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Öğe Böbrek naklinde sitomegalovirüs enfeksiyonu için düşük doz valgansiklovir profilaksisinin etkinliği(Galenos, 2020) Özçelik Ü.; Alpay N.; Eren, Eryiğit; Uslu, Bora; Yardımcı, A.C.Amaç: Valgansiklovir böbrek nakli hastalarında Sitomegalovirüs (CMV) profilaksisi için tercih edilen ilaçtır. Standart dozun (900 mg/gün) böbrek fonksiyonlarına olan olumsuz etkisi ve lökopeni yan etkisi nedeniyle düşük doz (450 mg/gün) Valgansiklovir kullanımı giderek yaygınlaşmaktadır. Bu çalışmada düşük doz Valgansiklovirin etkinliği ile ilişkili sonuçlarımızı sunduk. Yöntemler: 01 Aralık 2017 ile 01 Eylül 2018 tarihleri arasında İstanbul Aydın Üniversitesi Tıp Fakültesi, Uygulama ve Araştırma Merkezi Hastanesi ve İstinye Üniversitesi Tıp Fakültesi, Uygulama ve Araştırma Merkezi Hastaneleri’nde yapılmış olan böbrek nakli hastaları incelendi. Hastaların demografik bulguları, preoperatif CMV durumları, postoperatif CMV ve lökopeni insidansı değerlendirildi. Bulgular: Ortalama yaşı 42,85 olan toplam 113 hasta (46 kadın, 67 erkek) dahil edildi. Hastaların tümünün preop CMV IgG (+), donörlerin de tümünün preop CMV IgG (+) idi. Ortalama takip süresi 7 ay (6-13 ay) idi. Bu süreçte iki hastada CMV hastalığı (%1,76) gelişti. Her iki hasta da intravenöz gansiklovir ile tedavi edildi. CMV’ye bağlı herhangi bir komplikasyon gelişmedi. Hiçbir hastada valgansiklovire bağlı lökopeni görülmedi. Sonuç: Bu çalışmada düşük doz Valgansiklovirin donör ve alıcı CMV pozitif olan böbrek nakli alıcılarında CMV profilaksisi için etkin olduğu görülmüştür. Biz de çalışmamızda postoperatif CMV insidansının düşük olması nedeniyle düşük doz Valgansiklovir kullanımını öneriyoruzÖğe Bridged mini gastric bypass: a novel metabolic and bariatric operation(Mary Ann Liebert, Inc, 2019) Sümer, Aziz; Atasoy, Deniz; Barbaros, Umut; Savaş, Osman Anıl; Eren, Eryiğit; Yurdaışık, Işıl; Mercan, SelçukIntroduction: In this article, we aimed to report the first five cases of laparoscopic bridged mini gastric bypass (BMGB) in the treatment of obesity and type II diabetes mellitus (DM). Presentation of Cases: We have performed five cases with a new modified surgical method that we call a BMGB. The patients' recoveries were uneventful. The weight losses of the patients were 15, 13, 14, 11, and 13 kg subsequently and with complete normalization of all metabolic parameters at first month of follow-up. Discussion: The BMGB was modified from the mini gastric bypass and resulted with the same nutritional results, less surgical complications, and a possible advantage of remaining access to the remnant stomach. Conclusion: BMGB may be as effective and possibly an even easier operation to treat obesity and uncontrolled type II DM with possible advantages over currently available metabolic procedures.Öğe Comparison of magenstrasse and mill gastroplasty and sleeve gastrectomy techniques as an experimental study on rabbits(Edizioni Luigi Pozzi, 2020) Sümer, Aziz; Çelik, Sebahattin; Aktokmakyan, Talar Vartanoğlu; Pekşen, Çağhan; Sancak, Tunahan; Kuşcu, Yağmur; Savaş, Osman Anıl; Eren, EryiğitAIM: Bariatric surgery is an important option when lift-style modification, diet, and medical treatment are inadequate in lose weight. Bariatric surgical methods have gained popularity in recent years. In this paper, we compared the Magenstrasse and Mill(M&M) technique, with performing a simpler and more physiological type of gastroplasty without implanted foreign material such as band and reservoir, to the Sleeve Gastrectomy (SG) technique. This study aimed to determine the effects of the M&M for obesity on the rabbits in comparison with the SG, which is accepted as a standard bariatric technique with creating a gastric tube. MATERIAL AND METHODS: The study was approved by the University of Van Yuzuncu Yil Regional Committee of Ethics (Institutional Animal Care and Use Committee). 20New Zealand Rabbits underwent operations. After prestudy with 2 rabbits, the remaining 18 rabbits were divided into 2 groups; Group 1 (SG) and Group 2 (M&M). RESULTS: Group 1 rabbits were observed to lose weight in all, while Group 2 rabbits; 2 of them died 5 of them lost weight, 2 of them gained weight. When the pre and post-operative weight of the rabbits were compared; preoperative median weight values of 9 rabbits in Group 1 were significantly higher than postoperative values. On the other hand, there was no significant change in the mean weight of Group 2 of 7 rabbits (living up to 8weeks). The mean weight of rabbits undergoing standard SG was significantly lower than the MeM technique. CONCLUSION: We believe that this animal experimental study, which we conducted intending to compare MeM and SG techniques, will contribute to the literature as a pilot study and determine the survey of M&M technique as a pioneer in other studies.