Karakas S, Ince V, Kement M, Ozdemir F, Ozsay O, Kutluturk K, Ersan V, Koc C, Barut B, Yilmaz S. Pregnancy After Liver Transplantation: Risks and Outcomes. Transplant Proc 2017; 49:1875-1878. [DOI: 10.1016/j.transproceed.2017.04.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/05/2017] [Accepted: 04/27/2017] [Indexed: 11/17/2022]
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Ersan V, Kutlu R, Erdem C, Karagul S, Kayaalp C. Colorectal Stenting for Obstruction due to Retrorectal Tumor in a Patient Unsuitable for Surgery. J Transl Int Med 2017; 5:186-188. [PMID: 29164050 DOI: 10.1515/jtim-2017-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fund of knowledge on palliative treatment of unresectable retrorectal tumors is scare. Here, we reported a non-surgical treatment of a huge retrorectal malignant tumor in an aged and debilitated patient complicated with colorectal obstruction. An 86-year-old male with severe comorbidities was admitted with acute colorectal obstruction owing to an untreated retrorectal malign epithelial tumor. There was a lobulated retrorectal mass, 20 cm × 15 cm at largest size, extending to the superior iliac bifurcation level, caused an obstruction of the rectal lumen. He was not suitable for surgical excision because of the severe comorbidities. Rectal obstruction was palliated by two self-expandable metallic stents. He tolerated the procedures well and post-procedural course was uneventful. After four months, stents were patent and the patient was continent. Stenting for colorectal obstruction owing to a retrorectal tumor can be feasible in patients who are not suitable for surgery (aged, debilitated, advanced tumor). It avoided the surgical trauma to a high-risk patient and ensured the continuity of continence. As far as we know, this was the first report on colorectal stenting for a retrorectal tumor.
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Affiliation(s)
- Veysel Ersan
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Inonu University, Malatya, Turkey
| | - Ceyhun Erdem
- Department of Surgery, Inonu University, Malatya, Turkey
| | - Servet Karagul
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
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Saglam K, Aktas A, Gundogan E, Ertugrul I, Tardu A, Karagul S, Kirmizi S, Sumer F, Ersan V, Kayaalp C. Management of Acute Sleeve Gastrectomy Leaks by Conversion to Roux-en-Y Gastric Bypass: a Small Case Series. Obes Surg 2017; 27:3061-3063. [DOI: 10.1007/s11695-017-2898-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yilmaz S, Kayaalp C, Isik B, Ersan V, Otan E, Akbulut S, Dirican A, Kutlu R, Kahraman AS, Ara C, Yilmaz M, Unal B, Aydin C, Piskin T, Ozgor D, Ates M, Ozdemir F, Ince V, Koc C, Baskiran A, Dogan SM, Barut B, Sumer F, Karakas S, Kutluturk K, Yologlu S, Gozukara H. Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach. Liver Transpl 2017; 23:751-761. [PMID: 28240812 DOI: 10.1002/lt.24753] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/14/2017] [Indexed: 02/05/2023]
Abstract
Reconstruction of anomalous portal vein branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. The goal of this article is to describe our surgical technique, named the Malatya Approach, in case of APVB during right lobe LDLT. The technique unifies the APVB and obtains a funnel-shaped common extension with a circumferential fence by a saphenous vein conduit. In total, 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into 2 groups according to the adopted surgical techniques: the Malatya Approach group (n = 91) and the previously defined other techniques group (n = 35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90-day mortality and survival. PVT developed in 3 patients (3.3%) in the Malatya Approach group and developed in 10 (28.6%) patients for the other group (P < 0.001). There were 8 (8.8%) 90-day mortalities in the Malatya Approach group (1 PVT related) and 15 patients (9 PVT related) died in the other techniques group (P < 0.001). Mean follow-up time for both groups was similar (999.1 days for the Malatya Approach group versus 1024.7 days for the other group; P = 0.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; P < 0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (P < 0.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751-761 2017 AASLD.
