E-ISSN 2980-2059
Volume: 1  Issue: 2 - August 2023
1.About the Book 'The Puzzle People' by Thomas Earl Starzl
Sezai Yilmaz, Sami Akbulut, Brian I Carr
doi: 10.14744/jilti.2023.07379  Pages 29 - 30
Abstract |Full Text PDF

2.Liver Transplantation for Severe Hepatic Trauma: Historical Review
Ez Eldin Abu zeid, Uri Netz, Sami Akbulut
doi: 10.14744/jilti.2023.70298  Pages 31 - 34
Objectives: Liver transplantation (LT) is rare in the context of liver trauma. There are no clear indications on which patients may benefit from LT, and what are the factors that may reduce or increase the success rate of LT for a trauma patient. We performed a review of the literature in order to better recognize indications and results in this setting.

Methods: A comprehensive review of the literature involving LT in the context of trauma using Pubmed and Google Scholar up to Dec 2022. As this is an uncommon event, we included all publications including case reports.

Results: A total of 19 case reports and one retrospective trial were included in the review. Most past cases were performed in two stages including resection of the native liver with an anhepatic phase followed by liver transplant within a few days with availability of the donor liver. However, one stage was also performed successfully in hemodynamically stable patients with the presence of a donor organ. Bridge to transplantation by portocaval shunt and piggyback anastomosis to native vena cava demonstrated the best results. LT under conditions of infection resulted in increased mortality but can be feasible if there is a possibility of achieving source control of the infection. Auto-transplantation is an accepted option in cases of severe vascular trauma without extensive damage to the liver tissue and bile ducts.

Conclusions: LT in a trauma patient is valid option with accepted success rates. When performed, it is usually in grade 4 or higher liver trauma in an unstable patient, which has failed other treatment options or if there is irreversible damage to the liver tissue and bile ducts. A decision should be based on a multidisciplinary team discussion in an experienced LT center which should consider the chances of saving the patient with an acceptable quality of life in the face of wasting a costly liver graft.

3.Effect of Underlying Chronic Liver Disease on Lysosomal Acid Lipase Activity: Case-Control Study
Zeynep Kucukakcali, Sami Akbulut, Tevfik Tolga Sahin, Cemil Colak
doi: 10.14744/jilti.2023.35744  Pages 35 - 40
Objectives: The goal of the current study is to examine the diagnostic usefulness of lysosomal acid lipase (LAL) activity in cirrhotic patients according to healthy control groups utilizing assessment methods including machine learning methods.
Methods: An open-access dataset was used in the current study and included 63 patients with cryptogenic cirrhosis (cryptogenic group), 88 patients with cirrhosis of known underlying causes (non-cryptogenic group), and 97 healthy individuals (control group). Mann Whitney U test was utilized for comparisons between cirrhosis groups and control group and for comparisons between cirrhosis groups. The Stochastic Gradient Boosting (SGB) method was utilized to model the patients with cirrhosis and the control group. Results: LAL activity was observed to be reduced in cirrhotic patients (cryptogenic and known etiology cirrhosis) when compared to control groups. The machine learning modelling algorithm showed that the cirrhotic group and the control group were distinguished from each other with an accuracy of 93.2%. The platelets, LAL activity, ALT, AST, and white blood cells were obtained as the most important variables according to variable importance values.
Conclusion: LAL activity value can be evaluated diagnostic marker in cirrhotic patients. However, it is not a discriminative marker that differentiates different etiologies (cryptogenic and cirrhosis of known etiology).

4.Resection in Patients with Combined Hepatocellular-Cholangiocarcinoma
Sertaç Usta, Serdar Karakas, Sezai Yilmaz, Volkan Ince, Aysegul Sagir Kahraman, Ayse Nur Akatli, Burak Isik, Sami Akbulut, Tevfik Tolga Sahin, Brian I Carr
doi: 10.14744/jilti.2023.69775  Pages 41 - 44
Objectives: Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare tumor that accounts for 2-3% of primary liver cancers. cHCC-CC mostly have a poor prognosis. There are publications reporting highly contradictory results regarding long-term survival after resection. The aim of this study is to examine the post-resection results of patients with cHCC-CC.

Methods: The data of 7 patients with histopathologically proven cHCC-CC collected prospectively at Inonu University Liver Transplantation Institute, between 2013-2023, were retrospectively analyzed. The preoperative variables examined were age, gender, underlying liver disease, alpha-fetoprotein (AFP) and carbonhydrate antigen (CA 19-9) levels. No patient was diagnosed with cHCC-CC in the preoperative tru-cut biopsies.

