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Echinococcus alveolaris is a parasite from tenia family which causes tumor-like lesions in the livers of infected people. If it is not diagnosed in the early stage of the disease, it frequently causes multiple cysts in the liver. The clinical importance of the disease is rapid progression, infiltration into different tissues like a malignant tumor and capacity of creating metastatic masses. The disease could be treated either by surgical resection or liver transplantation. The resection of the cystic disease is the preferred treatment method. In cases where resection is not possible, liver transplantation is the choice of treatment. Here we present three cases which were admitted to the hospital with unresectable hepatic alveolar echinococcosis and treated by liver transplantation successfully. Patients for whom surgical resection is not possible, we recommend liver transplantation as the treatment method.

Hepatorenal syndrome is defined as renal failure caused by acute or chronic liver failure without any laboratory or histological reasons. The exact etiology of this syndrome is unknown. However, vasodilatation in the splanchnic area as a result of cirrhosis and portal hypertension, reflex systemic and splanchnic vasoconstriction are the basic pathophysiological reasons of this syndrome. The decrease of renal perfusion, decrease in glomerular filtration rate, sodium retention and deterioration of excretion of free water are the major renal problems and these remain progressive according to the stage of liver disease. The treatment of this syndrome is correction of the underlying problem. Here, we report a patient who was having hemodialysis due to renal failure as a consequence of liver cirrhosis for three months and returned back to his normal life without a need for dialysis after liver transplantation.

Thrombosis of recipient hepatic artery is a life threatening complication for liver transplantation. The etiology of hepatic arterial thrombosis is multi-factorial and can be caused by intimal dissection, poor surgical technique and coagulopathies. The patency of hepatic arterial flow is very important for both graft survival and patient survival. Intraoperative diagnosis of inadequate hepatic arterial flow found with Doppler ultrasonography is essential in order to achieve good results after liver transplantation. Urgent re-anastomosis is necessary when the arterial blood flow is insufficient. We performed 317 living donor liver transplantations from July 2004 to July 2011. We used recipient splenic artery for hepatic artery reconstruction in six patients. These six patients were included in this study. Using the recipient splenic artery is a simple, safe and practical alternative for hepatic artery re-anastomosis in living donor liver transplantations.

Background/aims: HBsAg negative recipients of liver from anti-HBc positive donors are at a significant risk for developing de novo HBV infection after liver transplantation. The aim of this study was to assess the efficacy of lamivudine as mono therapy in preventing HBV transmission by graft with anti-HBc positive donors., Methodology: Between June 2004 and January 2009, 40 of 250 recipients received liver grafts from donors with anti-HBc positive in our centre. We analyzed 18 recipients with negative HBsAg who have at least follow-up of 6 months. All recipients and donors were negative for HBsAg and serum HBV DNA. Eleven of 18 patients had received liver grafts from living donor, while others from deceased donor. Mean age of these 18 patients was 49 (range, 25 to 66). Mean follow-up for patients receiving anti-HBc positive donor graft was 18.7 months (range, 6 to 48 months). Lamivudine mono-prophylaxis was given to all recipients since first post-transplant day. Recipient serological markers including HBsAg, HBV-DNA, anti-HBs, anti-HBc were routinely tested every 3 months or when liver function was abnormal., Results: One patient who discontinued lamivudine prophylaxis developed de novo HBV infection in 21 months after liver transplantation. Seventeen patients under lamivudine prophylaxis remained negative for serum HBsAg and HBV-DNA with a follow-up of 17 months., Conclusion: We concluded that lamivudine mono prophylaxis is effective in preventing de novo HBV infection in recipients receiving grafts from anti-HBc positive donors.

