E-ISSN 2980-2059
Volume: 1  Issue: 3 - 2023
1.Front Matters

Pages I - VIII

2.Non-Alcoholic Fatty Liver and Periodontal Disease: Is there a Relationship? A Contemporary Review
Hasan Hatipoglu, Aysun Kartal, Ibrahim Kartal, Faik Yaylak
doi: 10.14744/jilti.2023.10820  Pages 81 - 89
Periodontal disease is a common inflammatory disease and is known to be related to other systemic diseases. This bidirectional relation between periodontal disease and other disease processes has led to outstanding research recently. In addition, periodontal disease has been advocated to exacerbate metabolic disorders including non-alcoholic fatty liver disease (NAFLD). In this traditional review, general characteristics of periodontal diseases, general characteristics of NAFLD/ Nonalcoholic steatohepatitis (NASH), and their causality were discussed for treatment providers. The collected data significantly corroborate a greater incidence of periodontal disease among individuals with NAFLD in comparison to the general healthy population. Healthcare professionals need to be aware of the association between NAFLD and periodontal disease thus patient management effectiveness can be enhanced.

3.Large Hypovascular Hepatocellular Carcinoma: Non-Classical Type
Sezai Yilmaz, Brian Carr, Volkan Ince, Sami Akbulut
doi: 10.14744/jilti.2023.24008  Pages 90 - 93
Objectives: As the frequency of surveillance protocols increases in patients with chronic liver disease, the rate of detection of radiologically atypical lesions such as hypovascular hepatocellular carcinoma (HCC) increases. There is no concensus regarding the frequency, size, differentiation, relationship with biomarkers, treatment and survival of hypovascular tumors.
To examine the clinical characteristics and clinical outcomes of resected hypovascular HCCs with known pathology.
Methods: Data of 62 HCC patients treated with resection between January 2009 and December 2022 were retrospectively examined. Twenty-five of these patients had radiological hypovascular HCC and 37 had hypervascular HCC. Patient characteristics (age, gender, blood count and liver function tests, and AFP), tumor variables (differentiation grade, portal vein invasion, Milan Status), and outcome variables (survival, recurrence) were compared between the two radiological groups.
Results: Comparison of quantitative variables between the 2 groups, showed that only GGT values were significantly higher in the hypovascular HCC group. There were no significant differences between the qualitative variables. Overall survival at 1, 3, and 5-years was 79.2%, 55.9%, and 51.2% in the hypovascular group and 83.1%, 61.8%, and 32.4% in the hypervascular group, respectively (p=0.517). Disease-free survival at 1, 3, and 5 years was 58.5%, 46% and 46% in the hypovascular group and 60.3%, 36.5% and 18.2% in the hypervascular group, respectively (p=0.572).
Conclusion: Unlike smaller HCCs, large-dimension hypovascular HCC cases were found to be biologically similar to hypervascular HCC cases. This result may be due to the larger size of the hypovascular tumors. There is a need for studies on bigger series of large size hypovascular HCC cases.

4.Is Obesity a Risk Factor for Recurrence in HCC Patients Who Undergo Liver Transplantation?
Yavuz Selim Angın, Sertaç Usta, Cengiz Ceylan, Volkan İnce, Burak Isik, Brian I. Carr, Sezai Yilmaz
doi: 10.14744/jilti.2023.69885  Pages 94 - 99
Objectives: It is known that obesity is associated with increased complications and early recurrence after cancer surgery. This may also be the case in patients with hepatocellular carcinoma (HCC) who treated with liver transplantation (LT).
Methods: This retrospective observational study aimed to investigate the potential impact of pre-transplant body mass index (BMI) on tumor recurrence and disease-free survival (DFS) in patients who underwent LT for HCC. The study analyzed data from 423 HCC patients who underwent LT at the Inonu University Liver Transplant Institute between 2006 and 2023.
Results: The median age of the 423 patients included in the study was 56 years (range: 18-72), with 367 (86.8%) of them being male. The median BMI was 26 kg/m2 (range: 16.4-46.9). The recurrence rates were 24.3% in the non-obese group, 18.3% in the overweight group, and 16.7% in the obese group (p=0.239). The mean DFS durations were 8.4 years ± 0.6 in the non-obese group, 8.7 years ± 0.5 in the overweight group, and 9.7 years ± 0.9 in the obese group (p>0.05).
Conclusion: This study suggests that obesity should not be considered a predictive factor for HCC recurrence when selecting candidates for liver transplantation.

5.Histopathological Analysis of Gallbladder Specimens Obtained During Living Donor Hepatectomy
Ahmed Elsarawy, Sami Akbulut, Sema Aktas, Sinasi Sevmis
doi: 10.14744/jilti.2023.29392  Pages 100 - 103
Objectives: Cholecystectomy is routinely performed during living donor hepatectomy and subsequently sent for routine histopathological examination. In this report, we reviewed the clinical and histopathological data of the resected gallbladders to give insight about the incidence of occult gallbladder pathologies among healthy adults.
Methods: The medical records of adult living liver donors between December 15th, 2017 and October 15th, 2023 were reviewed. Demographics, gallbladders gross and microscopic pathological data were collected. Male Vs. Female donors clinicopathological data were compared. A p value <0.05 was considered statistically significant.
Results: Two hundred-ninety five donors were reviewed. The median (95 % CI) age was 33 (32-35) years. The male/female ratio was 187 /108. The median (95 % CI) body mass index was 24.8 (24.2-26.0) kg/m2. The blood group were as follows: O (145; 49%), A (95; 32%), B (46; 16%) and AB (9; 3%). Topographically, the resected gallbladders showed a median length of 75 (75-80) mm, median width of 30 (30-35) mm while the median wall thickness was 2.0 (2.0-3.0) mm. The overall incidence of chronic cholecystitis was 41% (122/295) and normal gallbladder structure was found in 166 (56%) cases. No metaplastic or invasive pathologies were detected. Male donors were younger [32 (30-34) vs 34 (32-37); p=0.040], with higher median BMI [26 (25.5-27.1) vs 22.9 (21.6-24.3); p=0.002], with longer gallbladders [80 (80-85) vs 75 (75-80); p=0.002] and with more thick gallbladder wall [2.0 (2.0-3.0) vs 2.0 (2.0-3.0); p=0.034] than females. There was no statistically significant gender difference as regards the incidence of final histopathological diagnoses.
Conclusion: Resected gallbladders during living donor hepatectomy should be routinely sent for histopathological analysis for the detection of occult pathologies among healthy adults.

