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Öğe 100 consecutive adult to adult right lobe living donor liver transplantation.(Blackwell Munksgaard, 2004) Kucuk, HF; Cag, MM; Unsal, G; Icoz, G; Nart, D; Karasu, Z; Zeytunlu, M; Kilic, M; Yuzer, Y; Tokat, YÖğe Adefovir dipivoxil therapy in liver transplant recipients for recurrence of hepatitis B virus infection despite of lamivudine plus hepatitis B immuneglobulin prophylaxis.(John Wiley & Sons Inc, 2006) Akyildiz, M; Karasu, Z; Zeytunlu, M; Aydin, U; Ozacar, T; Kilic, MÖğe Adult and pediatric living donor liver transplantation for acute liver failure.(John Wiley & Sons Inc, 2006) Kilic, M; Aydin, U; Kirdok, O; Aydogdu, S; Karasu, Z; Akyildiz, M; Yilmaz, F; Nart, D; Tumgor, G; Tamsel, S; Zeytunlu, MÖğe Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations(Wiley, 2003) Icoz, G; Kilic, M; Zeytunlu, M; Celebi, A; Ersoz, G; Killi, R; Memis, A; Karasu, Z; Yuzer, Y; Tokat, YBiliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.Öğe Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations(Wiley, 2003) Icoz, G; Kilic, M; Zeytunlu, M; Celebi, A; Ersoz, G; Killi, R; Memis, A; Karasu, Z; Yuzer, Y; Tokat, YBiliary complications appear to be the leading cause of postoperative complications after living donor liver transplantation (LDLT). The aim of this study is to analyze the complications, treatment modalities, and outcomes of biliary anastomoses in a series of 50 consecutive right-lobe LDLTs. Median patient age was 45 years, and median right-lobe graft volume was 740 g. Graft-recipient weight ratio was 0.69 to 1.80. Median follow-up time was 15 months (range, 2 to 38 months). Eleven of 50 patients died, resulting in an overall allograft and patient survival rate of 78%. In biliary reconstruction, a duct-to-duct (D-D) anastomosis or a standard Roux-en-Y (R-Y) anastomosis was performed. Twenty-nine grafts (58%) had a single duct for anastomosis. Seventeen grafts (34%) had two bile duct orifices, and four grafts (8%) had three bile duct orifices. A D-D anastomosis was performed in 36 cases (72%), whereas R-Y reconstruction was preferred in 14 cases (28%). The overall incidence of biliary anastomotic complications was 30% in this series. Five patients developed biliary leaks, presumably from the cut surface, and all of them healed spontaneously. Two bilomas were drained percutaneously. Anastomotic strictures occurred in 8 patients (16%) and were significantly greater than in the R-Y group (P =.03). Although strictures seemed to develop more frequently in allografts with multiple bile ducts, this did not reach statistical significance (P =.05). All strictures were managed by nonsurgical measures initially. Restenosis occurred in 2 patients, both of whom had an R-Y anastomotic stricture. These anastomoses were revised surgically, giving a reoperation rate of 4% for biliary problems. No graft or patient was lost because of biliary problems. Our data suggest that D-D anastomosis is a safe and feasible method of biliary reconstruction in LDLT by preserving physiological bilioenteric continuity and allowing easy access through endoscopic techniques.Öğe A comparison of the caval clamping techniques during adult to adult right lobe liver transplantation.(John Wiley & Sons Inc, 2005) Ulukaya, S; Ayanoglu, O; Acar, L; Zeytunlu, M; Kilic, MÖğe Donor safety in adult to adult living donor liver transplantation(Elsevier Science Bv, 2003) Zeytunlu, M; Kilic, M; Aynaci, M; Icoz, G; Tokat, Y; Yuzer, YÖğe Donor safety in adult to adult living donor liver transplantation(Elsevier Science Bv, 2003) Zeytunlu, M; Kilic, M; Aynaci, M; Icoz, G; Tokat, Y; Yuzer, YÖğe Donor safety in adult-to-adult living donor liver transplantation(Elsevier Science Inc, 2003) Zeytunlu, M; Icoz, G; Kilic, M; Demirbas, T; Tokat, Y; Yuzer, YÖğe Donor safety in adult-to-adult living donor liver transplantation(Elsevier Science Inc, 2003) Zeytunlu, M; Icoz, G; Kilic, M; Demirbas, T; Tokat, Y; Yuzer, YÖğe Experience of transplant team: A real impact factor on patient survival in living related right lobe liver transplantation.