Background/aims: Until recently chronic hepatitis B virus (HBV) infection was considered a formal contraindication for liver transplantation, since recurrence of infection without prophylaxis occurs in 75%-90% of the patients. However, the introduction of hepatitis B immunoglobulin (HBIg) plus lamivudine has reduced the reinfection rates of the grafts less than 10%. The purpose of this study is to report our experience in a single transplant center and contribute to arguments about prophylaxis in areas where the prevalence of HBV is high., Methodology: From July 2004 to September 2008, 50 living donor liver recipients with HBV were included in our study. Preoperative HBV-DNA was positive in 25 patients and negative in the remaining 25. HBIg was first administered during the unhepatic phase of surgery as intravenous (i.v.) bolus and repeated in daily doses as intramusculary (IM) until seroconversion was achieved. Two different low dose HBIg protocols were used for HBV-DNA negative patients. First 15 patients transplanted until January 2006 received 1200 IU HBIg during the operation. From 2006 onwards, 10 patients who were transplanted received 2000 IU HBIg. HBV-DNA positive patients received 5000 IU HBIg during surgery. Until postoperative anti-HBs levels were above 100 mIU/mL and seroconversion was achieved; patients received maintenance doses of HBIg as detailed below: patients with negative preoperative HBV-DNA who received 1200 HBIg preoperative dose received 300 IU/day, those who received 2000 IU had 500 IU/day, those with DNA positivity had 1000 IU/day of maintenance HBIg. Lamivudine was given to all recipients begining on postoperative day 1., Results: Three of 15 patients who were HBV-DNA negative and who received 1200 IU HBIg intraoperatively developed HBV reinfections. The following 10 DNA negative patients who received 2000 IU of HBIg prophylaxis during the operation and those 25 patients who were DNA positive and received 5000 IU HBIg did not have any HBV reinfections., Conclusions: Higher doses of HBIg plus lamivudine therapy is a very effective prophylactic regimen for recipients with pre-operative HBV-DNA positivity in preventing a recurrent HBV infection. For preoperative HBV-DNA negative patients, low doses of HBIg plus lamivudine therapy is a feasable prophylactic option when ease of use, cost and low incidence of side effects are taken into consideration. However, it is still a controversial issue how much the required lowest dose should be and at the same time safe for prophylaxis.

Background/aims: Acute liver failure is a fatal condition unless an urgent liver transplantation is performed. In countries like Turkey, because of limited availability of cadaveric allografts, living donors could be used as an organ source for acute liver failure. We report our single center experience., Methodology: Six adult-to-adult right lobe living donor liver transplantations have been performed for those patients admitted with fulminant liver failure between September 2000 and April 2004., Results: The age of the patients ranged between 19 and 54 years. Etiology was fulminant hepatitis B in 4 patients, Wilson's disease in 1 patient, and unknown in 1 patient. Five of 6 patients survived and are currently alive and well with a mean 30 (2-46) months follow-up. None of the survivors had neurological sequela. One patient died because of sepsis 2 months after transplantation. There was no donor mortality., Conclusions: Adult-to-adult right lobe living donor liver transplantation seems to be an effective and safe option for patients with fulminant liver failure, especially in countries with a limited number of available cadaveric donors.

Background/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 mesoaval 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 polytetrafluoroethylene graft while four patients with established cirrhosis underwent 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 o f shuntsurgery, 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.

Background/aims: Esophageal replacement therapy has developed an increasing role in the management of severe esophageal strictures due to caustic ingestion. The aim of this study is to discuss methods of reconstruction and results of them in corrosive esophagitis at our Institute., Methodology: Thirty-three patients underwent 34 esophagocoloplasties for benign strictures of the esophagus over a 17-year period. The left colon was used in 8 patients, the right colon in 3 patients, and the right colon with the terminal ileum in 23 patients., Results: Three patients died in the first postoperative month, and there was an overall mortality rate of 9%. The most severe complication was graft necrosis (2 patients). The remainder of the patients survived without any deleterious complications., Conclusion: Esophageal replacement therapy using the right colon with the terminal ileum is superior to the modalities in terms of the continuity of peristalsis of the interposed bowel segment with an intact ileocecal valve, which decreases the hazard of regurgitation from the colon. It is also easier to perform an anastomosis between the ileum and the cervical esophagus from the point of view of surgical manipulation.