Determinants and characteristics of tuberculosis in liver transplant recipients

Background/aim: Solid organ transplant (SOT) recipients have increased risk of tuberculosis (TB). We aimed to investigate the prevalence and features of TB in liver transplant (LT) recipients at our transplantation canter. Materials and methods: All patients who underwent LT between January 2004 and December 2013 and whose data were accessible were included in the study. Demographic features, tuberculin skin test (TST) results, and TB prevalence were recorded. Characteristics of LT recipients who developed TB were evaluated. Results: A total of 403 patients underwent LT during this period. Mean age was 47.27 ± 11.04 years; 280 (69.47%) were males. The TST was administered to 108 (25.91%) and the QuantiFERON-TB test to 1 patient. TST positivity was determined in 28 (25.93%). Latent TB infection (LTBI) treatment was not recommended to any of the LT candidates. In the posttransplant period, 5 patients (1.24%) developed TB over a median duration of 14 (min: 7, max: 84) months, 2 of whom were found to have had LTBI in the pretransplant period. Conclusion: The prevalence of TB in LT recipients at our center was similar to that in the current literature. LTBI screening, including risk factor assessment and TST/QuantiFERON-TB testing, is necessary in the early diagnostic workup for TB in LT recipients.

Manual and semi-automated computed tomography volumetry significantly overestimates the right liver lobe graft weight: a single-center study with adult living liver donors.

PURPOSE: Preoperative evaluation of donor liver volume is indispensable in living donor liver transplantation to ensure sufficient residual liver and graft-to-recipient weight ratio. This study aims to evaluate the accuracy of two computed tomography (CT) volumetry programs, an interactive manual and a semi-automated one, in the preoperative estimation of the right lobe graft weight. METHODS: One hundred and nine right liver lobe living donors between January 2008 and January 2020 were enrolled in this retrospective study. Two radiologists measured the liver graft volumes independently using manual and semi-automated CT volumetry, and the interaction time was recorded. Actual graft weight (AGW) measured intraoperatively served as the reference standard. The paired samples t-test was used to compare the estimated graft weight (EGW) and the AGW. Inter-user and inter-method agreements were assessed with Bland-Altman plots. RESULTS: Both manual and semi-automated CT volumetry significantly overestimated the graft weight (EGW manual: 893 ± 155 mL vs. AGW manual: 787 ± 128 g, P < 0.001, EGW semi-automated: 879 ± 143 mL vs. AGW semi-automated, P < 0.001). The junior radiologist measured higher volumes than the senior radiologist with either method (P < 0.001). The Bland-Altman analysis revealed mean difference and standard deviation for inter-method agreement of 7 ± 48 cc for the senior radiologist, and 34 ± 54 cc for the junior radiologist. The mean difference and standard deviation for inter-method agreement was 63 ± 59 cc in manual volumetry and 22 ± 38 cc in semi-automated volumetry. The mean interaction time was 27.3 ± 14.2 min for manual volumetry and 6.8 ± 1.4 min for semi-automated volumetry (P < 0.001). CONCLUSION: Both manual and semi-automated CT volumetry significantly overestimated the right liver graft weight, while semi-automated volumetry significantly reduced the interaction time.

lncRNA XIST Interacts with Regulatory T Cells within the Tumor Microenvironment in Chronic Hepatitis B-Associated Hepatocellular Carcinoma.

OBJECTIVE: Alterations in the expression of several long non-coding RNAs (lncRNAs) have been shown in chronic hepatitis B-associated hepatocellular carcinoma (CHB-HCC). Here, we aimed to investigate the association between the expression of inflammation-associated lncRNA X-inactive specific transcript (XIST) and the type of inflammatory cells within the tumor microenvironment. MATERIAL AND METHODS: Twenty-one consecutive cirrhotic patients with CHB-HCC were included. XIST expression levels were investigated on formalin-fixed paraffin-embedded (FFPE) tumoral and peritumoral tissue samples by real-time polymerase chain reaction (RT-PCR). Immunohistochemical staining for CD3, CD4, CD8, CD25, CD163, CTLA4, and PD-1 were performed. The findings were statistically analyzed. RESULTS: Of the 21 cases, 11 (52.4%) had tumoral and 10 (47.6%) had peritumoral XIST expression. No significant association was found between the degree of inflammation and XIST expression. The number of intratumoral CD3, CD4, CD8 and CD20 positive cells was higher in XIST-expressing tumors, albeit without statistical significance. Tumoral and peritumoral XIST expression tended to be more common in patients with tumoral and peritumoral CD4high inflammation. The number of intratumoral CD25 positive cells was significantly higher in XIST-expressing tumors (p=0.01). Tumoral XIST expression was significantly more common in intratumoral CD25high cases (p=0.04). Peritumoral XIST expression was also more common among patients with CD25high peritumoral inflammation, albeit without statistical significance (p=0.19). CONCLUSION: lncRNA XIST is expressed in CHB-HCC and its expression is significantly associated with the inflammatory tumor microenvironment, particularly with the presence and number of CD25 (+) regulatory T cells. In vitro studies are needed to explore the detailed mechanism.

Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy.

BACKGROUND/AIMS: Development of pancreatic fistula after distal pancreatectomy is still a major problem. Various methods have been defined to prevent the development of the fistula. In this study, the results of suture closure of pancreatic duct and closure of pancreatic stump with "U" sutures passing through each other and the risk factors affecting the development of fistula are studied. METHODOLOGY: Fifty-one patients with prospectively collected data were included in the study. In all patients, pancreatic stump was closed with the same surgical technique. Risk factors that may affect fistula formation were studied between groups with and without fistula. Pancreatic fistula definition was made according to the International Study Group on Pancreatic Fistulas classification. RESULTS: Eight (15.7%) of the 51 patients had fistula. Clinically significant fistula ratio was 9.8% (according to ISGPF B and C). Additional organ resections were performed in 18 patients (35.3%). In multivariate analysis, the soft texture of pancreatic parenchyma (OR: 12.420, p = 0.048) and over 150 mL of blood loss (OR: 1.003, p = 0.043) were found as risk factors for the development of fistula. CONCLUSIONS: Closure of pancreatic stump after distal pancreatectomy with "U" shaped sutures passing through each other is a method that can be performed safely.

Vascular Complications After Liver Transplantation.

OBJECTIVES: Vascular complications after liver transplant can be lethal. High levels of suspicion and aggressive use of diagnostic tools may help with early diagnosis and treatment. Here, we share our experiences regarding this topic. MATERIALS AND METHODS: Adult and pediatric patients who had liver transplant between February 1997 and June 2018 in our clinic were included in the study. Patients were grouped according to age (pediatric patients were those under 18 years old), male versus female, indication for transplant, type of liver transplant, type of vascular complication, treatment, and survival aftertreatment.We analyzed the statistical incidence of vascular complications according to age, male versus female, and type of liver transplant. RESULTS: Our analyses included 607 liver transplant procedures, including 7 retransplants, with 349 (57.4%) from living donors and 258 (42.6%) from deceased donors. Of total patients, 539 were adults (89.8%) and 61 were children (10.2%). Vascular complications occurred in 25 patients (4.1%), with hepatic artery complications seen in 13 patients (2.1%) (10 adults [1.8%] and 3 children [4.9%]), portal vein complications seen in 9 patients (1.5%) (6 adults [1.1%] and 3 children [4.9%]), and hepatic vein complications seen in 3 patients (0.5%) (2 adults [0.36%] and 1 child [1.6%]). Rate of vascular complications was statistically higher in pediatric patients (11.4% vs 3.3%; P = .007) and higher but not statistically in recipients of livers from living donors (5.2% vs 2.7%; P = .19). Twelve patients (48.8%) were treated with endovascular approach, and 11 (0.44%)required surgicaltreatment. Two patients underwent immediate retransplant due to hepatic artery thrombosis. CONCLUSIONS: Because vascular complications are the most severe complications afterlivertransplant,there must be close follow-up of vascular anastomoses, particularly early postoperatively, with radiologic methods. In cases of vascular complications, emergent treatment, including endovascular interventions, surgery, and retransplant, must be performed.

Evaluation of the Effects of Immunosuppressive Drugs Following Liver Transplantation on Pregnancy Outcomes: A Retrospective Study.

BACKGROUND: Liver transplantations can be safely performed in women of reproductive age. Women with chronic liver disease may have infertility for various reasons, although fertility returns after recovering >90% of sexual disorders following liver transplantation. The present study examined the effects of immunosuppressive drugs used by women of reproductive age undergoing liver transplantation in our clinic on pregnancy and pregnancy outcomes and evaluated mortality and morbidity in this patient population. METHODS: Among the patients undergoing liver transplantation in our clinic between 1997 and 2020, those conceiving after liver transplantation were evaluated in the present study. Demographic data on maternal and newborn health, as well as mortality and morbidity, were recorded. Maternal transplant indications, graft type, the interval between transplantation and pregnancy, maternal age at pregnancy and the number of pregnancies, the number of living children, complications, delivery mode, immunosuppressive drugs, and blood levels were investigated. RESULTS: A total of 615 liver transplantations (353 from a living donor, 262 from a cadaveric donor) were performed in our clinic. Furthermore, 33 pregnancies occurred in 22 women following transplantation (17 living donor liver transplantations, 5 deceased donor liver transplantations), and the data of these patients were recorded. Tacrolimus and mycophenolate mofetil were used as immunosuppressive therapy. CONCLUSIONS: Liver transplantations can be safely performed in women of reproductive age if indicated, and these patients can be safely followed up throughout the pregnancy and during labor by a multidisciplinary team.

