Serdar Karakas

Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

BACKGROUND The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. METHOD Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearsons χ(2) test, Fishers exact test, and Yates corrected χ(2) test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index. RESULTS The 153 patients with pulmonary complication were divided into 2 groups: mortality (n = 53) and survival (n = 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P = .035), duration of mechanical ventilation (P > .001), pneumonia (P = .01), and endotracheal culture results (P = .001). In the multivariate analysis, hemoglobin (P = .03, odds ratio [OR]: 1.239), MELD score (P = .027, OR: 1.064), duration of mechanical ventilation (P = .003, OR: 1.091), and age (P = .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%). CONCLUSION Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.

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 (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.

A pancreatic pseudopapillary tumor enucleated curatively.

Highlights • 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.

Living donor liver transplantation for Budd-Chiari syndrome: Overcoming a troublesome situation.

Background: The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd–Chiari syndrome (BCS). Methods: Demographic and surgical techniques characteristics of 39 patients with BCS who underwent LDLT were retrospectively reviewed. Thirty-two of them had native vena cava inferior (VCI) preservation and 6 had retrohepatic VCI resection with venous continuity established by cryopreserved VCI (n = 4) or aortic graft (n = 2). In 1 patient, the anastomosis was established between the graft hepatic vein (HV) and the suprahepatic VCI. For preservation of the native VCI, immediately before the graft implantation, the thickened anterior, and right/left lateral walls of the recipient VCI were resected caudally and cranially until the intact vein wall was reached, and then an anastomosis was created between the (HV) of the graft reconstructed as a circumferential fence and the reconstructed recipient VCI. For resection of the retrohepatic VCI, the anastomosis was created with the same technique in all 6 patients in whom VCI was reformed by using a vascular graft. Results: Post-LT complications developed in 19 of the patients. Complications related to the biliary anastomosis accounted for 12 of these cases, with 11 treated by PTC and/or ERCP, and 1 by hepaticojejunostomy. Two of the 39 patients developed recurrent BCS and were treated by interventional radiological methods. Thirteen patients died and none were related to the BCS recurrence. Conclusion: Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools.

Intestinal perforation after regorafenib usage

Angiogenesis is effective in tumor growth and vascular endothelial growth factor, an angiogenesis factor in chemotherapy drugs, is targeted. Bevacizumab (BV) (Altuzan, Roche) sunitinib sorafenib tyrosine kinase inhibitors that target vascular endothelial growth factor pathways. These anti-neoplastic agents have some important side effects, such as gastrointestinal perforation and fistula, on patients.

Surgical Treatment of Portal Vein Thrombosis With the Use of Cadaveric Venous Patch After Donor Hepatectomy: A Case Report

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.

Liver Transplantation for Hepatocellular Carcinoma at Inonu University

There is a great effort in the world to find a new drug in hepatocellular carcinoma (HCC) treatment. Turkey has a limited number of basic science studies to discover a new therapeutic drug for HCC. It seems that Turkey is distanced from the global drug discovery race and competition, however, Turkey has the advantage of a wide experience in living donor liver transplantation, like South Korea and Japan. Turkey can plan new studies on HCC, particularly with living donor liver transplantation. Neoadjuvant treatment methods before living donor liver transplantation for advanced tumors would be a good idea for study in Turkey. Because Inonu University has the busiest liver transplantation program in Turkey, the contribution of Inonu University to trials like this can improve the depth of the studies. To conclude, the Inonu University Liver Transplantation Institute has the busiest program in Turkey with 1,600 transplantations in eight years. The program is based on living donor liver transplantations (80%). Living donor liver transplantation for advanced HCC patients is our favorite topic to study.

Co-existence of idiopathic cecal ulcer and incidental appendix carcinoid tumor

Idiopathic cecal ulcer or solitary cecal ulcer is a rare entity that can only be diagnosed by histopathological evaluation. Generally, it is diagnosed by histolopathological evaluation of biopsy specimens obtained by colonoscopy that is performed for lower gastrointestinal bleeding. It can also be diagnosed after surgical resection performed for acute abdomen or cecal mass mimicking malignancy. Cecal carcinoid tumor is a rare cause of this condition; however, coexistence of cecal ulcer and appendix carcinoid tumor has not been previously reported. In this case, we present a 73-year-old woman who clinically presented as acute appendicitis with cecal wall thickening, underwent right hemicolectomy and was subsequently diagnosed with cecal ulcer, serosal abscess and coexisting appendix carcinoid tumor.

Transverse Sinus Thrombosis in a Living Donor: A Case Report

BACKGROUND Liver transplantation is among the treatment options for end-stage liver disease. Limited organ donation in our country has resulted in an increased performance of living donor liver transplantations. This case report describes a left transverse cerebral venous sinus thrombosis diagnosed in a living donor hepatectomy patient. PATIENT A 45-year-old man underwent right lobe hepatectomy of a 330-g graft for living donor liver transplantation to his 55-year-old hepatitis B virus-positive brother. On the first postoperative day, without any surgical problems he presented with loss of consciousness. Previous medical history was unremarkable. Neurology consultation revealed lethargy and an acute confusional state. Cerebral magnetic resonance imaging venography showed signal alterations in the left transverse sinus wherein thrombosis was diagnosed. Heparin infusion initiated for antithrombotic treatment was adjusted to provide a 1.5 to 2-fold increased baseline activated partial thromboplastin time. On the second day of treatment has clinical status improved and he was discharged on the, fifth day on oral anticoagulant (warfarin) therapy for outpatient follow-up. RESULTS Cerebral venous sinus thrombosis is a rare disease with variable clinical onsets. Surgical procedures are among risk factors. An early diagnosis is essential to achieve low mortality and morbidity rates.