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Öğe Comparison of Liver Transplant Outcomes in Biliary Atresia Patients, Considering Whether They Underwent the Kasai Procedure Beforehand: A Single Center Analysis of 72 Patients(Elsevier Inc., 2023) Demir, H.B.; Umman, V.; Gümüs, T.; Tunalı, S.; Barut, D.; Karakoyun, M.; Akarca, U.S.Background: This study examines the results of liver transplantation (LT) in patients with biliary atresia, considering whether they underwent the Kasai procedure beforehand. LT and determine postoperative and long-term graft outcomes. Methods: This single-center, retrospective study included 72 pediatric patients diagnosed with postpartum biliary atresia who underwent LT between 2010 and 2022. We included patients who underwent LT either after or without the Kasai procedure and compared the demographic data of the patients with various factors, such as the Pediatric End-Stage Liver Disease scores and laboratory values. Results: The study included 72 patients, with 39 of them being female (54.2%) and 33 of them being male (45.8%). Of the 72 patients in the study, 47 (65.3%) had undergone the Kasai procedure, and 25 (34.7%) had not. The preoperative and postoperative month 1 bilirubin values were lower in patients who underwent the Kasai procedure and were higher in postoperative months 3 and 6. Preoperative bilirubin values, postoperative month 3 bilirubin values, and preoperative albumin values were higher in patients who developed mortality (P <.05). Cold ischemia time was longer in patients who developed mortality (P <.05). Conclusions: Our study showed a higher mortality rate in patients who underwent the Kasai procedure. The results also showed that LT was more effective in children, as patients with Kasai had higher mean bilirubin values and higher preoperative albumin values than patients without Kasai. © 2023 Elsevier Inc.Öğe Immunosuppression after Liver Transplantation in Pediatric Population(Springer Nature, 2023) Umman, V.; Zeytunlu, M.; Emre, S.Pediatric liver transplantation has become the standard of care for children with end-stage liver disease, owing to advancement of surgical techniques including split liver transplantation and living donor liver transplantation which increased available organs. Furthermore, technological advancements, better understanding of disease process, patient selection and improved pre- and postoperative ICU care, better managing of short- and long-term complications secondary to increasing experience, and team effort have played important role for patient outcomes and satisfaction. In addition to these factors, understanding the immunological issues and development of new immunosuppressive medications have made the field of liver transplantation as an acceptable treatment modality. These advancements improved outcomes dramatically to 94% 1-year survival [1, 2]. Immunosuppressive therapy has substantial contribution in these results by prevention of rejection and early complications. On the other hand, immunosuppressive management of pediatric recipients has continued to be challenging for various reasons. In this chapter we aim to overview the current immunosuppressive medications, their mechanism of actions, pharmacokinetics, pharmacodynamics, side effects, and immunosuppressive strategies/protocols. © Springer Nature Singapore Pte Ltd. 2023.Öğe Impact of Postoperative Complications on Portal Thrombosis In Splenectomy Patients(Istanbul University Press, 2023) Umman, V.; Atalay, H.B.; Temel, R.; Ali?Soy, T.; Balci, K.; Okutan, S.F.; Sezer, T.Ö.Objective: Venous thromboembolism is one of the significant complications after elective and emergency splenectomy. Up to 35% of portal and splenic venous thromboembolism has been reported in the first two months after splenectomy for hematologic malignancy. Our objectives were to compare emergency and elective splenectomy and their complications, and to analyze the risks on the development of portal vein thrombosis (PVT). Material and Method: A total of 78 splenectomy cases performed between 2017-2023 and that had complete medical records were included in this study. Of these cases, 39 were emergency and 39 were elective procedures. The two groups were compared retrospectively for risks of PVT. Result: We found a significant relationship between the development of postoperative complications and the risk of PVT (p=0.004). The risk of developing PVT in emergency cases in the post-operative 2 weeks was significantly higher than elective cases (p=0.048). Shorter operation times, larger spleen sizes, lower platelet counts and malignancy in pathology results were found to be significantly in favor of elective cases (p=0.007, p=0.004, p<0.001, p=0.001, respectively). In emergency cases, the need for RBC transfusion and complications were more frequent (p<0.001, p=0.021). Conclusion: High-risk patients should be evaluated for prophylactic anticoagulation with low-molecular-weight heparin in the postoperative period and after discharge. Anticoagulation should be considered for emergency splenectomy, factoring in cost-benefit, and a low suspicion for venous thromboembolism should be maintained with timely investigation. In this sense, our study supports the existing data with its current results. © 2023 The Author(s).Öğe Predictive Value of Red Blood Cell Distribution Width, Platelet Count to Lymphocyte Count Ratio, and Neutrophil Count to Lymphocyte Count Ratio Values for the Detection of Postoperative Infection in Patients Undergoing Liver Transplantation(Elsevier Inc., 2023) Umman, V.; Gumus, T.; Kivratma, H.G.; Tabatabayi, P.; Uguz, A.; Zeytunlu, M.; Emre, S.Background: The red blood cell distribution width (RDW) value is a simple and fast parameter that shows an elevation in the presence of infectious disease. It is thought that proinflammatory signals cause changes in the cell wall of the erythrocytes. In our study, we aimed to investigate the prognostic value of RDW and other parameters in patients undergoing liver transplantation. Methods: We retrospectively investigated 200 patients who underwent liver transplantation (LT) in our center. The study group was 100 patients who underwent LT and developed a postoperative abdominal or catheter-related infection in the early period between the first and second weeks of hospitalization. The control group comprises 100 patients who underwent LT and were discharged without complications. In 4 different periods, inflammatory markers and RDW, platelet count to lymphocyte count ratio, and neutrophil count to lymphocyte count ratio (NLR) values were compared in the 2 groups. Results: In our study, we found RDW and NLR parameters to be elevated in correlation with infection in patients who underwent LT (P <.05). Other markers were elevated but not significantly correlated with infection. Conclusions: These parameters can be simple and effective additional tools to implement in patients suspected of infection. Further prospective studies with larger patient groups and varying infection states are required for validating RDW and NLR as additional diagnostic markers. © 2023 Elsevier Inc.Öğe Use of donation after circulatory death donors in pediatric liver transplantation(Elsevier Inc., 2023) Umman, V.; Zeytunlu, M.; Emre, S.After advancement of technical aspects, use of well-established and novel immunosuppressive therapies, and better pre and postoperative care, which resulted in high overall survival rates with liver transplantation, waiting list mortality has become the main issue for pediatric patients with end stage liver disease. Insufficient organ donors have become a challenging issue especially in the pediatric patient population, for whom size match of donor or graft is harder to achieve. In order to expand the donor pool and decrease the gap between the demand and supply of donor organs, use of donation after circulatory death (DCD) donors have been proportionally increased. In this chapter we aim to discuss current practices, issues and outcomes with DCD in pediatric liver transplantation, as well as future strategies for improvement of results. © 2023
