Objectives: Intrahepatic cholangiocarcinoma (ICC), the second most common primary liver cancer, is associated with a poor prognosis with a very low survival rate. Therefore, a comprehensive understanding of the molecular pathways involved in the disease is of great importance for the development of targeted therapies and personalised treatment strategies. The aim of this study was to identify possible biomarkers associated with ICC by analysing gene expression in ICC tumor and non-tumour liver tissues.
Methods: The dataset included in the study comprises gene expression data from ICC and non tumor liver tissue. The gene expression analysis of this data set was conducted using the capabilities provided by the limma package. The distribution of each tissue in the dataset is shown by the distribution graph. The UMAP graph represents the association of tissue types. The genes exhibiting different regulation are represented in the volcano plot.
Results: The UMAP analysis revealed a perfect separation of the tissues in the dataset into two distinct groups: ICC tumor tissues and non tumor liver tissues. The analysis showed that many genes differed in both groups under log2FC>1 p<0.05 and log2FC<-1 and p<0.05 conditions. The resultsshow that there are genes that are upregulated and down regulated in ICC tissues compared to non tumor liver tissues.
Conclusion: Genetic research has a pivotal role in enhancing investigate molecular pathways and treatment of ICC. Genes that have been identified can function as biomarkers, which can assist in the creation of medication therapies that are specifically targeted and enhance the quality of patient care and the efficiency of healthcare. As genetic research advances, the utilization of these biomarkers is anticipated to improve personalization.

Objectives: In countries that do not have legal regulations regarding organ donation and brain death, only living donor liver transplantation (LDLT) centers can be established. LDLT is a very difficult operation and consists of a series of complex surgeries. Establishing an LDLT center in underdeveloped or developing countries is only possible with a long-term, patience and devoted cooperation of a developed transplant center.
Methods: In this study, LDLT training between the new LDLT center planned to be established in Kyrgyzstan and Inonu University Liver Transplantation Institute (LTI), one of the world's leading institutes in LDLT, and the first 2 LDLTs at the center in Bishkek were presented. LTI's mentoring process started 9 years ago. The training process continued intermittently, but an intensive training program was implemented for the last two years. During this process, a total of 74 doctors or nurses, mainly general surgeons, received training on LDLT.
Results: At the end of the training process, a team of surgeons from both centers performed 2 LDLTs on 2 separate days in Bishkek, on June 10 and 11, 2024.
Conclusion: The purpose of this cooperation is to plan and implement joint programs between states, universities and LT centers and to obtain good results for patients. This study focused on the implications, results, and future expectations of this cooperation, which was written as the first LDLTs in the history of Kyrgyzstan.

Objectives: We aimed to determine the burden of care of individuals caring for pediatric patients who have undergone liver transplantation.
Methods: The study was conducted at the Inonu University Liver Transplant Institute pediatric liver transplantation ward between May 2022 and February 2023. Data were the "Zarit Care Burden Scale," and the "Beck Depression Scale," and demographic characteristics of the patients and their caregivers.
Results: The average age of the caregivers was 38.35±11.82 years; 72.7% were women, 69.7% were the child's mother, and 81.8% reported that caregiving impacted their daily lives. The effect of caregivers' burden of care on their daily lives was found to be statistically significant (p = 0.021). Among the pediatric recipients, 42.4% were aged 13-18 years, 60.6% were female, 45.5% had been post-transplant for more than 25 months, and 54.5% developed complications. The burden of care was severe at 38.87±10.21, and the depression was mild at 10.81±8.65. A moderate positive relationship was observed between burden of care and depression level (r: .602, p: 0.000). Simple linear regression analysis showed that caregivers' depression levels significantly affected their burden of care, (R2=0.363).
Conclusion: The study concluded that caregivers of pediatric liver transplant patients experience a very high burden of care and mild depression. This high burden of care negatively impacts their daily lives and leaves them with less personal time. Providing social support to these families can improve caregivers' quality of life by reducing their depression levels.