Complications and Long-Term Outcomes in Adult Patients Undergoing Living Donor Liver Transplantation Because of Fulminant Hepatitis.

BACKGROUND: The present study investigates the complications that may occur during long-term follow-up in patients aged 18 years and older undergoing living donor liver transplantation (LDLT) in our clinic because of fulminant hepatitis. METHODS: The study included patients aged 18 years and older with a minimum survival of 6 months who underwent an LDLT between June 2000 and June 2017. The demographic data of the patients were evaluated in terms of late-term complications. RESULTS: Of the 240 patients who met the study criteria, 8 (3.3%) underwent LDLT for fulminant hepatitis. The indication for transplantation in patients with fulminant hepatitis was cryptogenic liver hepatitis in 4 patients, acute hepatitis B infection in 2 patients, hemochromatosis in 1 patient, and toxic hepatitis in 1 patient. Of the 240 patients, 65 (27%) undergoing LDLT underwent a liver biopsy for suspected rejection because of an elevation in liver function test results during follow-up. Histopathologic scoring was carried out according to the Banff scoring system. A diagnosis of late acute rejection was made in only 1 of the 8 patients (12.5%) who underwent LDLT for fulminant hepatitis. CONCLUSION: Patients with fulminant hepatitis must be prepared for an LDLT, if available, while waiting for a cadaveric donor. The results of the present study suggest that LDLTs in patients with fulminant hepatitis are safe, and the outcomes are acceptable in terms of survival and complications.

COVID-19 in Liver Transplant Patients: A University Hospital Experience.

BACKGROUND: We aimed to examine the comorbidity, disease progress, and vaccination status of liver transplant patients followed up in our hospital who had COVID-19. METHODS: Liver transplant patients with COVID-19 were included between 11 March 2020 and 15 September 2022. Demographic data, disease progress, and COVID-19 vaccines were recorded. The SPSS 24.0 (IBM SPSS, Inc, Armonk, NY, United States) program was used for analysis. The data were analyzed using the χ2 test. P values < .05 were considered clinically significant. RESULTS: Sixteen SARS-CoV-2 polymerase chain reaction (+) patients were detected. Twelve (75.0%) patients were male; the mean age was 49.56 ± 14.0 years (24-76 years). The mean transplant time was 156.69 ± 54.05 months. Four (25.0%) of the 5 (31.3%) patients with comorbidities had hypertension, and 1 (6.3%) had diabetes. None of the patients had an underlying lung disease. All the patients received immunosuppressive therapy, and the most common combination was antimetabolite and calcineurin inhibitor (9 patients [69.2%]). Nine patients (56.3%) had a fever, whereas 6 (37.5%) had respiratory symptoms. Two (33.3%) had pneumonia. Five (31.4%) patients were hospitalized, and 1 (20%) was admitted to the intensive care unit due to non-invasive mechanical ventilation needs. No patient died due to COVID-19. A statistically significant correlation was found between the presence of fever, respiratory symptoms, and hospitalization (P < .05). Of those vaccinated, 10 (66.7%) were infected before the COVID-19 vaccination. CONCLUSIONS: The course of COVID-19 in liver recipients without any underlying disease other than transplantation is not different from that in the healthy population. Immunosuppressive therapy was continued in patients with the disease, and two-thirds did not require hospitalization.

[Ocular toxoplasmosis developed after liver transplantation]. / Karaciger Transplantasyonu Sonrasi Gelisen Oküler Toksoplazmoz.

Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation in the literature, however, no reports were detected in the national data. In this report a 35-year-old female patient diagnosed as ocular toxoplasmosis following reactivation in the second year after liver transplantation, was presented. The case was successfully treated with trimethoprim/sulfamethoxazole and clindamycin. This case was presented to emphasize late presentation of toxoplasmosis in transplantation patients and to withdraw attention to the importance of serological investigations done before transplantation.

Tumoral and Parenchymal Morphological Assessment in Liver Metastases of Colorectal Carcinoma: Micrometastasis, Peritumoral Lymphocytes, Tumor Budding and Differentiation are Potential Prognostic Factors.

