Cemalettin Koç

Chronic Graft-Versus-Host Disease After Liver Transplantation: A Case Report

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 hosts 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.

Storage of allogeneic vascular grafts: experience from a high-volume liver transplant institute.

Allogeneic vascular grafts are often required for vascular reconstruction during living donor liver transplantation. Such grafts are obtained prior to use, making storage conditions a critical issue for maintaining the integrity of the tissue to ensure a successful transplantation. This study describes an optimized storage protocol currently in use at a high-volume liver transplant center. Twenty-nine allogeneic vascular graft tissues obtained during cardiovascular surgery or from cadaveric donors were stored respectively in sterile 50 mL of Ringer lactate solution, without any preservation solutions or antimicrobials, at -22°C for a maximum of 3 months. Prior to use in vascular reconstruction, grafts were thawed in 0.9% NaCl solution at 37°C, and 1 × 0.5-cm(2) tissue samples were collected for microbial culturing and viral serology. ABO compatibility was not performed for any patients receiving vascular grafts. During this prospective study, all 29 allogeneic vascular grafts were used for back-table vascular reconstruction in living donor liver transplantation procedures. A total of 16 grafts were from the saphenous vein, 10 were from the iliac vein, and 3 were from the iliac artery. Bacterial growth was not detected in any tissue samples taken from the stored grafts. No vascular graft-related complications occurred during the 5 months of follow-up. The successful vascular reconstructions achieved with all 29 study grafts demonstrate that the simple, inexpensive storage method described herein is feasible and safe. Randomized, controlled studies should be carried out to further optimize and standardize the technique.

Barolith, a rare cause of acute appendicitis: a case report

A barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90~95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.

Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach

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 (nu2009=u200991) and the previously defined other techniques group (nu2009=u200935). 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 (Pu2009<u20090.001). 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 (Pu2009<u20090.001). 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; Pu2009=u20090.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; Pu2009<u20090.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (Pu2009<u20090.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751–761 2017 AASLD.

Pregnancy After Liver Transplantation: Risks and Outcomes

OBJECTIVEnThe aim of this study was to evaluate the outcomes of liver transplant recipients who became pregnant after transplantation.nnnMETHODSnThe clinical data of all patients who underwent liver transplantation between January 2007 and December 2016 in our liver transplantation institute were reviewed. The following data were analyzed: indications for transplantation, recipient age at the beginning of pregnancy, the interval between transplantation and pregnancy, maternal and fetal complications, type of delivery, the health condition of neonates, and modifications in immunosuppressive therapy.nnnRESULTSnDuring the study period, 1890 patients underwent liver transplantation. There were 185 women (9.8%) in childbearing age (15-45 years old), and 18 (9.7%) of them became pregnant during the study period. There were a total of 26 pregnancies. The mean age of patients at the time of operation was 25.3 ± 5.2 years, and the mean interval between operation and conception was 32.7 ± 15.3 months. Seventeen pregnancies (65.4%) ended in a live birth in the study. Six pregnancies (23%) resulted with no maternal or fetal complications. The most frequent maternal complication during pregnancy was pregnancy-induced hypertension (nxa0= 3; 16.6%).nnnCONCLUSIONSnDespite advances in immunosuppressive therapy and increasing experience in the management of these patients, pregnancies in liver transplant recipients are still more risky than in the general population for both the mother and the fetus. Thus, the issues related to fertility should be comprehensively discussed with the patients and their partners, preferably before transplantation, and pregnancies in liver transplant recipients should be followed up more carefully by a multidisciplinary team.

Unusual complication in patient with Gardner’s syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

Gardner’s syndrome (GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and mid-rectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodeno-jejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.

Can Patients Who Develop Cerebral Death in Fulminant Liver Failure Despite Liver Transplantation Be Previously Forseen

BACKGROUNDnThe outcome of medical treatment is worse in fulminant liver failure (FLF) developing on acute or chronic ground. Recently, liver transplantations with the use ofxa0living and cadaveric donors have been performed in these diseases and good results obtained. In this study, we aimed to present the factors affecting the recovery of cerebral functions after liver transplantation in hepatic encephalopathy (HE) developingxa0in FLF, to identify irreversible patient groups and to prevent unnecessary liver transplantation.nnnMETHODSnIn Inonu Universitys Liver Transplant Institute, 69 patients who made an emergency notice to the National Coordination Center for liver transplantation owing toxa0FLF from January 2012 to December 2015 were included in the study. Patients were divided into 2 groups. Group 1 consisted of 52 patients who underwent liver transplantation and recovered normal brain function, and group 2 had 17 patients who underwent liver transplantation and did not recover normal brain function and had cerebral death. All patients were evaluated before surgery for clinical encephalopathy stage, light reflex, and convulsions. Groups were compared and assessed according to age (>40, 10-40 andxa0<10 years), body mass index, etiologic factor, preoperative laboratory values, transplantation type, mortality, and encephalopathy level. Multivariate analysis was done for specific parameters.nnnRESULTSnProthrombin time (PT), international normalized ratio (INR), and total bilirubin values were significantly different between the groups. There was no significant difference between the groups regarding ammonia and lactate levels. There was axa0statistically significant difference between the groups regarding sodium and potassium levels from serum electrolytes. However, the averages of both groups were withinxa0normal limits. pH and total bilirubin levels were meaningful for multivariate analysis.nnnCONCLUSIONSnHE reversibility, mortality, and morbidity are important in patients withxa0HE who undergo liver transplantation. Therefore, West Haven clinical staging andxa0serum INR, PT, and total bilirubin level may be helpful in predicting the reversibility of FLF patients with HE before liver transplantation. It was determined thatxa0West Haven encephalopathy grading is important in determining the reversibility of HE after transplantation in FLF; especially the probability of reversibility of stage 4xa0HExa0decreases significantly. High PT and INR levels, hyperbilirubinemia, and serumxa0sodium and potassium concentrations were risk factors for the reversibility of HExa0in this study.

Konjenital transmesenterik defekt: İnternal herniasyona bağlı intermittan intestinal obstrüksiyon

Bagirsak tikanikliginin nadir nedenlerinden birisi de internal fitiklardir. Dogumsal ya da edinsel olarak olusan defektlerden gelisen fitiklasma sonucu bagirsak tikanikligi meydana gelir. Zamaninda cerrahi mudahale yapilmadiginda mortalite oranlari %20‘lere ulasmaktadir. Tekrarlayan bagirsak tikanikligi sikayeti ile basvuran, gecirilmis ameliyat oykusu olmayan 27 yasindaki bayan hastanin zamaninda mudahale ile fitiklasan ince bagirsakta geri donussuz degisiklikler gelismeden, sadece fitik reduksiyonu ve mezenterik defektin kapatilmasi ameliyatiyla tedavisi anlatilmaktadir.