M Kilic

Ege University, Ismir, İzmir, Turkey

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Publications (58)125.74 Total impact

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    ABSTRACT: Biliary atresia is associated with polysplenia in 2-10% of cases and is defined as Biliary Atresia Splenic Malformation syndrome (BASM). The main features of BASM syndrome include extrahepatic biliary atresia and polysplenia besides the characteristic findings of laterality anomalies, cardiac anomalies, intraabdominal vascular anomalies, pancreatic anomalies and malrotation. Here we present a 6-month-old male patient with BASM having atrial septal defect, umblical hernia, inguinal hernia, and hypospadias. Clinical history revealed that his father also had hypospadias which showed a rare form of autosomal dominant inheritance. The karyotype was normal and the molecular analysis of CFC1 gene revealed no mutation. We emphasize the importance of a detailed physical examination in cases with BASM.
    No preview · Article · Jan 2011 · Genetic counseling (Geneva, Switzerland)
  • Z Karasu · S Akay · F Yilmaz · U Akarca · G Ersoz · F Gunsar · M Kilic
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    ABSTRACT: Although end of treatment virological responses are similar in posttransplant patients with recurrent chronic hepatitis C virus infection and nontransplant patients, the sustained virological response rate is lower in the posttransplant setting. We investigated the efficacy of a longer duration (3 years) of therapy. Thirteen patients with biopsy-proven recurrent hepatitis C were included in the study. In the first year of therapy, all patients were treated with a standard regimen of interferon alpha 2b 3MU 3 times in a week plus ribavirin (800 to 1000 mg/d). After the availability of pegylated interferon, patients were converted to pegylated interferon (1.5 microg/kg body weight). Hepatitis C virus RNA was evaluated at months 3, 6, 9, 12, 24, 36, and 42. If hepatitis C virus RNA was negative at month 12, the patients continued treatment for 36 months. Hepatitis C virus RNA was negative in six patients at 12 months, including two who became hepatitis C virus RNA negative after 3 months; two, after 6 months; and two, after 12 months of therapy. Those six continued treatment completing 3 years of treatment with a sustained virological response. Four of those six patients with sustained virological response required colony-stimulating factors during treatment. Although the hepatitis C virus RNA status of patients at 12 weeks is a good marker to predict a sustained virological response in the nontransplant setting, it is not valid in posttransplant patients. A prolonged duration of therapy for patients who are viral responders at 12 months may prevent recurrence and increase the sustained virological response rate.
    No preview · Article · Nov 2009 · Transplantation Proceedings
  • I Alper · S Ulukaya · F Demir · M Kilic
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    ABSTRACT: Our aim was to investigate the effects of cardiac valve dysfunction on perioperative management of orthotopic liver transplantation (OLT) among a retrospective cohort. Three hundred forty-six patients underwent echocardiographic (ECHO) examination prior to OLT. Data of patients with valvular dysfunctions were compared to subjects with normal ECHO. We evaluated patient characteristics, operation variables, hemodynamic course, blood products, fluid and drug requirements, extubation, and mortality rates. Ninety-five patients (27.5%) with cardiac valve dysfunction were classified as mitral valve insufficiency (MVI; n = 32), tricuspid valve insufficiency (TVI; n = 23), or both MVI and TVI (n = 40). One hundred fifty-two patients displayed normal ECHO examinations (control). Ninety-nine patients with other pathologies were excluded from the study. Systemic vascular resistance was significantly lower among the MVI group, and cardiac output (CO) significantly higher in the MVI and both MVI and TVI groups compared with controls. More MVI and both MVI and TVI patients required epinephrine compared with controls. The number of patients who required blood transfusion was higher in the MVI than the control group (P < .05). Patient characteristics, end-stage liver failure scores, duration of operations, hemodynamic variables, incidence of postreperfusion syndrome, mean doses of ephedrine and epinephrine, red blood cells, fresh frozen plasma and fluid requirements, number of patients extubated immediately after surgery, and mortality rates were not different between the groups. Our study demonstrated that cardiac valve dysfunction may be associated with end-stage liver disease among patients undergoing OLT. Patients with MVI or both MVI and TVI required more care in perioperative management.
    No preview · Article · Jun 2009 · Transplantation Proceedings
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    ABSTRACT: Kazimi M, İbis C, Alper I, Ulas M, Baran M, Arikan C, Aydogdu S, Ulukaya S, Zeytunlu M, Kilic M. Right-sided diaphragmatic hernia after orthotopic liver transplantation: Report of two cases. Pediatr Transplantation 2010: 14:e62–e64. © 2009 John Wiley & Sons A/S. Abstract: Diaphragmatic hernia after OLT is a rare surgical complication. We here report successful diagnosis and treatment of two cases with right-sided diaphragmatic hernia developed after OLT both utilizing left-sided allografts. Combination of factors related to the surgical techniques and patient characteristics might explain the pathophysiology behind the diaphragmatic hernias following liver transplantation. Respiratory as well as non-specific gastrointestinal symptoms may be hints for an overlooked diaphragmatic hernia after liver transplantation. Diaphragmatic hernia should be added to the list of potential complications of liver transplantation for prompt diagnosis and appropriate treatment.
    No preview · Article · May 2009 · Pediatric Transplantation
  • D Nart · N Incili · M Zeytunlu · M Kilic · Z Karasu · F Yilmaz

