Search

Objective: Hydatid cyst disease is a widespread zoonotic disease infecting humans as an intermediate host. Since the first description of this pathology, many modalities have been introduced into modern treatment protocols. Minimally invasive surgical treatment is well-described and widely used, but has many points where rationalization and modification can be applied. In this case series, we describe small differences in surgical technique and the corresponding treatment results. Materials and Methods: Out of 44 patients, 16 were included in this study. Patients were retrospectively evaluated in two groups in accordance with the preferred cyst aspiration technique, i.e. via a standard laparoscopic aspirator or a large diameter venous catheter (the control and study groups, respectively). Demographic, clinical and surgical data like duration of surgery, hospital stay and complication rates were evaluated in both groups. Results: Equal numbers of males and females participated, with a median age of 40 years. Most patients had a type III hydatid cyst (n=11, 68.75%). Surgery duration and hospital stay were significantly shorter in the study group, without a significant difference in terms of complication rates. Conclusion: Laparoscopic procedures quickly became plausible for selected hydatid cysts located in liver. Success of such procedures shows to be depending on the success and duration of the laparoscopic intervention. The latter, according to our calculations, seems to be inversely proportional to the diameter of the aspirator tip and its piping.

Objective: The number of cases with graft failure, which is the most frequent complication of renal transplantation, is increasing due to the increasing number of kidney transplant surgeries. Graft nephrectomy is the last treatment option in renal transplant recipients with graft failure due to the high complication risk it entails. The aim of the present study is to evaluate the clinical characteristics, etiologies for nephrectomy, pathological analysis of explanted graft, and surgical complications in recipients with graft nephrectomy. Material and Methods: We retrospectively analyzed 38 recipients who had undergone graft nephrectomy for different reasons in the center since 2010. The recipients were divided into two groups, according to the time of surgery, with characteristics analyzed retrospectively. The early graft nephrectomy group consisted of patients who had undergone graft nephrectomy in the first 6 months after transplant surgery; the late graft nephrectomy group consisted of patients who had undergone graft nephrectomy more than 6 months after surgery. Results: Indications for early graft nephrectomy were mostly vascular, surgical problems, and infection, whereas indications for late graft nephrectomy were rejection and infection. There was a statistically significant difference between the two groups with respect to rejection. The rate of graft survival, post-operative vascular and surgical complications were higher in the early group (p=0.011, and p=0.005, respectively). Panel Reactive Antibody (PRA) positivity was evaluated, and no difference was observed between the two groups in terms of immunological risk. Conclusions: As graft nephrectomy has high morbidity and mortality rates, it should only be applied in selected cases, where necessary, in order to prevent potentially serious complications. Keywords: Graft, nephrectomy, kidney, transplantation, renal, complications

BACKGROUND In this study, we present the results of two patients with vascular graft migration to the duodenum after liver transplantation. METHODS The results of two patients who underwent living donor liver transplantation and vascular graft to the duodenum were evaluated. RESULTS In our center, 201 liver transplants were performed, including 154 a right lobe living donor liver transplant. A synthetic graft was used to reconstruct segment 5 and 8 hepatic veins in 78 of the 154 LDLT. During the mean follow-up 19.6 ± 12.1 months (1-44 months), graft migrated to the duodenum in two patients who were present in this study. Contrary to the literature, it was followed nonoperatively. No problem was observed in the follow-up process. CONCLUSION In patients with vascular graft migration to the duodenum after living liver transplantation, non-operative follow-up can be performed in appropriate patients.

