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Background/aim: Despite advancements in surgical methodologies and the extensive perioperative and postoperative care administered to recipients, the prevalence of complications requiring early relaparotomy following living donor liver transplantation (LDLT) remains persistent. This study sought to analyze the determinants influencing relaparotomy occurrences in the initial 30 days following LDLT. Additionally, it was aimed to evaluate the impact of early laparotomy on both graft and patient survival within this distinct patient cohort. Materials and methods: The study encompassed recipients (n = 535) aged 18 years and older who underwent primary LDLT at our institution from January 2019 to December 2021. Exclusion criteria involved patients necessitating early retransplantation. Early relaparotomy was specified as surgical intervention within the initial 30 days following LDLT. Results: The study enrolled a total of 535 patients, among whom 85 (15.9%) underwent early relaparotomy. The median age of the patients was 54 (range: 41-60) years, with a predominant male representation (66.2%). Univariate analysis comparing the laparotomy and nonrelaparotomy groups revealed statistically significant differences in the creatinine (p = 0.043) and sodium (p = 0.025) levels, graft side (p < 0.001), etiology (p = 0.005), and blood loss (p = 0.012). In the multivariate analysis, creatinine (p = 0.039; OR = 1.668; 95% CI = 1.027-2.709) and left lobe graft (p < 0.0001; OR = 3.611; 95% CI = 1.960-6.652) emerged as independent risk factors for relaparotomy. Conclusion: The primary causes of early relaparotomy following LDLT include postoperative bleeding, biliary leakage, and vascular complications. Preoperative elevation in creatinine and sodium levels, the presence of Budd-Chiari syndrome, utilization of a left lobe graft, and intraoperative blood loss are identified as risk factors associated with early relaparotomy after LDLT. Patients undergoing early relaparotomy exhibit inferior survival rates compared to those who do not. [ABSTRACT FROM AUTHOR]

Background: The current study's objective is to evaluate the molecular genetic mechanisms influencing the biological behavior of hepatocellular carcinoma (HCC) by analyzing the transcriptomic and epigenetic signatures of the tumors. Methods: Transcriptomic data were downloaded from the NCBI GEO database. We investigated the expression differences between the GSE46444 (48 cirrhotic tissues versus 88 HCC tissues) and GSE63898 (168 cirrhotic tissues versus 228 HCC tissues) data sets using GEO2R. Differentially expressed genes were evaluated using GO and KEGG metabolic pathway analysis websites. Whole genome bisulfite sequencing (WGBS) and Methylated DNA Immunoprecipitation Sequencing (MeDIP-Seq) data sets (26 HCC tissues versus 26 adjacent non-tumoral tissues) were also downloaded from the NCBI SRA database. These data sets were analyzed using Bismark and QSEA, respectively. The methylation differences between the groups were assessed using functional enrichment analysis. Results: In the GSE46444 data set, 80 genes were upregulated, and 315 genes were downregulated in the tumor tissue (HCC tissue) compared to the non-tumor cirrhotic tissue. In the GSE63898 data set, 1261 genes were upregulated, and 458 genes were downregulated in the cirrhotic tissue compared to the tumor tissues. WGBS revealed that 20 protein-coding loci were hypermethylated. while the hypomethylated regions were non-protein-coding. The methylated residues of the tumor tissue, non-tumorous cirrhotic tissue, and healthy tissue were comparable. MeDIP-Seq, conducted on tumoral and non-tumoral tissues, identified hypermethylated or hypomethylated areas as protein-coding regions. The functional enrichment analysis indicated that these genes were related to pathways including peroxisome, focal adhesion, mTOR, RAP1, Phospholipase D, Ras, and PI3K/AKT signal transduction. Conclusions: The investigation of transcriptomic and epigenetic mechanisms identified several genes significant in the biological behavior of HCC. These genes present potential targets for the development of targeted therapy. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the burden of care of individuals caring for pediatric patients who have undergone liver transplantation. Methods: The study was conducted at the Inonu University Liver Transplant Institute pediatric liver transplantation ward between May 2022 and February 2023. Data were the "Zarit Care Burden Scale," and the "Beck Depression Scale," and demographic characteristics of the patients and their caregivers. Results: The average age of the caregivers was 38.35±11.82 years; 72.7% were women, 69.7% were the child's mother, and 81.8% reported that caregiving impacted their daily lives. The effect of caregivers' burden of care on their daily lives was found to be statistically significant (p = 0.021). Among the pediatric recipients, 42.4% were aged 13-18 years, 60.6% were female, 45.5% had been post-transplant for more than 25 months, and 54.5% developed complications. The burden of care was severe at 38.87±10.21, and the depression was mild at 10.81±8.65. A moderate positive relationship was observed between burden of care and depression level (r: .602, p: 0.000). Simple linear regression analysis showed that caregivers' depression levels significantly affected their burden of care, (R²=0.363). Conclusion: The study concluded that caregivers of pediatric liver transplant patients experience a very high burden of care and mild depression. This high burden of care negatively impacts their daily lives and leaves them with less personal time. Providing social support to these families can improve caregivers' quality of life by reducing their depression levels. [ABSTRACT FROM AUTHOR]