    No preview · Conference Paper · Jan 2009
  • D Nart · Y Ertan · E.E. Pala · M Zeytunlu · M Kilic · F Yilmaz
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    ABSTRACT: Hepatitis C virus (HCV) or hepatitis B virus (HBV)-related cirrhosis is known to be a risk factor for hepatocellular carcinoma (HCC). Recently, these viruses have been reported to have an etiologic role in the development of intrahepatic cholangiocarcinoma (ICC). Herein we have reported two cases of HCV- and HBV-related cirrhosis with ICC in whom the pretransplant diagnosis was HCC. The patient with HCV cirrhosis, was a 47-year-old woman with a large nodule in the right lobe. The patient with HBV cirrhosis was a 45-year-old man with two nodules. Serum tumor marker levels, carcinoembryonic antigen (CEA), alphafetoprotein (AFP), and carbohydrate antigen 19-9 (CA 19-9) were determined before live donor liver transplantation (LDLT). The patient with HCV cirrhosis showed mildly elevated serum levels of AFP. The patient with HBV cirrhosis showed an elevated CA 19-9 level. On microscopic examination, all nodules exhibited typical morphological findings of adenocarcinoma. The patient with HCV cirrhosis developed brain metastases 4 years after LDLT. The patient with HBV cirrhosis is disease-free at 18 months after transplantation. In cirrhotic patients with active malignancy who are candidates for LDLT, ICC should be considered in the differential diagnosis. Although the literature is limited, selected patients with ICC may benefit from LDLT.
    No preview · Article · Jan 2009 · Transplantation Proceedings
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    ABSTRACT: In this case report, the diagnosis and treatment of venous air embolism requiring vasoconstrictor drug treatment together with cardiac compressions and rapid volume replacement during dissection period of living donor liver transplantation in a pediatric case is discussed.
    No preview · Article · Nov 2008
  • S Ulukaya · B Basturk · M Kiliç · E Ulukaya
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    ABSTRACT: The molecular basis underlying the clinical response to acute liver stress remains to be clarified. Postreperfusion syndrome (PRS) occurring after the meeting of grafted liver with the recipient blood is characterized by hemodynamic instability that develops immediately after reperfusion of an orthotopic liver transplantation (OLT). Cytokines have a role during PRS. The aim of this study was to evaluate the role of some cytokine gene polymorphisms on PRS in patients. Forty-six patients who underwent OLT were divided into two groups: with versus without PRS. Cytokine genotyping using patient blood was determined by the PCR-SSP method. Liver transplant patients as a whole are usually characterized as low producers of tumor necrosis factor (TNF)-alpha and interleukin (IL)-10, high producers of transforming growth factor (TGF)-beta1 and IL-6 and intermediate producers of interferon (IFN)-gamma. However no significant relationship was shown between the development of PRS and cytokine gene polymorphisms of TNF-alpha (-308 G/A), TGF-beta1 (C/T codon 10, C/G codon 25), IL-10 (-1082 G/A, -819 T/C, -592 A/C), IL-6 (-174 G/C), or IFN-gamma (+874 A/T). It seemed that our limited data did not substantiate a role of certain cytokine gene polymorphisms on PRS occurence during OLT. A larger study population may be required to examine this relationship.
    No preview · Article · Jul 2008 · Transplantation Proceedings
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    Preview · Article · Jun 2008 · European Journal of Heart Failure Supplements
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    ABSTRACT: Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) recurrences affect both patient and graft survivals post-orthotopic liver transplantation (OLT) in HBV patients with HCC. We analyzed the relationship between HBV and HCC recurrence in a large cohort of HBV-OLT patients with versus without HCC. Two hundred eighty-seven HBV patients with OLT (72 also with HCC) were included in the study. Mean follow-up in the post-OLT period was 31.7 +/- 24.7 (range, 3-119) months. Post-OLT HBV recurrence observed in 10.1% of patients was more prevalent among the HCC group; 23.6% versus 5.5% in patients with and without HCC, respectively. The mean interval for the development of HBV recurrence was 39.5 +/- 28.5 (range, 2-99) months. Among 72 HCC patients, 8 patients (11.1%) had recurrent HCC, and 7 of them also had HBV recurrence. The mean interval