Öğe 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 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 Karaciğer nakli sonrası hepatit B nüksünün önlenmesinde kısa süreli düşük doz hepatit B immünoglobulini ile nükleotid analoğu kombinasyonunun etkinliği(DergiPark, 2020) Özçelik, Ümit; Eren, Eryiğit; Talih, Tutkun; Özozan, Ömer Vefik; Ensaroğlu, FatihAmaç: Hepatit B’ye bağlı siroz nedeniyle karaciğer nakli yapılan hastalarda hepatit B nüksünün önlenmesi için kısa süreli düşük doz hepatit B immünoglobulini ile nükleotid analoğunun birlikte kullanımının etkinliğini belirlemek amaçlandı. Gereç ve Yöntem: 01 Aralık 2017 ile 01 Eylül 2018 tarihleri arasında İstanbul Aydın Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi ve İstinye Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi hastanelerinde Hepatit B’ye bağlı siroz veya hepatosellüler kanser nedeniyle karaciğer nakli yapılmış hastalar retrospektif olarak incelendi. Hastaların demografik bulguları, ameliyat öncesi viral belirteçleri, hepatosellüler kanser varlığı, HBV DNA varlığı, kullanılan hepatit B immünoglobulin dozu, ameliyat sonrası HBsAg, Anti-HBs, HBV DNA düzeyleri değerlendirildi. Bulgular: Ortalama yaşı 54±11 (aralık; 30-69) olan toplam 17 hasta (3 kadın, 14 erkek) çalışmaya dâhil edildi. Hastaların tümünün ameliyat öncesi HBsAg’si pozitif, 2 tanesinin ise HBV DNA’sı pozitifti. Ortalama takip süresi 16±3.3 ay (aralık; 12-22 ay) idi. Bu süreçte hiçbir hastada hepatit B nüksü gelişmedi. Sonuç: Bu çalışmada kısa süreli düşük doz hepatit B immünoglobulini ile nükleotid analoğu kombinasyonunun karaciğer nakli sonrası erken dönemde hepatit B nüksünü önlemede etkin olduğu görülmüştür. Bulgunun uzun dönem sonuçlarıyla desteklenmesi gerekmektedir.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 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 Renal transplantation in high immunological risk patients: A single-center experience(Elsevier Science Inc, 2019) Alpay, Nadir; Özcelik, Umit; Eren, Eryiğit; Uslu, BoraBackground. Renal transplantation (RT) in high-risk patients is increasingly performed due to an inadequate organ pool and increased rate of RT after a failed transplantation. Safety and prognosis of RT in such patients with high risk is an ongoing debate. Herein we aimed to present our single-center experience on RT of high-risk patients. Methods. A total of 89 consecutive RT patients were included into this study in a 10-month period. Patients were divided into 3 groups: the low-risk group (n = 47) with negative panel reactive antibody (PRA), medium-risk group (n = 18) with positive PRA but mean fluorescence intensity (MFI) <2000, and high-risk group (n = 24) with positive PRA and MFI >2000 or donor specific antibody (DSA) positivity. Groups were compared in terms of demographic features, serum creatinine levels, acute rejection rates, delayed graft function (DGF), and patient or graft loss. Results. Age of the recipients were similar between the groups. Desensitization (7% vs 11% vs 42%, respectively, in low-, medium-, and high-risk groups; P = .001), plasmapheresis (6% vs 11% vs 46%, respectively, P < .001), and rituximab treatments (0% vs 0% vs 25%, respectively, P < .001) were significantly more frequently performed in high-risk patients. Serum creatinine levels at 1 month and 6 months after RT were similar between the groups (P = .43 and P = .71, respectively). Rates of acute rejection (6% vs 6% vs 16%, respectively, P = .52) and DGF (9% vs 11% vs 29%, respectively, P = .15) were similar between the groups. Frequencies of loss of patient or graft were also similar (0% vs 6% vs 4%, P = .15). Conclusion. RT may be successfully performed in high-risk patients without an increase in the risk of acute rejection, DGF, or patient/graft loss.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 Right lobe liver transplantation for Wilson's disease from heterozygote donor: case report(Elsevier Inc, 2019) Özçelik Ü.; Eren, Eryiğit; Tokaç M.; Dinçkan A.Background: Use of liver grafts from heterozygote genetic carriers for Wilson's disease was considered safe. We present a 14 year-old male patient with Wilson's disease who was undergone right lobe liver transplantation from his heterozygote mother. Case report: The patient was admitted to our hospital with decompensated liver cirrhosis due to Wilson's disease as a liver recipient candidate. His Child score was 11 (Child C) and MELD score was 28. His weight was 52 kg. Total liver volume of his 40-year-old mother was calculated 1488 mL in computed tomography. Right and left liver lobe of the donor were calculated as 1044/444 (70.16%/29.84%) mL. Preoperative ceruloplasmin level, 24-h urinary copper excretion, serum copper level and liver biopsy of the donor were all normal. Right lobe liver transplant was performed. Recipient and donor were discharged from the hospital uneventfully. The patient's preoperative ceruloplasmin level was 15.3 mg/dL and increased to 22 mg/dL after liver transplant. Also urinary copper decreased from 1939 to 68 ?g/day and serum copper improved from 72 to 82 mg/dL after liver transplant. There were no statistically difference between preoperative and postoperative serum copper, ceruloplasmin and 24 h urinary copper levels of the donor. Discussion: Equal outcomes of living related liver transplantation for Wilson's disease were reported for heterozygote and nonheterozygote donors previously. Usually left liver lobes were used for transplantation from heterozygous donors. The use of right liver lobe of the heterozygous donor has no negative impact on both the donor and recipient for Wilson's disease. © 2019Öğe 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.