Introduction Despite recent advances, lymphoceles are the most frequent complications following renal transplantation (RT), with an incidence of 0.6% to 51%. In this study, we present risk factors, treatments, and outcomes for lymphoceles after RT at our center. Material and Methods Since January 2018, 461 RTs were performed at our center. Nine recipients were excluded. The remaining 452 RTs were analyzed retrospectively. Recipients were divided into 2 groups: a lymphocele group (n = 29) and a nonlymphocele group (n = 423). Lymphoceles were diagnosed by ultrasound. Statistical analyses were made using the SPSS 15 software program. Results Twenty-nine (6.4%) of the 452 recipients developed lymphoceles. Seven of these 29 (24.1%) recipients were asymptomatic. The most common symptom was hydronephrosis (34.4%). Percutaneous drainage was performed in 21 recipients; sclerotherapy with percutaneous drainage was used in the remaining 8. In 5 (17.2%) recipients, there was a recurrence of lymphoceles. There were significant differences with respect to age (50-65 years; P = .016), use of a drainage catheter (P = .044), and polycystic kidney diseases (P = .049). Conclusion Lymphoceles can be treated successfully using the percutaneous drainage technique alone or in combination with povidone iodine. Drainage use, polycystic kidney disease, and age (50-65 years) were established as risk factors for lymphocele development.

Background Urological complications after renal transplantation (RT), including urine leaks, remain the most common type of surgical complications in the early post-transplant period. In this study we evaluated 324 consecutive RTs recipients in whom Haberal’s corner-saving anastomosis technique was used for ureteroneocystostomy. Material and Methods Since January 2018, 461 RTs were performed at our center. Haberal’s corner-saving anastomosis technique was used in 324 of these 461 RTs and the effectiveness of the technique was analyzed retrospectively. There were 115 female patients and 209 male patients, with a mean age of 42.1 ± 13.9 years. The most common etiology resulting in RT was hypertension among the recipients. Results We observed 8 (2.4%) ureteral complications in 7 recipients as follows: ureteral stenosis in 2 recipients (0.6%), anastomotic leaks in 1 (0.3%), concomitant leak-stenosis in 1 (0.3%), and vesicoureteral reflux in 3 (0.9%). Six complications were treated with interventional radiological techniques and 2 were treated surgically. There was no graft and patient loss in the event of urological complications. Conclusion Because of the low complication rate, we believe that Haberal’s corner-saving ureteral anastomosis technique is a safe method for performing a ureteroneocystostomy.

Amaç Böbrek alıcılarında sitomegalovirüs (CMV), poliyoma B-K virüs (BKV) ve kalsinörün inhibitörü (KNİ) toksisitesi ve malignite geliştiğinde immünosupresyonu azaltmak gerekir. İmmünosupresyon azaltma protokolleri genellikle standart doz KNİ’nin azaltılması ve bir mTORi eklenmesini içerir. Bu çalışmada standart bir immünsupresyon protokolünden mTORi içeren düşük immünosupresyon protokolüne geçtikten sonra ki greft fonksiyonlarını incelemeyi amaçladık. Metod Bu tek-merkezli, retrospektif ve gözlemsel çalışma 2014-2016 yılları arasında yapılmış böbrek nakillerinin sonuçlarını içermektedir. Toplan 322 alıcı incelendi ve bunların 231’i çalışmaya alındı. En az 12 ay mTORi alanlar mTORi kolunda değerlendirildi. CMV ve BKV test sonuçları ve hiç greft biyopsisi olmayan alıcılar çalışma dışı bırakıldı. Geriye kalan alıcılar mTORi içermeyen gurubu oluşturdu. mTORi öncesi ve mTORi sonrası birinci ve üçüncü yıl greft sağkalımları ve fonksiyonları karşılaştırıldı. Sonuçlar Toplam 231 alıcı ortalama 5 yıl takip edildi. mTORi kolunda CMV ve BKV pozitifliği daha sıktı (p=0,001). Ayrıca, mTORi kolunda akut rejeksiyon sıklığı daha fazlaydı; p=0,001. Tahmini glomerüler filtrasyon hızı (tGFH) mTORi sonrası birinci ve üçüncü yılda daha azdı (p=0,001). Ancak, mTORi sonrası birinci ve üçüncü yıl greft sağ kalım oranları mTORi kullanmayanlar ile benzerdi (p=0,52 ve p=0,72, sırasıyla). Sonuç Böbrek alıcılarında mTORi, genellikle immünsupresyon dozunun azaltılmak zorunda olduğu durumlarda (CMV ve BKV viremisi varlığı, KNİ ilişkili nefrotoksisite gibi) düşük doz KNİ’ler ile birlikte kullanılır. Tüm dezavantajlara rağmen mTORi standart protokollere benzer greft sağkalımı sağlayabilir. Ancak, mTORi kullanımı daha fazla akut rejeksiyon ile ilişkilidir ve tGFH’da azalmayı engelleyemeyebilir.

