A Dalgiç

Baskent University, Engüri, Ankara, Turkey

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Publications (9)8.57 Total impact

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    ABSTRACT: There are numerous recent reports on the use of lamivudine for hepatitis B virus (HBV) infection after renal transplantation. However, the optimal strategy (prophylactic, preemptive, or salvage approach) for starting lamivudine treatment in this patient group has not been determined. The aim of this study was to assess how the timing of lamivudine therapy affected the HBV serological status and the transaminase levels in renal allograft recipients with chronic HBV infection. We investigated outcomes for patients who were seropositive for hepatitis B surface antigen (HBsAg) and underwent transplantation before or after October 2004 (the date our institution implemented a prophylactic lamivudine treatment strategy against HBV). The data included serum liver enzyme levels and polymerase chain reaction (PCR) screening results for HBV-DNA in serum. Fifteen patients (11 before October 2004, four after October 2004) were included in the study. Preoperatively all patients had normal transaminases levels and 2 of 15 patients had detectable HBV-DNA on PCR. Eight of the 15 total HBsAg-positive patients in our series were not placed on lamivudine at the time of renal transplantation. Half of those who were not treated initially showed transaminase elevations in the first year of follow-up requiring lamivudine therapy at that time. In contrast, all seven individuals who received lamivudine at the time of transplantation were negative for HBV-DNA throughout the follow-up. To prevent viral replication in HBsAg-positive patients who are scheduled for renal transplantation, it is best to initiate lamivudine therapy before or immediately after transplantation.
    Transplantation Proceedings 04/2006; 38(2):496-8. · 0.95 Impact Factor
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    ABSTRACT: Some patients who undergo donor hepatectomy for adult living donor liver transplantation develop hypophosphatemia postoperatively. Since this imbalance appears to be a factor in postoperative complications, some authors advocate routine supratherapeutic phosphorus repletion. The purpose of this study was to determine the frequency of hypophosphatemia after elective donor lobectomy for liver transplantation and to assess whether phosphorus repletion is necessary in this patient group. The cases of 26 patients who donated 19 right lobe and seven left lateral lobe grafts between August 2004 and March 2005 were evaluated. Postoperative phosphorus levels and other relevant data were obtained from our institution's transplant database. Presence/severity of hypophosphatemia was categorized as follows: normal (>2.5 mg/dL), mild (1.5 to 2.5 mg/dL), moderate (1.1 to 1.5 mg/dL), and profound (<1.0 mg/dL). No patients undergoing donor hepatectomy suffered profound or life-threatening hypophosphatemia and no donor required hyperalimentation for phosphate repletion. Twenty one donors (80.7%) did not have postoperative hypophosphatemia. In addition there appears to be no increased morbidity related to hypophosphatemia. A left lateral segment donor (3.8%) had moderate hypophosphatemia that alleviated with oral intake gradually. Four patients (15.5%; three of right lobe donor, one of left lateral segment donor) had mild hypophosphatemia. We also appropriately corrected the hypophosphatemia with encouragement of normal oral intake. By postoperative day 5, essentially all donor phosphorus levels were corrected to normal range. The results suggest that hypophosphatemia after donor hepatectomy is not as common as previously reported. We find that appropriate early oral intake postoperatively effectively prevents/minimizes hypophosphatemia in patients who undergo donor hepatectomy.
    Transplantation Proceedings 03/2006; 38(2):559-61. · 0.95 Impact Factor
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    ABSTRACT: Biliary complications are one of the most important problems in liver transplantation. Despite various refinements of surgical technique, liver transplantation is associated with significant numbers of biliary problems. In this article, we describe our novel "intraoperative transhepatic biliary catheter insertion" technique for biliary reconstruction in 29 patients, since November 2004 comparing results before and after its implementation. 5-F Kumpe catheter is inserted into the biliary system in two steps. The first is completed at the back table, and the second during the recipient operation. The grafts were from cadavers in 10 cases, with the remaining ones from living donors. Ten patients received whole-liver grafts, 11 received a right lobe, and eight received a left-lateral lobe or left lobe. The mean weight of the living donor grafts was 598 g (range = 270 to 975 g). The mean graft weight-to-body weight ratio in the living donor liver transplantations was 1.6% +/- 1.0% (range, 0.8% to 4.1%). Intraoperative transhepatic biliary catheter insertion was performed with a duct-to-duct anastomosis in 27 cases and with a Roux-en-Y hepaticojejunostomy in two cases. The only biliary complication was one case (3.4%) of bile leakage from the anastomotic site. This rate is significantly lower than that for duct-to-duct biliary reconstructions prior to the new catheter technique (13.0%; P < .05). This new technique of biliary reconstruction with intraoperative biliary catheter insertion has significantly reduced our biliary complication rate. Transhepatic biliary stenting prevents biliary complications and makes it simple to maintain percutaneous access in case such problems arise. However, further studies are needed to compare incidence rates of biliary complications when our novel technique is used versus other surgical techniques.
