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Öğe A case report with literature review: long-term follow-up of kidney autotransplantation in fibromuscular dysplasia(Springer Science and Business Media Deutschland GmbH, 2024) Demirelli, Bülent; Barutçu Ataş, Dilek; Dinçkan, Ayhan; Baltacıoğlu, FeyyazFibromuscular dysplasia is a rare, idiopathic, systemic, non-inflammatory, and non-atherosclerotic vascular disease that primarily affects young women. It often presents as renal artery stenosis. Fibromuscular dysplasia can induce tissue damage in the post-stenotic kidney. Treatment options include antihypertensive therapy, surgical revascularization, and transluminal angioplasty with stent implantation. However, kidney autotransplantation is an alternative when these treatments are not feasible. This study presents a case report of a 22-year-old woman with fibromuscular dysplasia, highlighting the long-term success of kidney autotransplantation and reviewing the related literature. A multidisciplinary approach was employed in the treatment of this patient presenting with intermittent headaches, hypertension, and acute kidney disease, and who was diagnosed with fibromuscular dysplasia. She underwent left aorta-renal bypass and right autotransplantation. Following the procedure, her serum creatinine level decreased from 2.74 to 1.1 mg/dL, with an eight-year follow-up confirming the favorable outcome. Renal artery stenosis is a significant contributor to secondary hypertension, with fibromuscular dysplasia being a rare cause. While medical and interventional treatments are usually effective, complex cases may necessitate alternative approaches. Kidney autotransplantation, albeit uncommon, is an effective option for patients who are unresponsive to conventional therapies. This case demonstrates the successful management of fibromuscular dysplasia-associated renovascular hypertension via kidney autotransplantation, resulting in controlled blood pressure and preserved kidney function. In conclusion, kidney autotransplantation represents a valuable therapeutic option for severe renal artery stenosis caused by fibromuscular dysplasia, particularly when percutaneous procedures are impractical. Graphical abstract: (Figure presented.). © The Author(s) under exclusive licence to Italian Society of Nephrology 2024.Öğe Assessment of sleep pattern and quality before and after liver transplantation using different methods(AVES, 2020) Gençdal, Genco; Türker, Gamze; Gençdal, Işıl Yazıcı; Ekinci, Burçak; Acar, Sencan; Dinçkan, Ayhan; Akyıldız, MuratBackground/Aims: Sleep disorders (SDs) are frequently seen in patients with liver cirrhosis. Polysomnography (PSG), actigraphy, and electroencephalogram (EEG) are the common objective methods to diagnose SDs. The most commonly used subjective methods are the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS). We aimed to evaluate the effect of liver transplantation (LTx) on SDs using a combination of objective (PSG and EEG) and subjective (PSQI and ESS) methods. Materials and Methods: A total of 18 patients with cirrhosis on an LTx waiting list were included in this study. Patient clinical status and biochemical parameters were evaluated. All patients completed the validated Turkish forms of the PSQI and ESS before and 9 months after LTx. All patients underwent EEG and PSG before and 9 months after LTx. Results: In total, 18 patients with liver cirrhosis (men: 12; 66.7%, mean age: 53.22 +/- 10.43 years) were included in this study. Pretransplant mean PSQI and ESS scores were 8.4 +/- 3.11 and 7.28 +/- 3.89, respectively; 9-month posttransplant mean PSQI and ESS scores were 4.5 +/- 2.8 and 4.72 +/- 2.91 (p<0.01), respectively. Before transplantation, metabolic encephalopathy was detected in 6 patients by EEG, whereas metabolic encephalopathy was detected in only 1 patient posttransplant. Posttransplantation PSG sleep duration (all stages) increased relative to pretransplant PSG values. Sleep latency and rapid eye movement latency were found to be reduced compared to the pretransplant values. Conclusion: This pilot study compared SDs in patients with pre- and post-LTx by combining the subjective and objective methods. Significant SD improvements were found at the 9th month.Öğe A comparison of actual graft weight and estimated graft volume calculated with new software used for anatomical and volumetric analysis of the liver with computed tomography in living liver donors(DergiPark, 2021) Özçelik, Ümit; Eryiğit, Eren; Tutpınar, Yıldıray; Ulaş Urut, Devrim; Tokaç, Mehmet; Dinçkan, AyhanObjective: In the living donor liver transplantation (LDLT) context, accurate estimation of the graft weight to recipient weight ratio (GRWR) and future donor liver remnant volume by pre-operative volumetric analysis is very important. We aimed to compare the estimated graft volume (EGV) calculated with the LiverVision® soft-ware with the actual graft weight (AGW) measured in the back-ta-ble in this study. Material and Method: Patients who underwent right lobe LDLT and liver donors between 01.01.2018-30.05.2020 were retrospec-tively evaluated. Demographic data, body mass index, EGV, AGW and GRWR were recorded. Linear regression analysis, Pearson cor-relation coefficient and Bland-Altman plots were utilized for evalu-ation of the relationships between continuous variables. Results: A total of 108 liver donors were included in the study. The mean age of the donors was 32.6±8.8 years and mean EGV was 902.5±147.1 mL for all donors. The mean AGW was 890.6±145.9 g for all donors. A significant correlation was found between EGV and AGW for all donors (r=0.856, p<0.001). The mean difference between EGV and AGW was 11.9±78.5 for all donors. 