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    Histopathological diagnoses revealed by indication-based renal allograft biopsies: a retrospective analysis
    (2023) Eren, Eryiğit; Tokaç, Mehmet; Aydın, Alaaddin; Şahin, Taylan; Dinçkan, Ayhan; Uslu, Hikmet Bora; Alkan, Selman
    Objectives: Although there have been several advances in post-solid organ transplantation immunosuppression medications over the last two decades, the long-term survival of renal allografts did not significantly improve. Renal allograft biopsy is a helpful tool for determining the cause of graft dysfunction and adjusting patient management. Methods: Patients who received kidney transplantation and underwent allograft biopsy in Istinye University Hospital between January 2017 and January 2023 constituted the target population of this study. Demographic parameters, clinical data and biopsy indications, and histopathological assessment results of the patients were retrospectively analyzed. Results: Overall, 74 patients were included. The histopathology results included acute T-Cell mediated rejection (TCMR) (n = 15, 20%), tubular atrophy/chronic allograft nephropathy (IFTA) (n = 11, 15%), calcineurin inhibitor (CNI) toxicity (n = 2, 3%), chronic antibody-mediated rejection (ABMR) (n = 2, 3%), borderline pathology (n = 10, 13.5%), normal histology (n = 5, 6.5%), transplant glomerulopathy (TG) (n = 5, 6.5%), acute ABMR (n = 4, 5%), acute tubular necrosis (n = 7, 9%), polyomavirus nephropathy (n = 3, 4%) and non-specific changes (n = 10, 13.5%). The C4d was positive in 12% (n = 9) of the graft biopsies. In 73% (n = 54) of cases, the treatment strategy was changed based on biopsy results. Among all patients, 19 (25.6%) lost their grafts during follow-up. Conclusions: According to the histopathological analysis results, acute TCMR, IFTA, and borderline pathology were the most common causes of renal graft dysfunction. Renal allograft biopsy led to a remarkable change in treatment strategies in a significant number of cases.
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    Kidney transplantation in children weighing 15 kilograms or less
    (SPRINGER, 2021) Özkaya, Ozan; Evrengül, Havva; Eren, Eryiğit; Tokaç, Mehmet; Yaman, Ayhan; Şahin, Taylan; Sütçü, Murat; Dursun, İsmail; Dinçkan, Ayhan
    [No Abstract Available]
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    Paired exchange living donor liver transplantation: a single center experience from Turkiye
    (Elsevier inc., 2025) Dinçkan, Ayhan; Eren, Eryiğit; Ensaroğlu, Fatih; Şahin, Taylan; Parlak, Hakan; Koçyiğit, Ali; Alkara, Utku; Akyıldız, Murat; Tokaç, Mehmet
    Background. In countries with low rates of deceased donor solid organ transplantations, live- donor liver transplantation is the preferred definitive treatment for children and adults with end- stage liver disease. However, it is known that a remarkable number of potential living liver donors are rejected due to ABO incompatibility, suboptimal liver mass, or anatomical features. Paired exchange liver transplantation (PELT) practice emerged to overcome these obstacles. Herein, we present the results of our single-center experience with PELT and compare them with previously reported data. Methods. Patients who underwent PELT between January 2015 and December 2022 constituted the target population. The collected recipient data included demographic parameters, the model for end-stage liver disease score, graft-recipient weight ratio, indication for LT and paired exchange, body-mass index, duration of hospital stay, duration of intensive care unit stay, postoperative complications and inpatient mortality. Donor data, including demographic characteristics, body mass index, type of liver graft (right lobe or left lateral segment), graft weight (g), type of portal vein anatomy (Type 1, 2, or 3), type of biliary anatomy (Type 1, 2, 3a, 3b), duration of hospital stay, complications and mortality were retrieved. Results. Among 18 recipients, 14(78%) were male, and 4 (22%) were female. The mean recipient age was 50.7 [2-66], while the mean donor age was 29.3 [18-40]. The mean follow-up period was 31.9 [12-71] months. The 1-year patient and graft survivals were calculated as 83.3% and 88.9%. Conclusion. The PELT can be utterly feasible at transplant centers with remarkable LDLT experience.
