Objectives: This study primary objective to compare simultaneous Pleth Variability Index (PVI) and blood lactate measurements taken during different surgical phases to determine whether PVI is a reliable parameter for fluid monitoring in this patient group. Our secondary objective is to monitor changes in PVI in fluid-restricted liver donors.
Methods: The study was conducted in ASA I–II living liver donors aged 18–55 undergoing right hepatectomy; patients with cardiovascular disease or drug allergies were excluded. PVI and PI were recorded noninvasively using the Masimo SET® device. Measurements were taken at surgical start (T1), 1 hour (T2), end of surgery (T3), postoperative 3 hours (T4) and 24 hours (T5): AST, ALT, BUN, creatinine and blood lactate; and at T1–T4: SpO2, heart rate, arterial pressures, CVP, urine output, blood loss, administered fluid volumes, PVI and PI. Anesthesia and surgery durations, graft weight, and transfused blood/products were recorded.
Results: Our study involved 51 living donors (31 males and 20 females) with a mean age of 28.78 ± 9.64 years. In the intra-group evaluation of PVI, no significant differences were observed across all time periods, but significant correlations in lactate levels were found at multiple time points (p<0.05). A notable correlation between PVI and lactate levels was identified during the T3 period. Additionally, significant changes in sodium and creatinine were observed in T3 and T4 (p<0.05), along with an increase in bleeding and a decrease in urine output during the first hour of surgery (T2) (p<0.05).
Conclusion: We found a correlation between lactate levels at the end of surgery and PVI values in liver transplant donors. Despite adequate hepatic blood flow, hepatocyte damage during surgery may impact lactate metabolism. Therefore, further studies are needed to explore the relationship between PVI and lactate levels in various surgical procedures.

Objectives: Hepatocellular carcinoma (HCC) is a highly heterogeneous malignancy with poor prognosis and limited biomarkers for early detection or targeted therapy. This study aimed to comprehensively analyze differential gene expression in paired tumor and adjacent non-tumor liver biopsies, in order to identify transcriptional alterations with potential diagnostic, prognostic, or therapeutic relevance.
Methods: We utilized the publicly available GSE64041 dataset, comprising 60 paired biopsies (120 samples in total) from HCC patients. Data preprocessing and normalization were conducted in R using the limma package. Differentially expressed genes (DEGs) were determined with thresholds of |log2 fold change| > 1 and adjusted p-value < 0.05. Visualization tools included box plots, density plots, Uniform Manifold Approximation and Projection (UMAP), volcano plots, and mean difference (MD) plots to ensure robust evaluation of expression patterns and biological clustering.
Results: The transcriptomic analysis revealed clear separation between tumor and non-tumor tissues. A total of 20 top-ranked DEGs were identified, including markedly upregulated genes such as REG3A, SPINK1, GPC3, SLC7A11, and AKR1B10, as well as downregulated genes including CRHBP, FCN3, OIT3, STAB2, and CLEC1B. Many of these genes are known to be involved in oncogenic signaling, ferroptosis regulation, immune evasion, and tumor suppression. UMAP clustering and DEG visualization confirmed distinct transcriptional landscapes, supporting the biological divergence of HCC tissues from normal liver.
Conclusion: This study highlights a panel of significantly dysregulated genes reflecting both oncogenic activation and tumor suppressor loss in HCC. The findings provide valuable insights into the molecular mechanisms of hepatocarcinogenesis and suggest potential biomarkers for diagnosis, prognosis, and therapeutic targeting. These results may contribute to improving early detection, guiding risk stratification, and supporting the development of precision medicine approaches in hepatocellular carcinoma.

Objectives: Liver transplantation (LT) is being performed with increasing frequency in elderly patients in parallel with the aging population worldwide today. In this study, we aimed to analyze the outcomes of LT for HCC in patients aged ≥65 (Older) versus those <65 (Younger).
Methods: In total of 535 HCC patients undergone LT at İnönü University Liver Transplantation Institute between April 2006 and March 2025 were retrospectively reviewed from a consecutively and prospectively recorded database and were analyzed. Results: 68 out of 535 LT’s age were ≥65 (12.7%). The percentage of older HCC patients receiving LT increased over time: it was 6.3% from 2002-2010, 11.3% from 2011-2020, and 17.5% from 2021-2025, showing a significant upward trend (p=0.039). 1-5-, and 10-years OS was 89.1%, 66.8%, and 53.9% in Younger group, and 81.5%, 52.8%, and 39.7% in Older group (p=0.012). Age≥65years was an independent predictor of mortality in patients undergoing LT for HCC (HR = 1.65, 95% CI: 1.11–2.46, p = 0.013). DFS, recurrence rate, tumor characteristics, demographics were similar. Only the last creatin level before LT (0.88 vs 0.8, p=0.003) and beyond Milan criteria rate were significantly higher (39.7% vs 60.2%, p=0.039) in the Older group.
Conclusion: Older age was independently associated with worse post-transplant overall survival among patients undergoing LT for HCC. This inferior survival cannot attribute to the tumor-related factors. Future studies focusing on sarcopenia, frailty, causes of death, and post-transplant complications, immunosuppressive regimens to better define the mechanisms underlying poor survival outcomes in elderly liver transplant recipients and to improve patient selection and post-transplant management in this growing population.

