Yaman Tokat

Living donor liver transplantation for hepatocellular carcinoma: a single center analysis of outcomes and impact of different selection criteria

We examined the outcomes of patients who received living donor liver transplantation (LDLT) for HCC comparing the impact of up‐to‐seven criteria and Asan Criteria (AC) with Milan Criteria (MC). Between July 2004 and July 2009, of 175 consecutive LDLT, there were 45 consecutive patients with HCC. Forty patients who completed 12 months follow‐up were enrolled. In search for the highest number of expansion, we selected AC as the extended criteria. Patients were divided into having tumors within MC, beyond MC within AC and Beyond Criteria (BC) groups. With a median follow‐up of 46 months, overall 1, 3, and 5 years survival was −90%, −81%, and −70%, respectively. In patients within AC, estimated mean survival was 49.8 vs. 40.5 months for BC group (P = 0.2). Disease‐free survival was significantly higher in patients within AC comparing with BC group; 48.0 vs. 38.6 months (P = 0.04). Preoperative AFP level >400 and poor tumor differentiation were factors adversely effecting recipient survival. On multivariate analysis, the presence of poor tumor differentiation (P = 0.018 RR: 2.48) was the only independent predictor of survival. Extension of tumor size and number to AC is feasible, without significantly compromising outcomes; however, the presence of poor tumor differentiation was associated with worse outcomes after LDLT.

The long-term efficacy of combining nucleos(t)ide analog and low-dose hepatitis B immunoglobulin on post-transplant hepatitis B virus recurrence

The aim of this study was to determine the long‐term efficacy of nucleos(t)ide analog (NA) and low‐dose hepatitis B immunoglobulin (HBIG) combination treatment for preventing post‐transplant hepatitis B virus (HBV) recurrence.

Karaciğer transplantasyonu sonrası HBV profilaksisi

Amac: Ulkemizde karaciger transplantasyonu endikasyonlari icinde, Hepatit B viruse bagli karaciger sirozu birinci sirada yer almaktadir. Bu makalede Hepatit B virus profilaksisi acisindan merkezimizde uygulami s oldugumuz algoritmayi ve sonuclarini rapor ediyor ayni zamanda da transplantasyon sonrasi Hepatit B virus profilaksisi hususundaki tartismalara deginmek istiyoruz. Gerec ve Yontem: 2004-2007 yillari arasinda klinigimizde Hepatit B virus pozitif karaciger sirozlu toplam 64 hastaya karaciger transplantasyonu uygulanmis olup profilaksi icin bu hastalardan preoperatif Hepatit B virus-DNA pozitif olanlara yuksek dozda hepatit-B immunglobulini (HBIg), negatif olanlara ise dusuk dozda Hepatit- B immunglobulini uygulanmistir. Bulgular: Dusuk dozda Hepatit- B immunglobulini ile profilaksi yapilan 2 hastada Hepatit B virus nuksu gelismis olup yuksek dozda profilaksi uygulanan gurupta hic nuks gozlenmemistir. Sonuc: Hepatit B virus-DNA pozitif olan hastalarda daha yuksek dozda HBIg uygulanmasi, etkin ve guvenilir bir yontemdir. Preoperatif Hepatit B virus-DNA negatif hastalarda ise dusuk doz da HBIg uygulamasinin nuks riski acisindan kabul edilebilir, uygulama, maliyet, yan etkiler bakimindan ise daha avantajli bir profilaksi yontemi oldugu kanaatindeyiz.