Background: Acute and chronic calcineurin inhibitors (CNI) nephrotoxicity is a common concern in kidney transplant (KT) recipients. It is unclear whether diltiazem use can reduce CNI induced acute and chronic nephrotoxicity in (KT) recipients. In this study, we investigated the impact of diltiazem on 1 –year allograft survival and function.Materials and Methods: This single-center retrospective study included 312 kidney transplant recipients and donors. Diltiazem receiving and diltiazem-free recipients were compared for 1-year allograft survival and functions. Available allograft biopsies were investigated for the evidence pieces of CNI induced nephrotoxicity. Factors may have a potential impact on allograft functions were evaluated (cytomegalovirus and polyoma BK viremia positivity, acute rejection episodes, donors and recipients ages and body mass indexes). A statistical package program was used for data analysis. P

OBJECTIVE To present details of 2 living-related donors and our fusion division technique, where half of the horseshoe kidney (HSK) was retrieved and transplanted. METHODS Since January 2018, 461 renal transplantations have been performed at our center. In 2 of these 461 renal transplantations, which were analyzed retrospectively, a living donor, who had HSK, was used. Both donors had vascular anomalies, and the first donor also had urinary anomalies. RESULTS The transplanted kidney was placed in the recipient's contralateral iliac fossa. After perfusing for both grafts, no urine leakage was detected from the transected surfaces, and the graft began producing urine. There were no complications after surgery in the donor and recipients. The recipients were discharged on the 7th and 5th day after surgery with a creatinine level of 0.8 mg/dL and 0.9 mg/dL, respectively. The follow-up period was 24 months for the first recipient, and 12 months for the second. At the time of writing, both recipients and donors were alive with normal renal function. CONCLUSION In addition to expanding the donor pool for end-stage renal disease patients, a donor with HSK can be accepted for transplantation if no other donor option presents. Preoperative evaluation should be undertaken carefully for anatomy and HSK complications.

Objective: Today, it is recommended that the laparoscopic cholecystectomy (LC) is made with standard three ports. In this study, we aimed to determine the preoperative and intraoperative factors th...

OBJECTIVE In this study, we aimed to investigate the rates and causes of incisional hernia that developed in the postoperative follow-up of patients who underwent liver transplantation. MATERIAL AND METHOD The results of patients who underwent LT by using three different incisions at the Istanbul Yeni Yuzyil University Gaziosmanpasa Hospital organ transplant center between January 2015 and December 2019 were retrospectively analyzed. Patients were divided into Chevron (group-1), reverse T (group-2), and J incisions (group-3) and hernia development rates were examined. RESULTS There was no significant difference in terms of incisional hernia in groups 1 and 2 according to the incision type (p = .723). Incisional hernia rate was significantly lower in the J incision group (p

Background The existence of renal cell cancer (RCC) in a donated kidney may cause some confusion for clinicians. We aim to present our clinical experiences with 2 recipients who received an RCC-containing kidney from their living related donors. Methods Two male patients received a kidney containing resectable size RCC from their living related donors. The recipients were discharged with well-functioning kidneys and currently are being monitored on standard follow-up protocols, and there is no evidence of RCC in their grafts. Results The kidneys with resectable sizes of renal cell carcinoma were transplanted to the recipients after nephron-sparing surgery, with no sign of recurrent RCC in the 12-month follow-up period. Conclusions In the era of transplantation, the shortage of organ sources is the major barrier for the provision of organs to recipients. To enhance the graft donation pool, kidneys with resectable size RCC might be used in providing grafts to patients with end-stage kidney disease.