(W B Saunders Co, 2002) Karasu, Z; Tokat, Y; Yuzer, Y; Lebe, E; Gunsar, F; Ersoz, G; Akarca, U; Kilic, M; Zeytunlu, M; Batur, YÖğe Experience with mesocaval shunt with autologous jugular vein interposition in patients with Budd-Chiari syndrome(H G E Update Medical Publishing S A, 2005) Ilkgul, O; Kilic, M; Icoz, G; Zeytunlu, M; Demirpolat, G; Akyildiz, M; Tokat, Y; Parildar, M; Memis, ABackground/Aims: In the present era of interventional. radiology and liver transplantation, the role of mesocaval shunt surgery for portal hypertension in Budd-Chiari syndrome is reviewed. Methodology: This study analyzed the management of 35 patients with Budd-Chiari syndrome between June 1994 and June 2004 in our institution. During this 10-year interval, 31 of the 35 patients with Budd-Chiari syndrome underwent shunt procedures and four patients underwent liver transplantation. Mesocaval shunts were preferred in 27 patients and seven of these patients required prior caval stenting. One portocaval shunt was performed in a patient having a thrombosed mesocaval shunt. In all mesocaval. shunt procedures the patient's internal jugular vein was used as an interposition graft between the superior mesenteric vein and inferior vena cava. In four patients with thrombosed vena cava a mesoatrial shunt was performed using poly-tetrafluoroethylene graft while four patients with established cirrhosis under-went orthotopic liver transplantation. Results: In the group of mesocaval shunts, 3 patients were lost in the early postoperative period with a mortality rate of 11%, 2 of them due to thrombosed shunts and one of them due to pneumonia. The median follow-up was 42 months (6-120 months) and one patient experienced shunt thrombosis and died afterwards due to the complications of portal hypertension. In the whole series the patency rate of the mesocaval shunt was 89%. Conclusions: Patients with Budd-Chiari syndrome can be managed by a combination of shunt surgery, interventional radiology and liver transplantation. Our results demonstrate the effectiveness of mesocaval shunt procedure with autologous jugular vein interposition to maintain long-term patency and survival.Öğe Gastrointestinal complications in renal transplantation(Appleton & Lange, 1996) Tokat, Y; Zeytunlu, M; Kilic, M; Kaplan, H; Yararbas, OÖğe Hepatocellular carcinoma in liver transplant era: A clinicopathologic analysis(Elsevier Science Inc, 2003) Nart, D; Arikan, C; Akyildiz, M; Yuce, G; Demirpolat, G; Zeytunlu, M; Karasu, Z; Aydogdu, S; Killi, R; Yuzer, Y; Tokat, Y; Kilic, MHepatocellular carcinoma (HCC) is one of the most common tumors in the world, and the prognosis is usually poor. Today, liver transplantation (LT) is a radical but frequently curative treatment modality for HCC. In selected patients, it cures HCC and the underlying cirrhosis at the same time. The present clinicopathological study examined the importance of tumor characteristics for their effects on recurrence and survival rates after LT for HCC. Forty-two native hepatectomy specimens among 250 consecutive orthotopic liver transplantations contained HCC. Patients were predominantly men (30 men, 12 women), ranging in age from 1 to 61 years (median 51). While 20 patients received cadaveric organs, 22 were transplanted from living donors. In 14 patients (33%) HCC presented as a solitary nodule, 5 (12%) as two nodules; 2 (5%) as three nodules; and 21 patients (50%) as more