for the development of HCC recurrence was 11.2 +/- 7.85 (range, 2-23) months after OLT. OLT patients with HCC with tumors exceeding the Milan criteria had worse 1-, 3-, and 5-year survival rates than patients with HCC meeting the Milan criteria. HBV and HCC recurrence-free survivals were significantly lower in patients with HCC and HBV recurrence, respectively. In the 7 patients with both HCC and HBV recurrence, mean HBV recurrence time was 9.42 +/- 6.75 months and mean HCC recurrence time was 9.57 +/- 6.75 months. There was a strong correlation between HBV and HCC recurrence times. Cox proportional hazards regression analysis showed that only HCC recurrence was a significant independent predictor of HBV recurrence (P < .001; hazard ratio [HR] = 26.94; 95% confidence interval [CI] = 10.81-67.11). On the other hand, HBV recurrence (P = .013; HR = 5.80; 95% CI = 1.45-23.17) and nodule count (P = .014; HR = 13.08; 95% CI = 1.70-100.83) were significant predictors of HCC recurrence. HBV and HCC recurrences demonstrate a close relationship in patients with OLT.
    No preview · Article · Jun 2008 · Transplantation Proceedings
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    No preview · Article · Mar 2008
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    ABSTRACT: Chylous ascites are the accumulation of chylomicron-rich lymphatic fluid within the peritoneal cavity, resulting from obstruction or disruption of abdominal lymphatic channels. This rare condition may be associated with neoplastic or infectious infiltration of lymphatics, with pancreatitis, and with abdominal surgery. It may occur spontaneously in 0.5% of patients with cirrhosis; but only among a few liver transplantation cases. The management of chylous ascites is controversial; the variety of described treatments include repeated paracentesis, dietary control, peritoneovenous shunting, and surgical ligation of the disrupted lymphatic channels. In this article, we report 2 cases of rapid resolution of chylous ascites after liver transplantation following 5 days of treatment using a somatostatin analog and total parenteral nutrition (TPN). A 3.5-year-old girl and a 5-year-old girl underwent living related liver transplantation for biliary atresia and hepatoblastoma, respectively. Chylous ascites, diagnosed by ascitic fluid examination, developed within the 2 weeks after transplantation in the 2 cases. Treatment by fasting, TPN, and somatostatin analog resulted in rapid resolution of the ascites within 1 week. The prevalence of chylous ascites was noted in 1.6% of children (2/119) after liver transplantation. These cases highlight the use of somatostatin analog and parenteral nutrition in chylous ascites after liver transplantation.
    No preview · Article · Feb 2008 · Transplantation Proceedings
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    ABSTRACT: The purpose of this study was to evaluate the duration for organ procurement including both heart and visceral organs and outcomes of the simultaneous transportation of the teams back to the recipient hospitals. Between March 2005 and March 2007, 37/82 organ procurement was performed in the district hospitals and transported to our institution for organ transplantation. Combined heart and visceral organ procurement which was simultaneously transported to the recipient hospitals by one air vehicle was reviewed. After both the thoracic and abdominal cavities were entered, all intra-abdominal organs were mobilized allowing exposure of the inferior mesenteric vein and aorta. The supraceliac abdominal aorta was elevated. The attachments of the liver in the hilar region were incised and both kidneys and pancreas prepared for removal. After the inferior mesenteric vein and aorta were cannulated, simultaneous aortic cross-clamping was performed and cold preservation solution infused. Harvested organs were packed with ice and removed to the back table for initial preparation and packaging for air transport. The mean duration of 6 procurement procedures was 63 minutes (range 50-75 minutes) to aortic clamping, and 27.5 minutes (range, 20-40 minutes) between clamping and harvesting. Mean cold ischemia times for 6 hearts, 6 livers, 12 kidneys, 2 pancreas, and 1 small intestine were 2.4 hours (range, 2-3.5 hours), 5 hours (range, 3-8 hours), 10.3 hours (range, 8-15 hours), 6.7 hours, and 9.5 hours, respectively. No graft complication was observed to be associated with the procurement procedure. Better collaborations between surgical teams and rapid procurement techniques provide simultaneous air transportation back to the recipient hospital with reduced cold ischemia times of the visceral organs.