In this study, we aimed to investigate the surgical technique and biochemical parameters that affect biliary complications in liver transplants from live and cadaver in our center.In this study, 141 patients who underwent liver transplants at Istanbul Yeni Yüzyıl Universty Gaziosmanpaşa Hospital organ transplant center between January 2018 and January 2020 were included in the study. The patients were monitored for 12-24 months. The patients included in the present study were examined retrospectively. Factors that may cause biliary tract complications and treatment modalities for complications were examined.In this study, liver transplantation from 124 living donors and 17 cadavers was performed. Twenty-three patients were under the age of 18. Only seven of 39 biliary complications were operated on. The rate of finding the right graft in patients with biliary complications was higher (p0.05). There was no statistically significant difference between the groups concerning left, left lateral, and whole graft presence (p=0.561, p=0.172, and p=0.057, respectively). Double biliary anastomosis was to be higher in the biliary complication group, but there was no statistically significant difference (p=0.086).Biliary complications are common, especially in liver transplants taken from the right lobe. Significant patient survival can be achieved with an early diagnosis and an appropriate treatment approach.

Background The reconstruction of the hepatic artery (HA) is the most complex step in living-donor liver transplantation (LDLT) owing to the artery's smaller diameter and the increased risk for HA-related complications. In this study, we presented our HA anastomosis technique for LDLT, which employed interrupted sutures using magnifying loupes. Materials and Methods Since January 2019, we retrospectively analyzed 179 LDLTs that were performed at our center. HA anastomosis was performed under a loupes magnifier (2.5 or 4.5 × ) by the same surgeon. Results There were 65 female and 114 male recipients with a mean age of 41.6 ± 21.6 years. Of the recipients, 34 were children. HA thrombosis (HAT) was seen in 3 recipients (1.67%; 1 child and 2 adults) in this series. HAT occurred on the third, sixth, and seventh days after LDLT. HAT was successfully treated with interventional radiologic technique. All recipients are still alive with a patent HA. Conclusion The use of magnifying surgical loupes and interrupted sutures to perform HA reconstruction is safe, feasible, and yields a low rate of HAT. Also, endovascular treatment can be used safely for treatment of HAT within the first week after LDLT with a high success rate and is not associated with major complications.

Presentation of COVID-19 in renal transplant recipients is similar to that shown in the nonimmunocompromised population; almost all recipients who have this disease present with symptoms of the respiratory system. Acute kidney injury has been found prevalent in transplant recipients with COVID-19. In those with severe COVID-19 disease who transfer to an intensive care unit prevalence of acute kidney injury is more than 50%. The pathophysiological mechanisms of kidney involvement and the type of involvement are unclear. Here, we present a 71-year-old kidney transplant recipient who was admitted to our hospital with pulmonary and renal involvement. A kidney allograft biopsy demonstrated diffuse intrarenal hemorrhage, capillary congestion, and severe acute tubular injury. COVID-19 RNA was detected by real-time polymerase chain reaction from lysed allograft tissues, but no findings of acute or chronic cellular or antibody-mediated rejection were detected. This case indicates that COVID-19 may involve the allograft by causing hemorrhage within the renal parenchymal via direct or indirect pathways.