than three nodules. The maximal diameter of the largest tumor not larger than 3 cm in 28 patients (66%), exceeding this size in 14 patients (34%). There was a significant correlation between nodule number and tumor size (r = 0.36, P = 0.05). While 23 patients had no sign of vascular involvement, 17 tumors showed microscopic invasion and two large vessel involvement. There was a positive correlation between vascular invasion and nodule number (r = 0.41, P = 0.05). The histopathological grade of differentiation of the tumors was assessed as "well" in seven patients (14%), moderate in 28 (72%), and poor in 7 (14%). The differentiation was significantly poorer when vascular invasion was observed (r = 0.43, P = .01). According to the TNM classification, 11 patients (26%) were stage I, 6 (14%) stage II, 13 (31%) stage III, and 12 (29%) stage IV. After a median follow-up of 10 months (1-50 months), the overall mortality was 18% (n = 8). Patient survival at 6 month, 1, and 4 years was 88%, 80%, and 60%, respectively. The outcome was significantly poorer for TNM stage IV versus stage I, II, and III tumors to (P = .02). Tumor recurred in three patients at 4,6, and 50 months after liver transplantation. The sites of recurrence were bone, lung, and adrenal glands. In conclusion, liver transplantation represents a safe and feasible treatment for hepatocellular carcinoma with excellent outcomes compared with other treatment modalities. Liver transplantation offers excellent survival rates and chance for cure in stages I, II, and III hepatocellular carcinoma in cirrhotic patients.Öğe Hepatocellular carcinoma in liver transplant era: A clinicopathologic analysis(Elsevier Science Inc, 2003) Nart, D; Arikan, C; Akyildiz, M; Yuce, G; Demirpolat, G; Zeytunlu, M; Karasu, Z; Aydogdu, S; Killi, R; Yuzer, Y; Tokat, Y; Kilic, MHepatocellular carcinoma (HCC) is one of the most common tumors in the world, and the prognosis is usually poor. Today, liver transplantation (LT) is a radical but frequently curative treatment modality for HCC. In selected patients, it cures HCC and the underlying cirrhosis at the same time. The present clinicopathological study examined the importance of tumor characteristics for their effects on recurrence and survival rates after LT for HCC. Forty-two native hepatectomy specimens among 250 consecutive orthotopic liver transplantations contained HCC. Patients were predominantly men (30 men, 12 women), ranging in age from 1 to 61 years (median 51). While 20 patients received cadaveric organs, 22 were transplanted from living donors. In 14 patients (33%) HCC presented as a solitary nodule, 5 (12%) as two nodules; 2 (5%) as three nodules; and 21 patients (50%) as more than three nodules. The maximal diameter of the largest tumor not larger than 3 cm in 28 patients (66%), exceeding this size in 14 patients (34%). There was a significant correlation between nodule number and tumor size (r = 0.36, P = 0.05). While 23 patients had no sign of vascular involvement, 17 tumors showed microscopic invasion and two large vessel involvement. There was a positive correlation between vascular invasion and nodule number (r = 0.41, P = 0.05). The histopathological grade of differentiation of the tumors was assessed as "well" in seven patients (14%), moderate in 28 (72%), and poor in 7 (14%). The differentiation was significantly poorer when vascular invasion was observed (r = 0.43, P = .01). According to the TNM classification, 11 patients (26%) were stage I, 6 (14%) stage II, 13 (31%) stage III, and 12 (29%) stage IV. After a median follow-up of 10 months (1-50 months), the overall mortality was 18% (n = 8). Patient survival at 6 month, 1, and 4 years was 88%, 80%, and 60%, respectively. The outcome was significantly poorer for TNM stage IV versus stage I, II, and III tumors to (P = .02). Tumor recurred in three patients at 4,6, and 50 months after liver transplantation. The sites of recurrence were bone, lung, and adrenal glands. In conclusion, liver transplantation represents a safe and feasible treatment for hepatocellular carcinoma with excellent outcomes compared with other treatment modalities. Liver transplantation offers excellent survival rates and chance for cure in stages I, II, and III hepatocellular carcinoma in cirrhotic patients.