    No preview · Article · Feb 2008 · Transplantation Proceedings
  • S Ulukaya · I Alper · U Aydin · M Kilic
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    ABSTRACT: A patient with alcohol induced end-stage liver disease developed cardiac arrest immediately after reperfusion during orthotopic liver transplantation. In our case, advanced age of the patient, alcohol-related severe liver disease with high ASA score, and myocardial dysfunction, combined with acute metabolic and hemodynamic changes throughout the surgery may have contributed to the development of postreperfusion syndrome resulting in cardiac arrest. Our patient required a total of 5 mg epinephrine, 200 mg lidocaine, 100 mEq NaHCO3, and 40 mEq calcium gluconate together with direct cardiac compressions and ventilation enriched 100% oxygen to regain sinusoidal rhythm. In conclusion, during severe postreperfusion syndrome, the collaboration between the surgical and anesthesia teams is crucial to overcome cardiac arrest. In an open abdomen, direct cardiac compressions through the transdiaphragmatic pericardial window instead of chest compressions were important to restore effective circulation during advanced life support.
    No preview · Article · Jan 2008 · Transplantation Proceedings
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    ABSTRACT: In this study, we evaluated the effectiveness of two devices using ultrasonic energy for dissection of lung parenchyma in an experimental animal model by comparing the two methods with each other. Twenty New Zealand rabbits were used. One-lung ventilation was obtained under direct vision and the left lung was collapsed. The rabbits were ventilated with pressure-controlled ventilation during the experiment, beginning with a pressure level of 10 cmH(2)O. After a 1 x 1-cm pulmonary wedge resection of part of the collapsed left lung using a harmonic scalpel (group A) or an ultrasonic surgical aspirator (group B), the left lung was inflated and the pressure level was increased by 5 cmH(2)O every five minutes. The pressure level which caused an air leak from the resection surface was recorded. The morphological damage to the lung parenchyma was evaluated under light microscopy. The mean value of airway pressure levels that resulted in an air leak from the resection surface was 32.5 +/- 9.2 cmH(2)O for group A and 24.5 +/- 2.9 cmH(2)O for group B, and the difference between the two groups was statistically significant. The mean level of coagulation necrosis was 558.6 +/- 380.8 microns (133 - 1064 microns) for group A. No tissue damage to pulmonary parenchyma was observed in group B. The harmonic scalpel can be safely used in peripheral lung resections without needing any other method to ensure hemostasis and air tightness. The ultrasonic surgical aspirator can be used for the dissection and resection of deeper lesions and preserves more lung tissue but requires additional interventions for control of the air leak from the resection surface.
    Full-text · Article · Jan 2008 · The Thoracic and Cardiovascular Surgeon
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    ABSTRACT: Liver allografts from donors previously exposed to hepatitis B virus (HBV) carry the risk of transmission of HBV infection to immunosuppressed recipients. However, exclusion of donor candidates with the serologic evidence of resolved hepatitis B-HBV surface antigen (HbsAg) negative and HBV core antibody (anti-HBc) positive-is not feasible in countries endemic for HBV. Our aim was to assess the safety of living donor liver transplantation from anti-HBc positive donors. In our institution, 152 transplants were performed between June 1999 and April 2004. Fifty-six (37%) of the living donors were anti-HBc positive. Twenty of these liver grafts were transplanted to HbsAg-negative recipients. We excluded four HBsAg negative recipients who died because of early complications after transplantation. Lamivudine (100 mg/day) was given for prophylaxis of de novo HBV infection. The mean follow-up time for 16 HBsAg-negative recipients was 21.7 (7-48) months. None of them experienced de novo HBV infection. The use of liver allografts from anti-HBc-positive living donors is reasonably safe in HBsAg-negative recipients under lamivudine prophylaxis.
    No preview · Article · Jul 2007 · Transplantation Proceedings
  • A Isik · E Taydas · S Ulukaya · T Balcioglu · U Aydin · M Kilic