Results: Patients were predominantly male (M/F: 6/1) and median age 57 years. All patients had chronic hepatitis or cirrhosis. AFP levels were above 10 ng/dL in 5 cases (7-813 ng/dL) and CA 19-9 levels were normal in all cases. Perihilar lymph nodes resected during hepatectomy were involved with tumor in three patients. The maximum tumor diameter was 11 cm and the mean tumor diameter was 4.5 cm. Bisegmental resection was performed in four patients with cHCC-CC. Major hepatectomy was performed in two cases. Histopathologically, surgical margins were not tumor-free in two patients. The seventh case first underwent segment II-III resection for hepatocellular carcinoma (HCC), but left hemihepatectomy was performed 1.5 months later due to the presence of histopathological tumor in the surgical margins. Histopathological diagnosis confirmed HCC. After 27 months, the patient underwent salvage transplantation due to tumor recurrence within Milan criteria. Histopathological diagnosis was cHCC-CC. The patient who underwent right hemihepatectomy died on the 3rd postoperative day due to reasons other than hepatic failure (cardiac instability). One-year survival of the remaining 6 cases was 71.4%, 3-year survival was 14.3%, and 5-year survival was 14.3%.

Conclusion: cHCC-CC is an aggressive primary liver tumor associated with poor long-term oncological outcomes. Surgical resection is the only curative or palliative treatment option to improve the poor prognosis. In this study, we discussed the diagnosis, treatment and survival of 7 patients with advanced stage cHCC-CC. Studies that require a multidisciplinary approach for the treatment of these tumors are necessary to improve the survival of the patients.

5.Selective Gene Up- and Down-Regulation as Potential Predictors of the Behavior of HBV-Associated Hepatocellular Carcinoma?
Zeynep Kucukakcali, Sami Akbulut, Cemil Colak
doi: 10.14744/jilti.2023.68077  Pages 45 - 51
Objectives: The current study aimed to identify genes that show differential expression in tumor tissue by performing bioinformatic analysis from matched tumor and non-tumoral liver tissue samples obtained from HBV- HCC patients.

Methods: mRNA data from 21 HBV-HCC patients were used in this open-access database-based study. The mRNA sequence data were obtained from 21 pairs of tumors and non-tumoral liver tissue samples. Gene expression analysis was used in bioinformatics analyses and log2FC value was used to identify genes showing up- and down-regulation. To illustrate differentially expressed genes, the volcano plot was utilized.

Results: Our analysis showed that many genes showed quite different expression levels in tumor tissues. Among these genes, the genes that showed very high fold upregulation were GNG4, IGF2BP1, GPC3, PEG10, AFP, SPINK1, EPS8L3, MYCN, DUSP9, and DKK1 genes, respectively. The down-regulated genes were CNDP1, WAKMAR1, LINC01818, TH, LINC01093, MARCO, LOC101927078, LOC105372263, FCN2, and CLEC4M.

Conclusion: Our study defined various genes that might be utilized as potential biomarkers for HBV-related HCC. Targeted treatment for these genes can be developed and verified for efficacy in treatment.

6.A Novel Technique for Cadaveric Organ Procurement: Exposure with Internal Transverse Fascia and Vertical Skin Incision
Tuğrul Çakır, Arif Aslaner, Kemal Eyvaz, Murat Kazim Kazan
doi: 10.14744/jilti.2023.43531  Pages 52 - 56
Objectives: To describe a technique for retrieval of abdominal organs from a cadaveric donor and to report the outcomes of 59 cases at a single center.

Methods: We retrospectively analyzed data from 59 cadaveric organ retrieval operations between 2016 and 2021. The internal transverse fascia incision technique was used in all cases.

Results: Of the 59 patients 37 was male and 22 was female. Median intensive care unit stay was 10 days. The technique provided good exposure for abdominal closure, allowing for the retrieval of the liver, kidneys, and spleen. Aesthetic results and respect for the donor's body were also achieved.

Conclusion: Internal transverse fascia and vertical skin incision is a feasible and efficient method for abdominal organ procurement in cadaveric donors. Further studies are needed to validate and compare technique to other established methods.

7.Heterotopic Reversed Position Technique in Pediatric Liver Transplantation
Veysel Ersan, Fatma İlknur Varol, Cuneyt Kayaalp, Sezai Yilmaz
doi: 10.14744/jilti.2023.13007  Pages 57 - 62
Objectives: Many challenges persist, especially when transplanting large grafts into small pediatric patients in liver transplantation (LT). In this study, we will discuss the details of the "heterotopic reversed position technique" in LT, which is applied to prevent co-plications and allows primary closure of the abdomen in the initial surgery without causing an increase in intra-abdominal pressure.

Methods: From March 2002 to December 2021, our institution performed 3121 LT of these 691 (22.1%) were pediatric LT. We present the outcomes of 11 pediatric patients who underwent LT using this method.

Results: In the postoperative phase, none of the 11 cases had vascular complications. Five of the cases were alive for an average of 9.2 years. The causes of mortality in the three cases were due to persistent hepatic encephalopathy after surgery in one case, another due to hemodynamic instability in the early postoperative period, and the third due to graft-versus-host disease that manifested two months after surgery.

Conclusion: The reversed positioning technique offers a promising solution to the challenges of pediatric liver transplant, especially in cases of acute fulminant liver failure.

