TABLE OF CONTENTS | |
1. | Front Matters Pages I - XIV |
REVIEW | |
2. | Non-Alcoholic Fatty Liver Disease in Living Liver Transplantation: Defatting Strategies Sena Guzel Karahan, Volkan Ince doi: 10.14744/jilti.2025.51523 Pages 89 - 96 Liver transplantation (LT) is the only treatment option saving lives of the patients who have end-stage liver failure. The disparity between the number of patients waiting for transplantation and that of available cadaveric donors is increasingly being bridged through living donors. However, considering the post-transplantation process, graft selection remains a critical determinant of post-transplant outcomes. Despite the high demand and mortality on waiting lists, numerous donors are rejected due to non-alcoholic fatty liver disease (NAFLD). Consequently, defatting strategies are vital and promising for addressing organ shortage. NAFLD might recur following the transplantation or develop de novo in patients who underwent transplantation operation for other liver diseases. The development of de novo or recurrent NAFLD is closely related with metabolic risk factors and use of immunosuppressive medications by recipients. However, no pharmacological treatment specifically approved for NAFLD exists. Therefore, a multidisciplinary approach is necessary both before and after LT. This review aims to evaluate strategies for preventing NAFLD and implementing defatting techniques in living liver transplant donors and recipients. |
ORIGINAL RESEARCH | |
3. | Early Results of Hepatitis B Recurrence After Postoperative Close Monitoring of Patients Who Have Undergone Liver Transplantation for Hepatitis B Deniz Yavuz Baskiran, Ipek Balikci Cicek, Murat Harputluoglu, Sezai Yilmaz doi: 10.14744/jilti.2025.42714 Pages 97 - 101 Objectives: Hepatitis B virus (HBV) is a a frequent cause of liver cirrhosis and hepatocellular carcinoma (HCC), that requires liver transplantation. This study aims to analyze HBV recurrence rates in the early postoperative period. Our second goal was to identify contributing factors of HBV recurrence following liver transplantation. Methods: This retrospective study included 54 patients who underwent liver transplantation for HBV-related liver diseases at Inonu University Liver Transplant Institute in 2024. Data on demographics, preoperative viral markers, postoperative anti-HBs lev-els, and immunoglobulin and antiviral therapy regimens were collected from each patient. Statistical analyses were performed to compare outcomes based on risk stratification and anti-HBs levels. Results: Fifty-four patients (81.48% male; mean age: 52.13±10.54 years were included in the study. In total 1.9% (n=1) experienced HBV recurrence during the early postoperative period. The mean Model for End-Stage Liver Disease (MELD) score was 18.46±6.15, and HBV DNA was negative in 81.48% of patients in the pretransplant period. Anti-HBs titers exceeded 100 IU/L in 79.63% of patients on postoperative day 7. There were no notable differences in demographic or clinical variables between patients with anti-HBs titers exceeding 100 IU/L and those with levels below this threshold. Conclusion: The combination of hepatitis B immunoglobulin (HBIG) and antiviral therapy effectively prevents HBV recurrence following liver transplantation. Maintaining anti-HBs titers above 100 IU/L is critical. Further studies are needed to optimize prophylactic strategies to improve the outcomes in patients transplanted for HBV-related liver disease. |
4. | Identify of Potential Genetic Biomarkers for Hepatitis C Virus Related Hepatocellular Carcinoma Zeynep Kucukakcali, Sami Akbulut doi: 10.14744/jilti.2025.96268 Pages 102 - 108 Objectives: Hepatocellular carcinoma (HCC) is a considerable global health concern. This study attempts to analyze gene expression data between liver tissues with HCV-related HCC and healthy liver tissues to identify potential biomarkers that contribute to HCC development. Methods: We analyzed RNA sequencing data from liver tissues with HCV-related HCC and healthy liver tissues in this study. We retrieved the dataset from NCBI using the code GSE140845. We performed gene expression analysis using the Limma software package in the R programming language, defining genes as differentially expressed if they had a log2 fold change (log2FC) > 1 and a p > 0.05. We conducted data visualization using scatter plots, UMAP, volcano plots, and mean difference (MD) plots. Results: A total of 20,868 genes were analyzed between the HCV-HCC and healthy liver tissue groups, and 3,303 genes were found to be significantly differentially expressed. Genes such as AKR1B10, MUC13, SLC22A11, and SPINK1 showed upregulation in the HCV-HCC group, whereas CNDP1, IGFALS, PVALB, and CLEC4M showed downregulation. These genes have the potential to serve as biomarkers and play critical roles in understanding the mechanisms of HCC development. Conclusion: This study highlights the differential regulation of genes associated with HCV-HCC, emphasizing their potential roles in the pathogenesis of HCC. Notably, the identified biomarkers hold promise as therapeutic targets. These findings may contribute to personalized medicine approaches and enable the development of novel strategies for the prevention and treatment of HCC. |