Öğe Impact of pretransplant MELD score on posttransplant outcome in living donor liver transplantation(Elsevier Science Inc, 2004) Akyildiz, M; Karasu, Z; Arikan, C; Kilic, M; Zeytunlu, M; Gunsar, F; Ersoz, G; Akarca, U; Batur, Y; Tokat, YIt is not clear whether pretransplantation MELD (model for End-Stage Liver Disease) score can foresee posttransplant outcome. We retrospectively evaluated 80 adult patients (55 men, 25 women) who underwent living donor liver transplantation between September 1998 and March 2003. Five other patients with fulminant hepatitis were excluded. The UNOS-modified MELD scores were calculated to stratify patients into three groups: group 1) MELD score less than 15 (n = 13); group 2) MELD score 15 to 24 (n = 36); and group 3) MELD score 25 and higher (n = 26). The patients were predominantly men (n = 52, 69.3%) with overall mean age of 43.9 years (range, 17-62 years). The mean follow-up was 15.7 months (range, 1-47; median = 14 months). The mean MELD score was 22.7 (range, 9-50; median = 21). The overall 1- and 2-year patient survivals were 87% and 78.7%, respectively. The 1-year patient survivals for groups 1, 2, and 3 were 100%, 87%, and 79%; respectively. 2-year survivals, 100%, 79%, and 61%, respectively. Survivals stratified by MELD showed no statistically remarkable differences in 1-year and 2-year patient survival (P =.08). In contrast, 1-year and 2-year patient survival rates for UNOS status 2A, 2B, and 3 were 73%-50%, 95%-91%, and 91%-91%, statistically significant difference (P =.002). Finally, to date preoperative MELD score showed no significant impact on 1- and 2-year posttransplant outcomes in adult-to-adult living donor liver transplantation recipients, but we await longer-term follow-up with greater numbers of patients.Öğe Leiomyosarcoma of the inferior vena cava: Report of a case(Springer-Verlag, 2004) Yuzer, Y; Zeytunlu, M; Makay, O; Sozbilen, M; Yuce, GWe report a case of leiomyosarcoma of the inferior vena cava, which was successfully treated by surgical en bloc resection and reconstruction of the inferior vena cava, followed by adjuvant radiation therapy. A 39-year-old man presented with nausea, vomiting, epigastric pain, and weight loss. Radiologic examinations showed a mass originating from the inferior vena cava and surgical resection was performed. Histopathological examination of the specimen revealed a moderately differentiated (grade II) leiomyosarcoma arising from the inferior vena cava. We believe that radical resection with clear surgical margins followed by adjuvant radiation therapy is a good curative strategy for achieving any chance of long-term survival.Öğe The limit for residual donor hepatic volume in adult to adult right lobe living liver transplantation(W B Saunders Co, 2003) Zeytunlu, M; Kilic, M; Demirbas, T; Tokat, Y; Yuzer, YÖğe The limit for residual donor hepatic volume in adult to adult right lobe living liver transplantation(W B Saunders Co, 2003) Zeytunlu, M; Kilic, M; Demirbas, T; Tokat, Y; Yuzer, YÖğe Living donor liver transplantation for fulminant liver failure(Elsevier Science Bv, 2003) Tokat, Y; Ersoz, S; Karasu, Z; Arikan, C; Nart, D; Kilic, M; Yerdel, MA; Karayalcin, K; Zeytunlu, M; Aydogdu, S; Yuzer, Y