105 of the 108ith CT with the newly developed Turkish semi-automatic LiverVision® software. (97.2%) measurements were within the 95% ranges of agreement be-tween EGV and AGW according to the Bland-Altman plot. According to the regression model created to calculate the AGW, the formula AGW (g)=0.85xEGV (mL)+124.5 was obtained (r2=0.732, p<0.001). Conclusion: The liver volumes of the donors were successfully estimat-ed with computed tomography (CT) with the newly developed Turkish semi-automatic LiverVision® software(AGW) measured in the back-table in this studyÖğe Correlation Between the mayo adhesive probability score and the operative time in laparoscopic donor nephrectomy(Elsevier Inc., 2021) Özçelik, Ümit; Eren, Eryiğit; Urut, Devrim Ulaş; Talih, Tutkun; Tokaç, Mehmet; Dinçkan, AyhanBackground: Adherent perinephric fat (APF) is a known risk factor of surgical difficulty during laparoscopic donor nephrectomy (LDN). The Mayo Adhesive Probability (MAP) score predicts APF accurately. The aim of this study is to identify the association between MAP score and operative time in LDN. Methods: We retrospectively evaluated 154 kidney donors who underwent surgery from December 2017 to December 2019 at İstanbul Aydın University Hospital and İstinye University Hospital. All of the operations were done by 3 senior surgeons by a fully laparoscopic method. The MAP score was derived from computed tomography scans by 1 blinded reader. Demographic data, body mass index (BMI), MAP score, side selection, estimated glomerular filtration rate (eGFR), number of arteries and veins, operative time, hospital stay, and complications are recorded. Single and multiple variable analyses were used to evaluate the correlation between operative time and MAP score, BMI, side selection, and number of vascular structures. Results: A total of 154 patients (79 men, 75 women) with a mean age of 44.4 ± 12.72 were included in this study. None of the cases were converted to open nephrectomy. There were no major complications. Mean BMI was 27.59 ± 4.32 kg/m2, mean MAP score was 0.69 ± 1.15, and mean operative time was 40.25 ± 9.81 minutes. Although mean BMI was higher in women (28.19 ± 4.52 vs 27.03 ± 4.07; P < .05), mean MAP score was lower than in men (0.35 ± 0.86 vs 1.03 ± 1.29; P < .001). Older age, higher BMI, higher MAP score, and presence of multiple renal arteries were associated with longer operative time of LDN. The MAP score was associated with older age, male sex and higher BMI. Conclusions: This study showed that different risk factors can affect operative time in LDN. The MAP score was significantly associated with longer operative time, especially in men, so it can be useful for predicting surgical difficulty in kidney donors.Öğe Current induction therapy strategies and anti-t lymphocyte globulin usage in kidney transplantation: consensus-based recommendations by a Turkish expert panel(Aves, 2024) Çakır, Ülkem; Dinçkan, Ayhan; Karadoğan, Nayim; Keven, Kenan; Koçak, Hüseyin; Koç, Serkan Kubilay; Sezer, Siren; Töz, Hüseyin; Usalan, Celalettin; Yıldız, AlaattinThis advisory committee convened to review national and global kidney transplantation dynamics and provide recom-mendations on the use of anti-T lymphocyte globulin (ATLG) for prevention and treatment of rejection after allogeneic kidney transplantation. A critical evaluation of 6 relevant articles released up to October 2022 was performed to reveal their importance in clinical practice. Additionally, 27 key questions on the indication, dosage of ATLG, and risk stratification were used for the Delphi technique with 8 members of the Turkish Society of Nephrology including 5 kidney transplanta-tion (KTx) subcommittee members and a surgeon experienced in solid organ transplantation. The committee declared that T & uuml;rkiye had great potential in KTx; however, increase in transplantation would be possible in the case of raise in the deceased donor transplantation. As a consensus, ATLG was strongly recommended for induction and rejection treatment. Also, committee members recommended the safe dosage range in steroid resistant acute rejection as 2.5-3 mg/kg daily for 5-7 days, and the median of preferred dosage in induction sounded as 2-2.5 mg/kg daily for 3 days in intermediate risk state. Additionally, post-transplant infection and malignancy cases due to immunosuppression were much rarely encoun-tered than they were in the pastÖğe Does recipient weight and surgical approach really matter in pediatric renal transplantation?