6.Can Split Liver Transplantation be a Solution for Organ Shortage in Türkiye?
Fatih Ozdemir, Volkan Ince, Sezai Yilmaz
doi: 10.14744/jilti.2023.22932  Pages 104 - 106
Objectives: First split liver transplantation (SLT) which was performed by Rudolph Pichlmayr in 1988, a great hope has arisen to reduce organ shortage. Split liver transplantation is a challenging procedure. Increased perioperative complications and allocation of the split organ affect the results. Selection of both a suitable donor and an appropriate recipient is essential to achieve successful results. We aim to review SLT outcomes performed at our center.
Methods: We have performed 3611 liver transplantations between February 2007 and May 2023. During this period 75 split livers were transplanted. We retrospectively analyzed the 75 split liver transplanted patients data and recorded the age, gender, the reason for liver transplantation, and the survivals.
Results: There were 75 patients. The median age was 12 (0-64). The main reason for liver transplantation was fulminant hepatic failure (47 %, n=35) The 5-year overall survival rate before 2016 was 33 % (n=69). After 2016, the 5-year overall survival rate was 67 % (n=6).
Conclusion: The splittable deceased organ number in our country is extremely low, so SLT will not be a solution for organ shortage in Türkiye. We believe that successful outcomes can only be achieved by performing an in situ split in the same center.

7.Predicting Early Post-Transplant Mortality: The Role of ICU Stay in Liver Transplant Recipients with HBV-Related Cirrhosis
Akile Zengin, Yusuf Murat Bag, Yasin Dalda, Bora Barut, Sezai Yilmaz
doi: 10.14744/jilti.2023.36036  Pages 107 - 117
Objectives: Liver transplantation is the only treatment option for patients with end-stage liver disease. Hemodynamic, respiratory, and metabolic monitoring in the intensive care unit (ICU) is a vital step after the transplant procedure. While most recipients are discharged from the hospital within postoperative two weeks, some patients stay longer, which increases both morbidity and the costs of liver transplantation. We aimed to explore the implications of ICU stay for post-transplant early mortality.
Methods: This is a retrospective analysis of the liver transplant recipients with Hepatitis B virus (HBV)-related cirrhosis between January 2017 and June 2022. Patients ≥18 years with HBV-related cirrhosis were included in the study. The patients were analyzed in two groups: patients who survived (n=167) and patients with early mortality (n=11) defined as mortality within postoperative 90 days. Various operative and clinical data were compared among the groups.
Results: Post-transplant ICU stay was significantly longer in patients with mortality (11 (7-21) versus 5 (4-7), p<0.001). Although it was not statistically significant, the MELD score (20 (17-25) versus 17 (14-22), p=0.051) and postoperative severe complication rate (63.6% to 34.1%, p=0.058) tended to be higher in the mortality group. We performed a ROC curve analysis and showed that cut-off value for the length of ICU stay was 10.5 days in terms of 90-day mortality. The sensitivity was 64% and the specificity was 94% (the area under the curve = 0.820, 95% CI = 0.651- 0.990, p<0.001). In univariate analyses, duration of operation (HR = 1.005, 95% CI = 1.002-1.009, p=0.002) and ICU stay ≥10.5 days (HR = 19.855, 95% CI = 5.796-68.011, p<0.001) were found as significant variables, but in multivariate analyses, only the ICU stay ≥10.5 days (HR = 17.204, 95% CI = 3.881-76.265, p<0.001) was found as an independent predictor of early post-transplant mortality.
Conclusion: The prolonged ICU stay is an independent predictor of postoperative 90-day mortality in living donor liver transplantation for HBV-related cirrhosis. By using length of ICU stay, high risk patients can be determined and closely monitored for early detection and management of serious complications that may lead to early post-transplant mortality.

8.Varicella Zoster Fulminant Hepatitis in a Pediatric Patient with Leukemia: Recovery Without Liver Transplantation
Fatma İlknur Varol, Arzu Akyay, Kamuran Karaman, Nese Karadag
doi: 10.14744/jilti.2023.50479  Pages 113 - 116
Acute liver failure is a sudden and rapidly developing acute liver injury, with impaired metabolic-synthetic function of the liver, with or without encephalopathy that causes multi organ failure in a healthy person. Acute liver failure can develop due to many different reasons. In this report, we presented a child patient who received chemotherapy with the diagnosis of acute lymphoblastic leukemia and developed acute liver failure after Varicella-Zoster Virus infection.In this patient, liver transplantation could not be performed due to active viral infection, and she improved after acyclovir and supportive care with plasmapheresis. To the best of our knowledge, this is the only immunosuppressed child patient in the literature who improved from acute liver failure after Varicella-Zoster Virus infection without liver transplantation.

9.Inonu University Liver Transplant Institute Biliary Atresia Symposium 22 December 2023

Pages 117 - 137
Abstract |Full Text PDF

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