Objectives: The aim of this study is to present updated data on liver transplantation (LT) for hepatocellular carcinoma (HCC) of Inonu University, Liver Transplantation Institute, one of the largest volume liver transplant centers in the world.
Methods: The data of 492 LT patients with HCC were analyzed retrospectively from the databank which is recorded prospectively and sequentially. Post-transplant recurrence rates and patient survival according to Milan, Malatya and Expanded Malatya criteria were calculated. Milan Expansion rate of the Malatya and Expanded Malatya criteria were also calculated.
Results: Median follow-up period of the total cohort was 11.1±1.6 years (8.0–14.2, 95% CI) and the recurrence rate was 18.5 % (91/492). 5-year OS according to Milan, Malatya and Expanded Malatya criteria in our cohort were 80%, 79.3% and 78.4%, respectively. Post-transplant recurrence rates within these criteria were 3.2%, 3.8%, and 4.7%, respectively. Milan expansion rates were 25.2% for Malatya criteria and 35.2% for Expanded Malatya criteria.
Conclusion: Milan criteria can be expanded reasonably by Expanded Malatya criteria. Low GGT and low AFP are good prognostic biomarkers that predict survival following LT in patients with HCC. Patients within Expanded Malatya Criteria had 78.4% 5-year OS, 4.7% post-transplant recurrence rate and Expanded Malatya criteria expanded the Milan criteria by 35.2%. Thus, 88 patients were beyond Milan criteria and were within Expanded Malatya criteria and so had an opportunity for LT.

Gallbladder cancers are relatively rare malignancies. While early-stage cases can achieve good outcomes with cholecystectomy, the 5-year survival rate in advanced stages is extremely low. Primary sclerosing cholangitis is a progressive liver disease characterized by inflammation of the bile ducts and is associated with an increased risk of gallbladder cancers. A 32-year-old male patient with primary sclerosing cholangitis was referred for liver transplantation. Imaging revealed a suspicious polypoid lesion, 2.5 cm in diameter, in the gallbladder. With a Meld score of 30, the patient was placed on the transplant waiting list. After waiting period of one month a deceased donor liver transplant was performed. The hepatectomy specimen revealed T2 gallbladder cancer. No recurrence or metastasis was detected during 1 year of follow-up. There is no consensus on the management of suspicious gallbladder lesions in patients with primary sclerosing cholangitis. Cholecystectomy in these patients carries a risk of decompensation in cirrhosis. Considering the decompensated liver cirrhosis and high Meld score, we preferred transplantation over cholecystectomy. Therefore, liver transplantation can be considered as primary treatment option instead of cholecystectomy.

Hepatorenal syndrome is common in patients with decompensated cirrhosis with severe ascites. Liver transplantation (LT) is the only viable option. Combined Liver-Kidney transplantation (CLKT) is recommended in cases with irreversible renal damage. Recovery of the renal functions following LT is common. We aimed to present a pediatric patient with biliary atresia with full recovery of renal functions after retransplantation for chronic rejection and biliary obstruction.
Living donor LT (LDLT) was performed on a 4-year-old female patient due to biliary atresia 6 years before the admission to our department. The patient suffered chronic anastomotic stenosis, cholangitis, and subsequent chronic rejection. On admission, the patient was severely icteric with massive ascites. The renal function was poor with no urine output and required hemodialysis. CLKT was planned but only LDLT could be performed due to deterioration of the patient’s condition. However, the renal function improved dramatically in the postoperative period and the kidney transplant was not performed. The patient had an uneventful postoperative period.
Hepatorenal syndrome, can resolve following LT. The patients who have a high risk of chronic liver failure should be determined before the LT procedure to plant a CLKT and to allocate insufficient organ resources.

Crigler-Najjar syndrome (CNS) type 1 is a rare autosomal recessive disorder caused by mutations in the UGT1A1 gene, leading to a complete deficiency of the enzyme uridine diphosphate-glucuronosyltransferase (UGT1A1). This enzyme deficiency results in severe unconjugated hyperbilirubinemia, which poses a high risk of neurological complications, particularly kernicterus, if left untreated. While phototherapy provides temporary relief in early childhood, its diminishing effectiveness over time requires liver transplantation (LT) as the only definitive treatment. In this report, we present three pediatric cases of CNS type 1 treated successfully with living donor liver transplantation (LDLT). The first case, an 11-year-old girl, presented severe jaundice and neurological impairment but showed significant improvement in bilirubin levels and neurological symptoms after transplantation. The second case, a 12-year-old boy, had persistently high bilirubin levels despite phototherapy, which normalized after LDLT. The third case, an 11- month-old infant without prior treatment, also achieved complete normalization of bilirubin levels after transplantation. These cases demonstrate that LDLT is highly effective in preventing kernicterus, normalizing bilirubin levels, and improving clinical outcomes in patients with type 1 CNS. Long-term post-transplant care, including immunosuppressive therapy and regular follow- up, remains essential for optimal management and patient well-being.