(Medihealth academy yayıncılık, 27 Mart 2023) Eren, Eryiğit; Dinçkan, AyhanAim: To compare the outcomes between low-weight (<15 kg) and normal-weight (>15 kg) children who underwent renal transplantation (RT) and investigate the impact of the surgical approach (intraperitoneal or extraperitoneal RT). Material and Method: This study was designed as an observational single-centre study and was conducted in Istinye University Hospital, Istanbul, Turkey, between January 2018 and June 2021. Data including age, gender, weight, surgical approach (intraperitoneal/extraperitoneal), complications, length of hospital stay, graft and patient survival were collected. Low-weight (LW) and normal-weight (NW) patients were compared. A p value less than 0.05 was considered statistically significant. Results: Overall, 107 (33 LW and 74 NW) patients aged between 1 and 17 were included. The LW group had a significantly lower age and a significantly longer duration of intensive care unit (ICU), and inpatient floor stays than the NW group (p<0.001). Intraperitoneal RT (IRT) was significantly more common in the LW group (57.6% vs 42.4%), while ERT was more frequent in the NW group (87.8% vs 12.2%) (p<0.001). Both early complication and mortality rates were significantly higher in the LW group than in the NW group (p<0.001 and p<0.031). A comparison between the LW and NW patients who underwent ERT revealed that the mean patient age was significantly lower, while the duration of ICU stay was higher in the former than in the latter group (p<0.001 and p<0.004). However, the length of inpatient floor stay, early-term complication, and mortality rates were similar (p>0.05). Conclusion: The extraperitoneal approach should be encouraged in children weighing less than 15 kg.Öğe 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, SelmanObjectives: 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.Öğe 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]Öğe Liver transplantation in hepatic myelopathy(Turkish Association for the Study of the Liver, 2022) Acar, Sencan; Dinçkan, Ayhan; Akyıldız, MuratHepatic myelopathy (HMy) is a rare neurological complication of liver cirrhosis that involves spastic paraplegia caused by lateral cord demyelination especially due to the accumulation of some metabolites such as ammonia and manganese. We report a young adult woman presenting with spasticity and paraparesis in extremities after intrahepatic portosystemic shunting (TIPS) application and underwent deceased liver transplantation (LT). A 39-year-old woman underwent deceased LT because of cryptogenic liver cirrhosis. She underwent a TIPS procedure 5 years ago. After that, hepatic encephalopathy and spasticity appeared. She was on the waiting list for 3 years. Neurological findings after LT significantly decreased, but did not return to normal. After the emergence of neurological findings, the earlier LT can provide improvement in neurological findings.Öğe 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, MehmetBackground. 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.Öğe Renal hilus ligation with single stapler in laparoscopic donor nephrectomy(Elsevier Science Inc, 2019) Tokaç, Mehmet; Eren, Eryiğit; Özçelik, Ümit; Şahin, Taylan; Dinçkan, AyhanBackground. 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.Öğe 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, AyhanAbstract 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.Öğe A single-center kidney transplantation experience in children with low weight: is low weight a contraindication?(Verduci Editore s.r.l, 2022) Eren, Eryiğit; Tokaç, Mehmet; Özkaya, Ozan; Savaş, Osman Anıl; Sümer, Aziz; Dinçkan, AyhanOBJECTIVE: Kidney transplantation (KT) might be difficult for underweight kids (under 15 kg). Our goal was to convey information on KT in underweight children. PATIENTS AND METHODS: The study’s target population consisted of children (age 18) weighing 15 kg or fewer who received KT at our facility between January 2018 and June 2021. A retrospective analysis was performed on demographic and clinical data, including age, gender, primary disease, pretransplant dialysis status, recipient weight, recipient body mass index (BMI), surgical approach type (intraperitoneal/extraperitoneal), complications, graft status (functioning/failed), patient survival, and immunological data. RESULTS: There were 94 pediatric KTs completed. Thirty-three patients were included when the selection criteria were applied. The mean recipient weight was 11.45 [6.7-15] kg, and the average patient age was 3.36 [1-7]. Three (9.9%) patients had kidney transplants from dead adult donors, whereas thirty (90.1%) patients underwent live donor kidney transplantation (LDKT). While the intraperitoneal (IPA) technique was used in 19 cases, the extraperitoneal (KT) strategy was used on 14 patients (EPA). The donor BMI was 28.24 [19.6-42] kg/m2, and the mean donor weight was 78.13 [55-109] kg. Bridectomy was necessary because five individuals experienced ileus. IPA was performed in each of these patients during LDKT. Following IPA, a 2-year-old patient with a BMI of 16 kg/m2 had renal allograft compartment syndrome and required graft nephrectomy. CONCLUSIONS: Pediatric patients weighing 15 kg or fewer can get kidney transplants successfully. Gastrointestinal problems are relatively uncommon with EPA, even though there is no agreement on the best surgical strategy.