8.Living Donor Liver Transplantation for a 78-Year-Old Recipient
Adil Baskiran, Brian Carr, Ali Aloun, Sezai Yilmaz
doi: 10.14744/jilti.2023.03208  Pages 63 - 64
Advanced age of the patient carries a higher risk after liver transplantation (LT) and may lead to worse outcomes. As people's life expectancy increases and advances in the medical treatment of chronic liver disease have increased the need for LTs in the older population. LT recipients over the age of seventy have acceptable survival rates after LT, provided certain criteria are met.
A 78-year-old male patient with cryptogenic liver cirrhosis and tense ascites. His MELD-Na score was 27. He underwent a right lobe living donor liver transplant and was discharged from hospital in good health after a month.
LDLT for elderly recipients might be suitable if the recipients does not have any comorbidity, their outcomes are comparable to those for younger recipients which resulted in fairly acceptable long-term outcomes and if donor morbidity is acceptable.

9.Bowel Perforation due to Complicated Meckel’s Diverticulum in an Adult Living Donor Liver Transplant Recipient
Tevfik Tolga Sahin, Sami Akbulut, Volkan İnce, Sedar Karakas, Sezai Yilmaz
doi: 10.14744/jilti.2023.25733  Pages 65 - 69
Meckel’s diverticulum is a rare cause of bowel perforation in liver transplant recipients. The aim of the present study is to discuss our management protocol in a 57-year old male liver transplant recipient with intestinal perforation due to complicated Meckel’s diverticulum. We report a case of 57 years old male liver transplant recipient who had abdominal sepsis on posttransplant 13th day. He was operated on and found to have Meckel’s diverticulum that caused intestinal perforation due to volvulus around fibrous bands extending to the anterior abdominal wall. Segmental bowel resection with end-jejunostomy was performed. The patient had sepsis on the postoperative period and is followed in intensive care unit and treated with a combination of antibiotics.
Meckel’s diverticulum is a rare cause of bowel perforation and this is the first case presenting with perforation in early post-transplant period. Stoma is beneficial for reduction of abdominal sepsis related symptoms. Preemptive diverticulectomy should be considered for prevention of serious complications such as perforation.

10.Spontaneous Rupture of Hepatocellular Carcinoma with Hemorrhagic Shock
Fatih Ozdemir, Ramazan Kutlu
doi: 10.14744/jilti.2023.54264  Pages 70 - 72
Spontaneous rupture of hepatocellular carcinoma is a fatal and rare complication. Most of the patients admitted to the emergency department with abdominal pain and hemodynamic instability. After appropriate intravenous fluid therapy different treatment modalities can be chosen due to patient’s functional liver reserve, clinical status and tumor’s features.
A 48 years old male patient admitted to the emergency department with upper abdominal pain and severe hypotension. Dynamic contrast enhanced computerized tomography showed ruptured partially hypervascularized lesion at segment 4b and 5 in the liver. Also there were free hemorrhagic fluid densities at perihepatic and perisplenic areas. First of all transcatheter arterial embolization was performed at the interventional radiology department, then central hepatectomy including segment 5 and segment 4b was performed. The patient was discharged without any complication.
Ruptured hepatocellular carcinoma is an emergency clinical situation. Staged hepatectomy after transcatheter arterial embolization for ruptured hepatocellular carcinoma may be the best treatment option for patients who have acceptable liver functions and resectable tumor features.

11.Compression of Left Portal Vein By Giant Hydatid Cyst Extending from the Caudate Lobe to the Foramen of Winslow
Sami Akbulut, Adem Tunçer, Ali Aloun
doi: 10.14744/jilti.2023.57966  Pages 73 - 76
Hydatid disease may affect any organ or tissue, but the most involved organ is the liver. Despite the fact that it is an asymptomatic disease in most patients, about one-third of patients will have a complication. The most common complications of hydatid disease are cystobiliary communications, superinfection, cyst rupture, and mass effect induced complications. Primary aim of this study is to present this case study, 27 years old female patient, regarding a hydatid cyst originating from caudate lobe of the liver, extending to the foremen of Winslow and resulting in pressure on the left portal vein with heterogeneous liver parenchyma seen on computed tomography; as extensive, causing abdominal pain and treated before causing portal venous thrombosis or portal hypertension. The patient underwent cholecystectomy, pericystectomy and received preoperative and postoperative albendazole treatment. In the contrast enhanced computed tomography taken five months after the surgery, it was observed that the heterogeneity in the liver parenchyma completely resolved. After reviewing the literature, there were no studies showing early treatment of such cases before complications occurred.

12.Anatomical Variations and Reconstruction Techniques of the Left Hepatic Vein in Pediatric Living Donor Liver Transplantation
Sertaç Usta, Sezai Yilmaz, Sami Akbulut
doi: 10.14744/jilti.2023.43534  Pages 77 - 78
Abstract |Full Text PDF

13.Comment on Respiratory Complications Among Living Liver Donors: A Single-Center Retrospective Observational Study
Sami Akbulut
doi: 10.14744/jilti.2023.54254  Pages 79 - 80
Abstract |Full Text PDF

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