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Affiliation(s)
- Sezai Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Burak Isik
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Veysel Ersan
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Emrah Otan
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Abuzer Dirican
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | | | - Cengiz Ara
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Mehmet Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Bulent Unal
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Cemalettin Aydin
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Turgut Piskin
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Dincer Ozgor
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Mustafa Ates
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Fatih Ozdemir
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Volkan Ince
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Cemalettin Koc
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Adil Baskiran
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Sait Murat Dogan
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Bora Barut
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Fatih Sumer
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Serdar Karakas
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Koray Kutluturk
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Saim Yologlu
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Harika Gozukara
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
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Kayaalp C, Dogan MS, Ersan V. Surgery for intractable pain in a patient with chronic pancreatitis complicated with biliary obstruction, portal vein stenosis and mesenteric venous collaterals. Ann Hepatobiliary Pancreat Surg 2017; 21:101-105. [PMID: 28567456 PMCID: PMC5449365 DOI: 10.14701/ahbps.2017.21.2.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 12/19/2022] Open
Abstract
Pancreatic head resection for chronic pancreatitis is a challenging procedure, in the presence of venous collaterals, cavernous transformation, extensive fibrosis or porto-mesenteric stenosis or thrombosis. We present a surgically treated patient for the intractable pain of chronic pancreatitis. Complications with biliary obstruction and portal vein stenosis/thrombosis resulted in cavernous transformation. A pancreaticoduodenectomy combined with portal vein resection was intended in a 51 year-old male, but the procedure was terminated due to the high risk associated with intraoperative bleeding. The surgical procedure was switched to a Frey procedure, wherein partial pancreatic head resection, drainage of the pancreatic canal and sufficient pain palliation, without an increased risk of intraoperative hemorrhage, was ensured. The procedure was successfully combined with bilio-enteric anastomosis.
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Affiliation(s)
- Cuneyt Kayaalp
- Department of Surgery, Inonu University, Malatya, Turkey
| | | | - Veysel Ersan
- Department of Surgery, Inonu University, Malatya, Turkey
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Karakas S, Sarici K, Ozdemir F, Ersan V, Ince V, Baskiran A, Kayaalp C, Kutlu R, Yilmaz S. Telescopic Biliary Reconstruction in Patients Undergoing Liver Transplantation With 1-Year Follow-up. Transplant Proc 2017; 49:562-565. [DOI: 10.1016/j.transproceed.2017.01.026] [Citation(s) in RCA: 4] [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: 02/07/2023]
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Ozdemir F, Ersan V, Baskiran A, Ince V, Karakaş S, Kahraman AS, Yilmaz S. Surgical Treatment of Portal Vein Thrombosis With the Use of Cadaveric Venous Patch After Donor Hepatectomy: A Case Report. Transplant Proc 2017; 49:606-608. [PMID: 28340842 DOI: 10.1016/j.transproceed.2017.01.037] [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] [Indexed: 11/19/2022]
Abstract
Live donors should be the priority of transplant professionals to prevent surgery-related morbidity and mortality during living-donor liver transplantation. Portal vein thrombosis after donor hepatectomy is an important complication which can be prevented by careful preoperative as well as perioperative evaluation. If portal vein thrombus occurs after donor hepatectomy, anticoagulation and surgical thrombectomy and even portal vein reconstruction should be kept in mind. Cadaveric venous patches can be used for the reconstruction of narrowed and angulated portal veins. Here we report the surgical treatment of a donor with a cadaveric venous patch who developed portal vein thrombosis after donor hepatectomy.
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Affiliation(s)
- F Ozdemir
- Department of Surgery, Liver Transplantation Institute of Inonu University, Malatya, Turkey.