5. | A New Approach to Analysis of Clinical Data and Prognostication for Patients with Hepatocellular Carcinoma, Based Upon a Network Phenotyping Strategy (NPS) Computational Method Brian Carr, Patricia Sotákov, Petr Pancoska doi: 10.14744/jilti.2024.63935 Pages 109 - 116 Objectives: There is a multi-component nature of the influences on HCC progression but integrating them has been difficult. Network phenotyping strategy (NPS) integrates all multi-component relationship facets of HCC progression and aims to lead to a new way of understanding human HCC biology. Methods: We converted baseline patient demographics, tumor characteristics, blood hematology and liver function test results, consisting of values of 17 standard clinical variables, collected time-coherently at the index visit, into a graph-theoretical data representation. Results: These data were analyzed by NPS, which processes the patient parameter values together with their complete relationships network. NPS identified 25 disease-progression ordered HCC phenotypes. Clinically relevant NPS results are a) Portal vein thrombosis incidence during HCC progression stratified into 5 narrow ranges; b) NPS identified patients according to aggressive, slow and intermediate tumor growth sub-types; c) Personalized prognostication of mortality was achieved by the 25 NPS pheno-types, independently optimized for respective phenotype subcohorts. Conclusion: The NPS results were implemented as an internet application (https: //apkatos.github.io/webpage_nps), where input of 17 clinical parameters provides the patient phenotype, phenotype-characteristic average mortality and personal survival estimate. |
6. | Salvage Living Donor Liver Transplantation for Best Supportive Care Patients with Advanced HCC Volkan Ince, Fatih Ozdemir, Sertac Usta, Harika Gozde Gozukara Bag, Brian Carr, Burak Isik, Sezai Yilmaz doi: 10.14744/jilti.2025.70299 Pages 117 - 123 Objectives: Patients with advanced stage hepatocellular carcinoma (HCC) and liver decompensation have been suggested to receive best supportive care (BSC) according to BCLC algorithm and these patients have a median estimated survival of only 3 months (1). By contrast, living donor liver transplantation (LDLT) performed in a subgroup of BSC patients may not cure the advanced cancer, but it can cure the liver dysfunction. Thus, even if the tumor recurs after transplantation, patients can be treated with local or systemic therapies due to their good liver function, with potential for longer survival. The aim of this study was to compare the survival of BSC patients versus salvage LDLT (sLDLT). Methods: The data of 492 LT patients with HCC were analyzed retrospectively from our databank, which is recorded prospectively and sequentially (2). Among these LDLT patients, those with Child class C and advanced stage HCC [beyond Expanded Malatya criteria] (3) without extrahepatic metastasis aged between 18-60 years were included in the study as the sLDLT group. The data of non-transplant HCC patients were also reviewed and BSC patients were included as BSC group. The survival of sLDLT and BSC groups was then compared. Results: sLDLT group had 17 patients and BSC group had 48 patients. Median survivals were 1020 days (291.6 – 1748.4, 95% CI) in sLDLT group and 40 days (30.9 – 49.1, 95% CI) in BSC group. Hospital mortality (<90 days) in sLDLT group was 2 patients (11.7%), and in BSC group was 81.3% (39/48). Post-LDLT recurrence rate was 66.7% (10/15) and 3-year overall survival (OS) was 50%. We then dichotomized the LDLT group into >2 years and <2 years survival, patients who survive >2 years had significantly lower MTD (2.5 vs 7.5 cm, p=0.036) and lower platelet levels (60.5 vs 93, p=0.027) Conclusion: No palliative treatment could result in 50% 3-year OS in the BSC patients. However, we could achieve 3-year OS of 50% in selected patients in the BSC group (No extrahepatic metastasis, Child C and ages between 18-60) by LDLT. |