Objectives: This study aimed to retrospectively evaluate the clinical outcomes of surgical repair techniques applied in bile duct injuries occurring during laparoscopic cholecystectomy (LC).
Methods: A total of 20 patients who developed bile duct injury during laparoscopic cholecystectomy and subsequently under-went surgical reconstruction were retrospectively analyzed. Demographic characteristics, timing of injury recognition, type of injury according to the Strasberg classification, surgical techniques employed, postoperative complications, and length of hospital stay were evaluated.
Results: Thirteen patients were female (65%) and seven were male (35%), with a mean age of 57.6 years (range: 19–90). According to the Strasberg classification, the most common injury type was Type E2 (70%), followed by Type E1 (25%) and Type E3 (5%). Rouxen-Y hepaticojejunostomy was performed in 85% of cases. Concomitant vascular injury was present in two patients. The mean length of hospital stay was 7.2 days. Postoperative bile leakage developed in two patients and was successfully managed using interventional or conservative approaches.
Conclusion: Early diagnosis and appropriate surgical reconstruction are crucial in the management of bile duct injuries. Even in cases of delayed diagnosis, successful clinical outcomes can be achieved in experienced centers through a multidisciplinary approach.

Objectives: Transarterial radioembolization with 90Y (TARE) is used as neo-adjuvant therapy for resection, liver transplant down-staging, or frontline therapy for hepatocellular carcinoma (HCC) patients. There are few reports on its use from high-throughput liver transplant or HCC institutions in the developing world.
To evaluate responses of both the liver and tumor to TARE in patients awaiting living donor liver transplant (LDLT).
Methods: HCC patients received TARE, and suitable patients then received LDLT or otherwise continued TARE till disease progression. CAT scans, liver lobe volumes and liver function tests were assessed at baseline and 3 months.
Results: Less than 10% of patients developed decreased blood albumin or platelets, or increase in total bilirubin or ALBI grade at 3 months post TARE. Many patients with abnormal baseline liver values, had an increase in albumin (42.1% patients) and platelets (64.7% patients) or decrease in total bilirubin (71.4% patients) or ALBI grade (51.5% patients) at 3 months post TARE. To explain liver function improvements, lobar liver volumes were assessed and increased in the TARE-untreated, contralateral lobe (median 17.46%) pre-Tx. AFP levels decreased in 81.8% of patients with elevated baseline AFP levels. Survival was longer in the TARE-Tx compared with unrelated TARE-non transplanted patients.
Conclusion: Liver toxicities were low, and many patients had early improvement in liver parameters post TARE.

Objectives: External biliary stenting via the cystic duct is widely used in living donor liver transplantation (LDLT) to reduce biliary complications, particularly bile leakage, and to facilitate postoperative biliary management. While some centers apply this technique selectively, others routinely use external biliary stents in all recipients. However, stent-related complications, including mechanical failure, remain a concern.
Methods: Between January-2009 and May-2025, a total of 365 adult LDLTs were performed at our center. In all cases, duct-to-duct biliary reconstruction was completed with routine placement of an external biliary stent via the cystic duct, planned for removal at 5–6 months postoperatively. This retrospective analysis focused on patients who required surgical re-exploration due to stent fracture. Clinical presentation, imaging findings, intraoperative observations, surgical management, and postoperative outcomes were reviewed.
Results: Among 365 LDLT recipients, seven patients(1.9%) required laparotomy due to stent fracture. Stent fracture occurred between postoperative months 3 and 6, prior to the planned stent removal. All patients presented with acute abdominal pain and signs of peritonitis. Imaging demonstrated retained stent fragments within the biliary tract in all cases, with findings suggestive of biliary irritation or leakage. Urgent laparotomy was performed in all patients. Intraoperatively, fractured stent segments were identified in the biliary system. In two patients, fragments were embedded in the biliary tract, necessitating meticulous dissection. No perioperative mortality occurred however, all patients experienced prolonged hospitalization and postoperative morbidity. No graft loss directly attributable to stent fracture was observed.
Conclusion: Routine external biliary stenting via the cystic duct in adult LDLT may reduce bile leakage but is not without risk. Although stent fracture is rare, it can result in severe complications requiring reoperation and significant morbidity. These findings support reconsideration of a routine stenting policy and suggest that a selective approach based on intraoperative and patient-specific factors may be safer.

In RL-LDLT, both APVB and PVT are associated with adverse operative outcomes. Portal vein thrombosis surgical planning depends on the type and extent of portal vein thrombosis. While completely occlusive portal vein thrombosis is associated with higher morbidity and an unfavorable postoperative course, long-term outcomes may be comparable to those of patients without portal vein thrombosis when physiological portal venous inflow can be achieved. In this report, we present a successful liver transplantation in which a living donor graft with APVB was reconstructed on the back table using a homolog portal Y-graft. This reconstructed graft was then anastomosed to a cadaveric interposition graft of the recipient with Yerdel grade 3 portal vein thrombosis, resulting in a graft-to-graft portal vein anastomosis.

Gallbladder agenesis (GA) is a rare congenital condition with a reported incidence of 10–65 per 100,000 (1), though its true prevalence is likely underestimated due to frequent asymptomatic presentation. Symptomatic individuals may experience manifestations related to associated biliary tract disorders. We report a case of a living liver donor with GA, with particular emphasis on intraoperative considerations and surgical awareness required during donor hepatectomy.