| | - V Ersan
- Department of Surgery, Liver Transplantation Institute of Inonu University, Malatya, Turkey
| | - A Baskiran
- Department of Surgery, Liver Transplantation Institute of Inonu University, Malatya, Turkey
| | - V Ince
- Department of Surgery, Liver Transplantation Institute of Inonu University, Malatya, Turkey
| | - S Karakaş
- Department of Surgery, Liver Transplantation Institute of Inonu University, Malatya, Turkey
| | - A S Kahraman
- Department of Radiology, Liver Transplantation Institute of Inonu University, Malatya, Turkey
| | - S Yilmaz
- Department of Surgery, Liver Transplantation Institute of Inonu University, Malatya, Turkey
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Saydam M, Ersan V, Kayaalp C. Traumatic Transection of Pancreatic Neck in
Adults. Pol Przegl Chir 2017. [DOI: 10.5604/01.3001.0009.6011] [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: 11/13/2022]
Affiliation(s)
- Mehmet Saydam
- Research Scholar, University of Miami, Jackso Memorial Hospital Ryder Trauma Center, Miami, FL
| | - Veysel Ersan
- Inonu University, Turgut Ozal Medical Center, Department of Surgery, Malatya, Turkey
| | - Cuneyt Kayaalp
- Inonu University, Turgut Ozal Medical Center, Department of Surgery, Malatya, Turkey
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30
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Baskıran A, Ozdemir F, Barut B, Ince V, Koc C, Ersan V, Karakas S, Kutluturk K, Yılmaz S. Should We Use an Orphan Graft? Int J Organ Transplant Med 2017; 8:221-223. [PMID: 29321840 PMCID: PMC5756906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- A. Baskıran
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey,Correspondence: Baskiran Adil, Elazig Road, 15th km, Inonu University School of Medicine, Department of Surgery, Malatya, Turkey 44280 Tel: +90-422-341-06 60-6416, Fax: +90-422-341-0660, E-mail:
| | - F. Ozdemir
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - B. Barut
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - V. Ince
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - C. Koc
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - V. Ersan
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - S. Karakas
- Department of Surgery, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - K. Kutluturk
- Department of Radiology, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
| | - S. Yılmaz
- Department of Radiology, Inonu University School of Medicine, Turgut Ozal Medical Center, Malatya, Turkey
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Kayaalp C, Soyer V, Ersan V, Aydın C, Karagül S. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy. Ulus Cerrahi Derg 2016; 32:152-4. [PMID: 27436941 DOI: 10.5152/ucd.2015.3092] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/09/2015] [Indexed: 11/22/2022]
Abstract
Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.
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Affiliation(s)
- Cüneyt Kayaalp
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Vural Soyer
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Veysel Ersan
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Cemalettin Aydın
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Servet Karagül
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
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Cetinkunar S, Ince V, Ozdemir F, Ersan V, Yaylak F, Unal B, Yilmaz S. Living-Donor Liver Transplantation for Budd-Chiari Syndrome--Resection and Reconstruction of the Suprahepatic Inferior Vena Cava With the Use of Cadaveric Aortic Allograft: Case Report. Transplant Proc 2016; 47:1537-9. [PMID: 26093762 DOI: 10.1016/j.transproceed.2015.04.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Living-donor liver transplantation with inferior vena cava resection and reconstruction is rarely indicated for Budd-Chiari syndrome. The aim of this case presentation was to present and discuss the inferior vena cava reconstruction with the use of cadaveric aortic allograft after resection of the suprahepatic inferior vena cava in a patient with Budd-Chiari syndrome who was treated with living-donor liver transplantation. CASE REPORT A 29-year-old male patient with end-stage liver disease and suprahepatic inferior vena cava obstruction was referred to our center. He was scheduled for living-donor liver transplantation. The suprahepatic inferior vena cava was resected and reconstruction was achieved by means of interposition of the cadaveric aortic allograft between the right atrium and inferior vena cava. Postoperative course was uneventful. DISCUSSION Liver transplantation and vena cava reconstruction is indicated in some patients with end-stage liver disease and Budd-Chiari syndrome. Limitations in cadaveric organ donation may be compensated for with the use of living-donor liver. In this condition, various aspects of inferior vena cava reconstruction may be discussed. CONCLUSIONS Budd-Chiari syndrome due to suprahepatic inferior vena cava obstruction close to the right atrium may be treated with vascular reconstruction with the use of a cadaveric aortic allograft.
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Affiliation(s)
- S Cetinkunar
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
| | - V Ince
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - F Ozdemir
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - V Ersan
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - F Yaylak
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - B Unal
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - S Yilmaz
- Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey
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Karakas S, Dirican A, Soyer V, Koç S, Ersan V, Ates M. A pancreatic pseudopapillary tumor enucleated curatively. Int J Surg Case Rep 2015; 10:118-20. [PMID: 25828476 PMCID: PMC4430137 DOI: 10.1016/j.ijscr.2015.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 12/23/2022] Open
Abstract
Pancreatic pseudopapillary tumor is an rarely problem. Tumor may be more aggressive at males relatively to females. Complete resection is the main treatment option for these tumors.