7. | The Efficacy of Apigenin in the Treatment of High-Grade Hepatocellular Carcinoma: An Invitro Experiment Basri Satilmis doi: 10.14744/jilti.2025.03511 Pages 124 - 130 Objectives: Apigenin, a flavonoid with reported antineoplastic and anti-inflammatory properties, is being investigated for its potential in treating hepatocellular carcinoma (HCC). This study evaluated apigenin's effects on proliferation, invasion, and viability of the SNU-449 HCC cell line. Methods: To evaluate apigenin's antiproliferative and antimetastatic effects in HCC, we performed MTT assays at 24, 48, and 72 hours, using six apigenin concentrations (2.5–100 µM). Following the determination of the minimum effective concentration at 48 hours, SRB, colony formation, and wound healing assays were performed at that dose. All results are expressed as median (inter-quartile range). Results: The MTT assay identified 5 µM apigenin at 72 hours as the minimum effective dose. Absorbance at 5 µM apigenin and in the untreated control was 0.581 (IQR: 0.26) and 0.67 (IQR: 0.049), respectively (p>0.05). The SRB assay showed no significant difference between the apigenin-treated and control groups (0.54 [IQR: 0.07] vs. 0.381 [IQR: 0.365]; p>0.05). The colony formation assay revealed a modest reduction in survival fraction in the apigenin-treated group (74% relative to control). Wound areas at the end of the wound healing assay were 528,366 (IQR: 691,200) µm² in the apigenin-treated group and 528,861 (IQR: 523,150) µm² in the control group (p>0.05). Wound closure rates were similar between the apigenin-treated and control groups (59.5 [IQR: 36.9]% vs. 59.75 [IQR: 15.4]%; p>0.05). Conclusion: The results of this study suggest that apigenin's direct antiproliferative and antimetastatic effects on HCC cells may be limited. Further research focusing on the modulation of the tumor microenvironment and the induction of antitumor immune responses could provide valuable insights. |
CASE REPORT | |
8. | Primary Kidney Lymphoma Mimics Renal Cell Carcinoma in Preoperative Liver Transplant Patient: Postoperative Challenge – A Case Report Oguzhan Sal, Altan Alim, İsmail Tirnova, Sezan Vehbi, Baris Demir, Turan Kanmaz doi: 10.14744/jilti.2025.69188 Pages 131 - 134 Cancer screening is a critical component of the pretransplantation process. However, in patients with deteriorating liver function, the focus may shift towards acquiring a functioning liver, potentially delaying cancer evaluation. A 42-year-old male with primary sclerosing cholangitis (PSC), CTP score C10, and MELD score 19 was evaluated for liver transplantation (LT). Preoperative imaging revealed two lesions in the upper pole of the left kidney, raising concern for malignancy. After discussion at a uro-oncology meeting, the decision was made to resect the lesions post-LT. On postoperative day 5, the patient underwent entero-enterostomy revision and resection of the renal lesions due to melena. Pathological analysis confirmed Burkitt lymphoma/high-grade B-cell lymphoma-NOS. The patient completed four cycles of chemotherapy and remained free of recurrence by the second postoperative year. This case underscores the importance of cancer screening in LT candidates and highlights the need for biopsy when radiologic suspicion arises. Management should be individualized, considering both liver disease severity and malignancy, with a tailored treatment approach. |
9. | Coma Blister Mimicking Necrotizing Fasciitis in a Liver Transplant Patient: A Case Report Adem Tuncer, Mehmet Zeki Ogut, Sertac Usta, Fatih Ozdemir, Sezai Yilmaz doi: 10.14744/jilti.2025.18209 Pages 135 - 138 Coma blisters (CB) are self-limiting cutaneous lesions that typically occur in patients with prolonged impaired consciousness, often due to drug overdoses such as barbiturates. They are rarely observed in liver transplant patients and can clinically mimic conditions like necrotizing fasciitis. We report the case of a 49-year-old male post-liver transplant who presented with bullous and necrotic lesions on the anterior abdominal wall, initially suspected to be necrotizing fasciitis. A skin biopsy confirmed CB, and the patient responded to corticosteroid treatment, with improvement over 20 days. The patient returned 10 months later with similar lesions, which again resolved with similar management. Early diagnosis and appropriate treatment are essential, particularly in immuno-compromised patients, to distinguish CB from more serious conditions. |
LETTER TO THE EDITOR | |
10. | The Importance of Conventional Angiography in the Preparation for Living Donor Hepatectomy Kemal Baris Sarici, Ertugrul Karabulut, Isa Elbistan, Ramazan Kutlu doi: 10.14744/jilti.2025.91886 Pages 139 - 140 Abstract | |
OTHER | |
11. | Inonu University Liver Transplant Institute 12th National Gastroentererology Surgery Congress 2nd National Liver Transplantation Congress 7-9 November 2024 doi: 10.14744/jilti.2024.03411 Pages 141 - 155 Abstract | |