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    Renal hilus ligation with single stapler in laparoscopic donor nephrectomy
    (Elsevier Science Inc, 2019) Tokaç, Mehmet; Eren, Eryiğit; Özçelik, Ümit; Şahin, Taylan; Dinçkan, Ayhan
    Background. Ligation of renal hilus is the most important stage of laparoscopic donor nephrectomy. Laparoscopic staplers are securely used for renal pedicle control. We present our donor nephrectomy cases in which we used 1 stapler for renal artery and vein ligation. Methods. Demographic data, number of arteries and veins, ligation types, operation time, and complication rates are recorded. Results. One hundred twenty laparoscopic donor nephrectomy cases who were operated between December 2017 and August 2018 in Istinye University Hospital and Istanbul Aydin University Hospital were retrospectively evaluated. All of the operations were done by 2 surgeons with a fully laparoscopic method. None of the cases were converted to open nephrectomy. There was 1 renal artery in 110 (91.7%) cases, 2 renal arteries in 9 (7.5%) cases, and 3 arteries in 1 (0.8%) case. Renal artery and vein were ligated with single stapler in 115 (95.8%) cases. Double stapler was used in 5 (4.2%) patients. There were no major complications for donors and no implantation problems for grafts. Discussion. Laparoscopic donor nephrectomy is the most used technique for living donor operations. Vascular stapler is securely used for renal artery and vein ligation with high costs. Two or, due to the number of vessels, sometimes 3 staplers are used in the standard technique. In our study, the operation was finished securely in 95.8% of the patients with single stapler use. Single stapler use for ligating renal hilus is safe in kidneys even with suitable multiple arteries and veins in laparoscopic donor nephrectomy.
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    Results of using the cystic duct for reconstruction of one of the multiple bile ducts in right lobe living donor liver transplantation
    (Elsevier Inc., 2021) Özçelik, Ümit; Eren, Eryiğit; Tokaç, Mehmet; Şahin, Taylan; Parlak, Hakan; Dinçkan, Ayhan
    Abstract Background: In right-lobe liver grafts, variations in the biliary tree anatomy can result in multiple bile duct orifices. We present our experience of 10 patients in which biliary reconstruction was performed with the cystic duct for 1 of the anastomoses with 2 separated ducts. Also, we investigated whether the bile duct anastomosis technique, number of bile duct anastomoses, and use of biliary stents affect the rate of biliary complications. Methods: We evaluated patients who underwent right-lobe living donor liver transplantation (LDLT) at İstinye University Hospital and İstanbul Aydın University Hospital between December 2017 and June 2020. The patients were divided into 4 groups: duct-to-duct (D-D), duct-to-sheath, double duct-to-duct, and duct-to-duct plus cystic duct-to-duct. Biliary complication rates were compared among these 4 groups, between single- and double-duct groups, and between stent (+) and stent (?) groups. Results: Ninety-three patients who underwent right-lobe LDLT (60 men, 33 women) with a mean age of 51 ± 13 years were included. Mean follow-up time was 18.5 ± 8.3 months. The overall biliary complication rate was 17.2% for all patients, 12.1% for the D-D (single-duct) group (33 patients), 16.1% for the duct-to-sheath group (31 patients), 26.3% for the double duct-to-duct group (19 patients), 20% for the duct-to-duct plus cystic duct-to-duct group (10 patients), 20% for the double-duct group (60 patients), 14.5% for the stent (+) group (69 patients), and 25% for the stent (?) group (24 patients). There were no significant differences among these groups in terms of biliary complication rates. Bile stricture occurred in only 1 cystic duct anastomosis (10%), and no bile leakage was observed. Conclusions: Multiple D-D biliary reconstruction using the cystic duct with external drainage tubes is feasible and safe for LDLT.
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    The interaction of dexamethasone with sugammadex and rocuronium during general anesthesia in rhinoplasty surgeries
    (MediHealth Academy Yayıncılık, 30 Temmuz 2023) Şahin, Taylan; Eren, Eryigit
    Aims: Sugammadex is a cyclodextrin specifically designed to reverse the action of rocuronium through encapsulation. Theoretically, it is possible that sugammadex can encapsulate cortisone. There have been conflicting results regarding clinical dexamethasone-sugammadex interactions in patients under general anesthesia. The primary outcome of the present study is to investigate any possible alteration in the efficacy of sugammadex as a reversal of rocuronium due to dexamethasone injection in rhinoplasty surgery. The secondary outcome is evaluation of clinical observation sugammadex in these groups of patients. Methods: Adult patients with the American Society of Anesthesiology (ASA) II risk class undergoing rhinoplasty were included. All patients received standard general anesthesia with neuromuscular blockade using rocuronium. Patients were allocated to either the dexamethasone group or control group. The anesthesiologist measured the time interval between sugammadex injection and the recording of the 90% train of four. Additionally, the duration required for extubation after sugammadex injection was recorded. Finally, the signs of residual respiratory insufficiency and muscle weakness were checked in the post-anesthesia care unit until the 2nd-hour post-surgery. Results: Sixty-one patients were enrolled in the study. The dexamethasone group included 30, and the control group included 31 patients. The comparison of demographic and surgical characteristics of these two groups showed no statistical difference. The duration required for extubation was higher in dexmethasone group compared to control group (p=0.001). The total rocuronium administration dose was higher in dexmethasone group (p=0.01). The time required for the recovery of the head, upper, and lower extremity lifting was longer in the dexamethasone group (p=0.001, 0.003, and 0.047, respectively). Conclusion: The present study demonstrated an interaction between sugammadex and dexamethasone, which affected the reversal of neuromuscular blockade during rhinoplasty surgeries.