Gallbladder cancers are relatively rare malignancies. While early-stage cases can achieve good outcomes with cholecystectomy, the 5-year survival rate in advanced stages is extremely low. Primary sclerosing cholangitis is a progressive liver disease characterized by inflammation of the bile ducts and is associated with an increased risk of gallbladder cancers. A 32-year-old male patient with primary sclerosing cholangitis was referred for liver transplantation. Imaging revealed a suspicious polypoid lesion, 2.5 cm in diameter, in the gallbladder. With a Meld score of 30, the patient was placed on the transplant waiting list. After waiting period of one month a deceased donor liver transplant was performed. The hepatectomy specimen revealed T2 gallbladder cancer. No recurrence or metastasis was detected during 1 year of follow-up. There is no consensus on the management of suspicious gallbladder lesions in patients with primary sclerosing cholangitis. Cholecystectomy in these patients carries a risk of decompensation in cirrhosis. Considering the decompensated liver cirrhosis and high Meld score, we preferred transplantation over cholecystectomy. Therefore, liver transplantation can be considered as primary treatment option instead of cholecystectomy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to present updated data on liver transplantation (LT) for hepatocellular carcinoma (HCC) of Inonu University, Liver Transplantation Institute, one of the largest volume liver transplant centers in the world. Methods: The data of 492 LT patients with HCC were analyzed retrospectively from the databank which is recorded prospectively and sequentially. Post-transplant recurrence rates and patient survival according to Milan, Malatya and Expanded Malatya criteria were calculated. Milan Expansion rate of the Malatya and Expanded Malatya criteria were also calculated. Results: Median follow-up period of the total cohort was 11.1±1.6 years (8.0-14.2, 95% CI) and the recurrence rate was 18.5 % (91/492). 5-year OS according to Milan, Malatya and Expanded Malatya criteria in our cohort were 80%, 79.3% and 78.4%, respectively. Post-transplant recurrence rates within these criteria were 3.2%, 3.8%, and 4.7%, respectively. Milan expansion rates were 25.2% for Malatya criteria and 35.2% for Expanded Malatya criteria. Conclusion: Milan criteria can be expanded reasonably by Expanded Malatya criteria. Low GGT and low AFP are good prognostic biomarkers that predict survival following LT in patients with HCC. Patients within Expanded Malatya Criteria had 78.4% 5-year OS, 4.7% post-transplant recurrence rate and Expanded Malatya criteria expanded the Milan criteria by 35.2%. Thus, 88 patients were beyond Milan criteria and were within Expanded Malatya criteria and so had an opportunity for LT. [ABSTRACT FROM AUTHOR]

Aim: This study presents the causes of death-censored graft loss among kidney transplant recipients. Materials and Methods: Medical records of the patients, who had undergone kidney transplantation at a tertiary center between November 2010 and December 2018, were retrospectively reviewed. Death-censored graft loss was described as an irreversible graft failure signified by return to long-term dialysis (or re-transplantation). Inclusion criteria were: patients who had undergone kidney transplantation, and subsequently lost their first graft, and a follow-up of more than one year after kidney transplantation. Results: Of 269 kidney transplant recipients, 33 recipients with a mean age of 33.54 ± 15.37 years (17 male and 16 female) were included in the study. The rate of death-censored graft loss was 12.26%. Of graft failures, 3.03% occurred in the hyperacute phase, 18.18% in the acute phase, and 78.78% in the chronic phase. Chronic allograft nephropathy was the leading cause of graft failure (48.48%). Other causes were medical problems (18.18), immunological problems (18.18%) and surgical complications (15.15%). Conclusion: Identification of the true causes of graft failure described under the heading chronic allograft nephropathy is noteworthy. Comprehensive biochemical, physiological, pathological, immunological, and genetic research should be implemented to remove the obstacles in kidney transplantations. [ABSTRACT FROM AUTHOR]