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    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, Ayhan
    Objective: 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 study
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    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, Ayhan
    Background: 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.
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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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    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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    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, Ayhan
    OBJECTIVE: 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.