Introduction Pseudopapillary tumors (PPT) of the pancreas are very rare, comprising 0.3–2.7% of all pancreatic tumors, and they occur mostly in young women. Generally, they are benign, but in rare cases they can enlarge, invade adjacent organs, and metastasize distantly. Radiological assessments and biochemical markers are important for diagnosing tumor characteristics. The main treatment is tumor resection. Presentation of case An 18-year-old female was referred to our department suffering from abdominal discomfort and upper quadrant abdominal pain. Abdominal computed tomography (CT) revealed a 6- × 5-cm mass between the pancreatic head and right adrenal gland (Fig. 1). The histological assessment was a solid PPT of the pancreas with intact surgical borders. Discussion PPT are very rare, comprising approximately 5% of cystic pancreatic tumors and ∼1% of exocrine pancreatic neoplasms and present mainly during the second and third decades of life. PPTs are usually indolent tumors. As such, they tend to produce vague nonspecific symptoms or may be detected incidentally on imaging. Complete surgical resection (R0) is the most effective therapy for PPT. Conclusion Although PPT is a very rare, benign tumor, it has the potential to metastasize to adjacent and distant organs. Consequently, they should be detected early, so that they can be treated surgically before malignant conversion.
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Affiliation(s)
- Serdar Karakas
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey
| | - Abuzer Dirican
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey.
| | - Vural Soyer
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey
| | - Süleyman Koç
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey
| | - Veysel Ersan
- Inonu University, School of Medicine, Department of General Surgery, Malatya, Turkey
| | - Mustafa Ates
- Inonu University, School of Medicine, Department of General Surgery, Malatya, Turkey
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Yilmaz S, Aydin C, Isik B, Kayaalp C, Yilmaz M, Ara C, Kutlu R, Bayindir Y, Ersan V. ABO-incompatible liver transplantation in acute and acute-on-chronic liver failure. Hepatogastroenterology 2014; 60:1189-93. [PMID: 23478144 DOI: 10.5754/hge11289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS ABO-incompatible (ABO-I) liver transplantation (LTx) may be mandatory in urgent conditions such as acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) when deceased donor (DD) is unavailable or living donor (LD) selection is limited. This study specifically addresses the problem of urgent ABO-I LTx in critically ill adult patients having ALF or severely decompensated end-stage liver disease. METHODOLOGY This series included 16 patients, 10 underwent ABO-I LD LTx and 6 underwent 7 ABO-I DD LTx. Multiple sessions of plasmapheresis reduced isoaglutinin titres to 1/16 or below, before and after LTx. RESULTS Mean follow-up period was 10.37 months (1 to 38). Median for MELD scores was 22.5 (17 to 30). Median survival was 9 months and mean survival was 19.5 months. Hospital mortality was 3 (18.7%). Two patients died due to small for size graft syndrome and cerebrovascular bleeding respectively. Hepatic artery thrombosis developed in 3 patients. Two of them died at postoperative 4th and 9th months. Third patient is still alive with hepatic necrosis problem. CONCLUSIONS ABO-I LTx remains an important and unavoidable therapeutic option in adult patients with ALF or ACLF and urgent need for an allograft without the possibility to allocate a blood group compatible liver graft.
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Aydin C, Ersan V, Baskiran A, Unal B, Kayaalp C, Yilmaz S. Controlling massive hemorrhage from the retropancreatic portal vein as a complication of thromboendovenectomy during liver transplantation with balloon catheter tamponade: how to do it. Surg Today 2013; 44:792-4. [PMID: 23812900 DOI: 10.1007/s00595-013-0647-9] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/21/2013] [Indexed: 11/24/2022]
Abstract
We herein describe two cases of liver transplantation with portal vein thrombosis. In both cases, a tear advancing to the retropancreatic area occurred during portal vein thrombectomy. Hemorrhage from the limited visibility retropancreatic area made it impossible to stop the bleeding by clamping or direct suturing, and the clamping and suturing efforts actually increased the hemorrhage, possibly due to the damaged and thin portal vein wall. First, finger compression over the retropancreatic area was employed to stop the bleeding, then a Foley urinary catheter was introduced into the portal vein under the finger. The balloon of the catheter was inflated with 8 cc of normal saline, and the finger was released. The bleeding was stopped temporarily, and two different venous conduits were sutured to the trimmed portal vein stump in a bloodless surgical area. The venous conduits were easily controlled with vascular clamps after deflating the balloon catheters, and implantation of the liver was then done in a standard manner. Balloon tamponade can be a lifesaving technique that can temporarily stop a hemorrhage to allow for definitive repair in cases of retropancreatic portal vein hemorrhage.