Objective: The mortality was seen in the early period after kidney transplantation is one of the most undesirable consequences of kidney transplant treatment. This study was aimed to evaluate the factors affecting the 1st-year mortality in patients who underwent living donor kidney transplantation (LDKT) in our center. Material and Methods: Adult patients who underwent LDKT developed mortality within the 1st-year in our center between 2008 and 2020. Mortality group and the control group are compared according to donor and recipient characteristics. The risk factors that have an adjusted effect on 1st-year mortality after kidney transplantation were evaluated by cox regression survival analysis. Results: Total mortality incidence was 8.35% and the 1st-year mortality incidence was 1.67%. Median dialysis duration (13 months vs. 3 months) was longer in the mortality-group, p=0.022. Cardiovascular disease (CVD) was more common in the mortality-group (50% vs. 31.1%), p=0.037. Median HLA mismatch numbers was higher in the mortality-group (4 vs. 3), p=0.027. According to Model 1, in terms of 1st- year mortality, each 1 year increment in recipient's age increases the mortality by 1,034 times, and dialysis treatment increases the mortality 2.5 times. According to Model 2, in terms of 1st-year mortality, each 1 year increment in recipient's age increase the mortality by 1,039 times, dialysis treatment increases the mortality 2.8 times and each 1 mismatch increase in HLA mismatch numbers increases the mortality by 1.3 times. Receiver operating characteristic analysis showed that the moderate predictive power for recipient age was AUC 0.734 (95% CI 0.623-0.844, p

Background Renal grafts with multiple renal arteries (MRA) are a compelling issue in surgery of kidney transplantation. Transplantations using "grafts with MRA" have conflicting results. Here, we present our experiences on the issue. Method This is a single-center, observational, descriptive study. One hundred ninety-nine patients with end-stage renal disease received a kidney graft from their living- or deceased-related donors in our center between July 2016 and May 2017. We included all recipients to the study. Patients were divided into the following 2 groups: Group 1, recipients who received a renal graft with single renal artery, and Group 2, recipients who received a renal graft with MRA. Groups were compared for estimated glomerular filtration rates (months 1-3 and 12), delayed graft function, and graft survival. Data were analyzed by using SPSS for Windows version 15. Results One hundred ninety-five recipients with all documented data were analyzed. Graft function was compared between 2 groups in months 1, 3, and 12 and found both to have similar outcomes. MRA has been indicated to have no impact on delayed graft function, higher risk for vascular injury, and biopsy-proven acute tubular necrosis. Also, anastomosis sides have been found to have no importance on graft function in recipients with MRA (P > .05 between all sides). Conclusion Our study indicates grafts with MRA and grafts with a single renal artery have comparable results in the first post-transplant year.

Enlargement of the spleen is commonly observed in animal models of cancer. Here, in a breast cancer model, it was aimed to determine the effect of splenectomy on circulating and tumor-infiltrating myeloid-derived suppressor cells (MDSCs), tumor angiogenesis, and metastasis.Mice were inoculated with 4T1 breast cancer cells and underwent splenectomy or sham laparotomy. Tumor growth and survival of animals were followed. Macroscopic and histopathological analyses were performed to determine splenomegaly and metastasis. Immunophenotyping of myeloid cells was performed with flow cytometric analysis of CD11b, Gr-1, F4/80, CD206, CD11c, and F4/80 markers. Suppressive function of MDSCs on T cell proliferation was studied in cocultures. Tumor angiogenesis and granulocytic myeloid cell infiltration in the metastatic foci were studied by CD31 and Ly6G immunohistochemistry, respectively.The mice bearing breast tumors underwent total splenectomy at an early time point of tumorigenesis when only low levels of MDSCs had accumulated in the spleen. Circulating and tumor-infiltrating MDSCs, and tumor-associated macrophages (TAMs) were increased following splenectomy. Nevertheless, splenectomy could only lead to a temporary deceleration in tumor growth but favored lung metastasis and angiogenesis in the long run.Our data demonstrated a link among splenectomy-induced leukocytosis, accumulation of circulating and tumor-infiltrating MDSC, and enhanced angiogenesis and metastasis. Therefore, as a part of oncological surgery, favorable and unfavorable facets of the splenectomy must be considered to improve therapeutic efficacy.