    No preview · Article · Jul 2007 · European Journal of Anaesthesiology
  • U Aydin · P Yazici · M Sozbilen · C Kece · S Tamsel · M Kilic
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    ABSTRACT: Hepatocellular cancer (HCC) is the most common primary malignant hepatic tumor that accounts for over 80% of primary liver tumors. Hepatic resection is a well-accepted therapy for HCC, but 70% to 100% of patients, depending on patient selection, baseline tumor characteristics, and follow-up duration, develop cancer recurrence after resective surgery. Orthotropic liver transplantation is considered more appropriate in cases with HCC related to cirrhosis. Both procedures may result in recurrence. In some cases, diagnosis of recurrent HCC is difficult because of unexpected localization of the tumor. For these patients, aggressive diagnostic tests might be useful for appropriate therapy. We report a case of a 48-year-old man undergoing resection for HCC, who experienced early recurrence of HCC in the pelvic region.
    No preview · Article · Jul 2007 · Transplantation Proceedings
  • Ç. Arikan · M. Çakir · S. Aydoǧdu · M. Kiliç
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    ABSTRACT: The efficiency and success of liver transplantation has been proven in pediatric life-threatening acute and chronic liver diseases. Liver has transplantation superceded surgical therapies especially in high stage primary liver tumors of childhood, which have high mortality and morbidity. In this review, we discuss the indications of liver transplantation for primary childhood liver tumors, and summarize the experience of the world and our organ transplantation center regarding liver transplantation in childhood primary liver tumors.
    No preview · Article · Jul 2007 · Cocuk Sagligi ve Hastaliklari Dergisi

  • No preview · Conference Paper · Apr 2007

Publication Stats

405 Citations
125.74 Total Impact Points


  • 2003-2011
    • Ege University
      • • Department of General Surgery
      • • Department of Pathology
      • • Faculty of Medicine
      Ismir, İzmir, Turkey
    • Celal Bayar Üniversitesi
      Saruhan, Manisa, Turkey
  • 2006
    • Uludag University
      Boursa, Bursa, Turkey
  • 2004
    • Izmir University
      Ismir, İzmir, Turkey