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Affiliation(s)
- Cemalettin Aydin
- Department of Surgery and Liver Transplantation Unit, Inonu University, 44315, Malatya, Turkey
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Ince V, Dirican A, Yilmaz M, Barut B, Ersan V, Yilmaz S. Peritoneal encapsulation in a patient with incomplete situs inversus. J Coll Physicians Surg Pak 2013; 22:659-60. [PMID: 23058152 DOI: 10.2012/jcpsp.659660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/30/2012] [Indexed: 11/08/2022]
Abstract
Peritoneal encapsulation (PE) is an extremely rare congenital condition in which there is abnormal return of the midgut loop to the abdominal cavity in the early stages of development. It may be present in patients with congenital anomalies like incomplete situs inversus. Pre-operative diagnosis is possible with abdominal CT. A 71-year-old man with incomplete situs inversus was admitted to emergency department with symptoms and signs of peritonitis. Computed tomography (CT) of the abdomen showed characteristic features of the PE syndrome. He had exploratory laparotomy performed and arterial occlusion caused ileocaecal ischaemia and PE was observed. Capsule of PE and ileocaecal excision was done. Postoperative recovery was uneventful.
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Affiliation(s)
- Volkan Ince
- Department of General Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
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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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Yilmaz M, Unal B, Isik B, Ozgor D, Piskin T, Ersan V, Gonultas F, Yilmaz S. Can an extended right lobe be harvested from a donor with Gilbert's syndrome for living-donor liver transplantation? Case report. Transplant Proc 2012; 44:1640-3. [PMID: 22841234 DOI: 10.1016/j.transproceed.2012.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gilbert's syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient's selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1-2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is >30%. Livers with GS can be used successfully as grafts in LDLT recipients.
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Affiliation(s)
- M Yilmaz
- Department of Surgery, Faculty of Medicine, Division of Liver Transplantation, Inonu University, Malatya, Turkey
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Abstract
Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a rare but significant complication, occurring in 1%-2% of cases with a mortality rate of 85%- 90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the host's histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.
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Affiliation(s)
- M Yilmaz
- Department of Surgery, Division of Liver Traansplantation, Inonu University Faculty of Medicine, Malatya, Turkey.
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Yilmaz M, Piskin T, Akbulut S, Ersan V, Gonultas F, Yilmaz S. Is routine sternotomy necessary for organ recovery from deceased donors? A comparative retrospective study. Transplant Proc 2012; 44:1644-7. [PMID: 22841235 DOI: 10.1016/j.transproceed.2012.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
BACKGROUND Traditionally, sternotomy and laparotomy are performed to recover thoracoabdominal organs from deceased donors; however, recovering abdominal organs without sternotomy is possible. We evaluated and compared organ recovery from deceased donors, with and without sternotomy. METHODS Between February 2006 and November 2011, organ recovery was performed in 68 deceased donors by our transplantation team. The recovery procedure was carried out using standard techniques in 31 donors (with sternotomy; Group A) and with modified techniques in 37 donors (without sternotomy; Group B). Average age, gender, body mass index (BMI), and time to cold ischemia were compared retrospectively in both groups. The demographic and clinical parameters were compared using a Student t test and chi-square test. The level of statistical significance was set at P < .05. RESULTS Organ recovery was performed on 31 of 67 (45.6%) deceased donors with sternotomy (Group A) and 37 of 67 (54.4%) without sternotomy (Group B). Thirty-six donors were male and 32 were female. The average donor age was 40.4 ± 3.4 years in Group A and 52.4 ± 4.6 years in Group B (P < .02). The average BMI of donors was 26.2 ± 0.8 kg/m(2) in Group A and 23.9 ± 0.8 kg/m(2) in Group B. The average time to cold ischemia was 127 ± 6.2 minutes in Group A and 47.5 ± 1.8 minutes in Group B (P < .0001). CONCLUSION The transition time to cold ischemia can be shortened by harvesting organs without sternotomy in unstable donors, or under conditions in which intrathoracic organs are not recovered.
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Affiliation(s)
- M Yilmaz
- Department of Surgery, Faculty of Medicine, Division of Liver Transplantation, Inonu University, Malatya, Turkey.
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