    Transplantation Proceedings 03/2006; 38(2):584-8. · 0.95 Impact Factor
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    ABSTRACT: Vascular complications are the major cause of morbidity and mortality after liver transplantation, particularly in pediatric patients, owing to their smaller vascular diameters. Between September 2001 and June 2004, among 21 (16 boys and 5 girls) pediatric liver transplantations of mean age 8.3 +/- 5.1 years, hepatic arterial thrombosis (HAT) was diagnosed in 2 (9.5%) patients, and hepatic arterial stenosis (HAS) in 4 (19.4%). Vascular patency was evaluated with Doppler ultrasonography every 12 hours in the first postoperative week and daily in the second postoperative week. When occlusion was suspected, conventional angiography was performed. Thrombectomy was performed in one patient, and thrombectomy and reanastomosis were performed in another patient with HAT. Two patients with HAS were treated with balloon angioplasty. A third patient was treated with balloon angioplasty and endoluminal stent placement at the same time. The last patient with HAS had an intimate dissection, which occurred 24 hours after balloon angioplasty, that was treated with subsequent endoluminal stent placement. Mean follow-up for the patients with vascular complications was 9.5 +/- 5.7 months (range, 4 to 18 months). The overall mortality rate was 14.1% (3/21); however, no deaths were caused by vascular complication. Routine Doppler ultrasonographic evaluation is an effective choice for diagnosing vascular complications seen after liver transplantation. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated with balloon angioplasty and/or endoluminal stent placement.
    Transplantation Proceedings 10/2005; 37(7):3200-2. · 0.95 Impact Factor
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    ABSTRACT: It is not clear how HLA compatibility influences acute rejection and postoperative complications in cadaveric liver transplantation. Even less is known about this factor in pediatric living-related liver transplantation (LRLT). This research assessed HLA compatibility relative to rejection rates and complications in pediatric LRLT. The study retrospectively investigated data from 14 pediatric LRLTs in which the donor and recipient HLA genotypes were determined preoperatively. Three recipients (21.4%) developed biliary complications (two biliary leakage, one bile duct stenosis). Three others (21.4%) developed vascular complications (two hepatic artery thrombosis, one hepatic artery stenosis). Eight recipients (57.1%) were diagnosed with acute rejection. The incidence of acute rejection was not correlated with the number of HLA mismatches (P > .05), or with the number of HLA class I mismatches (P > .05); however, it was negatively correlated with number of HLA class II mismatches (P = .02). Arterial and biliary complications were not correlated with any of these categories of HLA compatibility. In conclusion, the data from this small group of patients provided no evidence that closeness of donor-recipient HLA matching influences outcome in pediatric LRLT.
    Transplantation Proceedings 10/2005; 37(7):3151-3. · 0.95 Impact Factor
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    ABSTRACT: Following living-donor liver transplantation, biliary complications are more prevalent among pediatric patients (<18 years old), with reported rates varying between 15% and 30%. In this study, we retrospectively analyzed biliary complications observed in 21 pediatric liver transplant patients (16 boys [76.2%], 5 girls [23.8%] of ages 1 to 18 years (mean, 8.3 +/- 5.05 years) between September 2001 and June 2004. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 12 (57.1%) and a Roux-en-Y hepaticojejunostomy in 9 (42.9%) patients. Postoperative biliary complications were encountered in six (28.5%) patients. Four of the biliary leaks were from a duct-to-duct anastomosis and two from an hepaticojejunostomy. One (4.7%) patient who experienced biliary leakage after a duct-to-duct anastomosis developed stenosis after the leak healed; five (23.8%) had the leakage treated successfully. One patient had biliary leakage from the duct-to-duct anastomosis subsequent to a hepatic artery thrombosis. All patients with biliary leakage were treated without surgery. Mean follow-up time was 10.2 +/- 9.6 months (range, 1 to 26 months). Three patients died during follow-up; however, these deaths were not related to the biliary complications. Interventional radiologic approaches are effective to biliary complications, even when the anastomoses are heavily disrupted. In cases of biliary complication, percutaneous combined with internal drainage may prevent biliary sepsis and provide long-term patency.
    Transplantation Proceedings 09/2005; 37(7):3174-6. · 0.95 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate liver arteries to depict variations by using multidetector computed tomography (CT) in donor candidates for living related liver transplantation. Computed tomographic hepatic angiography was carried out using a multidetector 16-row CT scanner (Sensation 16; Siemens) in 48 candidates between April 2003 and August 2004. Multidetector CT was performed after intravenous injection of 150 mL of contrast material at a rate of 4 mL/s. Arterial phase images were acquired after contrast injection. Afterward, maximum intensity projections and volume-rendered images were produced from the axial image data. Twenty-eight of these patients underwent conventional catheter angiography. Excellent arterial opacification was shown on multidetector CT scans in all patients; arteries up to tertiary branches were identified with CT. Of 28 patients who had both multidetector CT angiography and conventional angiography, only a branch of hepatic artery originating from superior mesenteric artery that supplied the posterior segment of the right lobe was not identified on multidetector CT angiography. In 27 donors, hepatic arterial anatomy depicted at multidetector CT angiography was identical to that at conventional angiography. We identified hepatic vascular variants in 22 of 48 patients with multidetector CT. The most common arterial variant was an accessory hepatic artery arising from the left gastric artery. Preoperative imaging evaluation of hepatic vascular anatomy is crucial for surgical planning in living related transplant donors. Multidetector CT is useful to depict hepatic arterial anatomy with high accuracy.
    Transplantation Proceedings 04/2005; 37(2):1070-3. · 0.95 Impact Factor
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    ABSTRACT: The first immunosuppressive regimens based on glucocorticoids and azathioprine were introduced in the early 1960s. However, many patients developed acute rejection, which required treatment with high doses of prednisolone. Leading to a high mortality due to opportunistic infection. Prior to 1985, our center used a regimen of prednisolone and azathioprine for 352 renal transplantations with 1-year graft and patient survival rates of 63.9% and 82.4%, respectively. Cyclosporine was introduced into clinical practice in 1978, enabling more effective control of acute rejection. In 1985, our center adopted a protocol consisting of prednisolone, azathioprine, and cyclosporine producing significantly increased 1-, 3-, and 5-year patient and graft survival rates for living-related and cadaveric renal transplants. Newer drug combinations, which are less toxic and more potent than cyclosporine based protocols, have further decreased acute rejection rates from 60% to approximately 10%. Still, graft loss continues to be a problem. We believe that the most recent strategy of combining monoclonal antibodies with less toxic agents, such as sirolimus and mycophenolate mofetil, may eventually replace calcineurin inhibitors. Such protocols would eliminate the side effects of calcineurin inhibitors, and possibly permit steroid-free maintenance therapy. The immunosuppressive therapy that is currently available is not ideal; the ability to convert patients to a state of permanent immunologic tolerance would minimize the need for these drugs. The new generation of agents that includes FTY 20, anti-sense oligonucleotides, and agents capable of blocking the costimulatory pathway of allorecognition may improve host tolerance.
    Transplantation Proceedings 04/2004; 36(2 Suppl):143S-147S. · 0.95 Impact Factor
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    ABSTRACT: Radionuclide imaging is a valuable tool during the early posttransplantation period for evaluating the functional status of renal and liver allografts. The aim of this study was to compare the early postoperative function of renal and liver allografts with serial radionuclide imaging. Twenty-two renal and 22 liver allograft recipients were evaluated with serial radionuclide imaging. All grafts were from living related donors. For renal scintigraphy, recipients were injected with Tc-99m DTPA, and imaging was performed on postoperative days 3 and 7. Liver allograft recipients were evaluated with Tc-99m mebrofenin hepatobiliary scintigraphy within the first postoperative week and as required thereafter. The following parameters were computed for each scintigraphy: uptake, time to excretion of the radiopharmaceutical (T(ex)), and retention of radioactivity at the end of the study. Among 22 renal transplant recipients, 19 (86%) had normal uptake and T(ex) values on day 7 posttransplantation. Nine (41%) renal grafts exhibited retention. Among 22 liver transplant recipients, 7 (32%) had normal findings on the first hepatobiliary scan. All except eight liver grafts (64%) had a delay in T(ex), and 15 (68%) had parenchymal retention on the first scan, with improvement of function observed on serial scintigraphies obtained during follow-up. Decreases in uptake were seen less frequently and correlated with a prolonged postoperative hospital stay. Renal transplant recipients are more likely than liver allograft recipients to have a normal scintigraphy in the early posttransplantation period. Retention of radioactivity at the end of the study was the most frequently observed abnormality for both renal and liver allografts. Most liver transplant recipients exhibited a delay in excretion, and parenchymal retention, of radioactivity on the first evaluation, with subsequent improvement on follow-up serial scintigraphy studies.
    Transplantation Proceedings 37(1):355-8. · 0.95 Impact Factor