Introduction: Various potential prognostic histopathologic factors for colorectal carcinoma liver metastasis have been proposed. However, there is still no consensus on pathological reporting of colorectal carcinoma liver metastasis resection materials. The aim of this study was to investigate the relation between selected tumoral and parenchymal histopathologic features and prognostic factors for better characterization and prognostic prediction of the patients with colorectal carcinoma liver metastasis. Methods: Hematoxylin-eosin stained slides from 100 patients who underwent hepatic resection were evaluated. Pathologic characteristics; including number of tumor nodules, largest tumor size, status of surgical margin, tumor distance to closest margin, tumor necrosis, the presence of tumor capsule, tumor differentiation, perineural and lymphovascular invasion, micrometastasis, tumor budding, peritumoral lymphocytic infiltrate and parenchymal features including steatosis, steatohepatitis, lobular inflammation, confluent necrosis, hepatocyte ballooning, portal inflammation were assessed. For 49 patients who were treated with preoperative chemotherapy, tumor regression grade and chemotherapy-related parenchymal changes such as sinusoidal damage, venous obstruction, nodular regenerative hyperplasia, steatosis and steatohepatitis were also evaluated. Results: The presence of lymphovascular invasion (p < 0.001), micrometastasis (p=0.004), absent or mild peritumoral lymphocytic infiltration (p =0.013), high tumor budding score (p=0.033) and moderate/poor differentiation (p=0.022) were significantly associated with shorter overall survival. Lymphovascular invasion (p < 0.001) was an independent predictor of mortality in multivariate analysis. Conclusions: We conclude that tumor differentiation, lymphovascular invasion, micrometastasis, peritumoral lymphocytic reaction and tumor budding score are potential prognostic histopathological features and candidates for inclusion in pathology reports of colorectal carcinoma liver metastasis resections.

The Site of Lymph Node Metastasis: A Significant Prognostic Factor in Pancreatic Ductal Adenocarcinoma.

OBJECTIVE: While the presence and number of metastatic lymph nodes (LNs) are important prognostic factors for pancreatic ductal adenocarcinoma (PDAC), there is no recommendation to specify metastatic regional LN localization in the current staging system. The aim of this study was to evaluate the prognostic effect of regional metastatic LN localizations in PDAC. MATERIAL AND METHOD: Metastatic sites of 101 consecutive PDAC patients who underwent pancreaticoduodenectomy were classified as peripancreatic, perigastric, hepatica communis, hepatoduodenal, and superior mesenteric artery. The frequency of metastasis in each region and the association between the presence of metastasis in each site and overall and disease-free survival were statistically analyzed. RESULTS: Eighty cases (79.2%) had peripancreatic, 7 (6.9%) had perigastric, 6 (5.9%) had hepatica communis, 7 (6.9%) had hepatoduodenal, and 4 (4%) had superior mesenteric artery LN metastasis. The overall and disease-free survival values were significantly shorter in patients with hepatoduodenal LN metastasis (log rank; p= 0.001, p=0.017, respectively). The presence of metastatic superior mesenteric artery LN was significantly associated with shorter disease-free survival in univariate analysis (p=0.017). Hepatoduodenal LN metastasis was an independent predictor of mortality (p=0.005) in multivariate analysis. CONCLUSION: The presence of hepatoduodenal LN metastasis is an independent poor prognostic factor for mortality. The presence of metastatic LN in the superior mesenteric artery region was significantly associated with shorter disease-free survival time, although not an independent predictor. We conclude that the metastatic regional LN sites, especially the hepatoduodenal region, have an impact on the prognosis, and should be included in synoptic pathology reports.

Peritumoral histopathologic findings in patients with chronic viral hepatitis-associated hepatocellular carcinoma.

Data on peritumoral histopathologic findings in patients with hepatocellular carcinoma (HCC) is limited. In this retrospective study, we evaluated the peritumoral histopathologic changes in patients with chronic viral hepatitis (CVH)-associated HCC (CVH-HCC) and their prognostic value. 61 consecutive cirrhotic patients who underwent liver transplantation due to CVH-HCC were included. Histopathologic features within 1 cm distance of the tumor, and their association with clinicopathological characteristics and prognosis were evaluated. A random representative slide of cirrhotic parenchyma unrelated to invasive and/or dysplastic foci was also evaluated for the same histopathologic criteria. The majority (85%, n = 52) were male with a median age of 55 ± 6.38 (range, 39-67). The etiologic agent was only HBV in 90% (n = 55). The most common peritumoral findings were portal inflammation (100%; n = 61), ductular reaction (100%; n = 61) and sinusoidal dilatation (95%; n = 58). Macrovascular invasion was observed only in four cases (7%) with mild peritumoral portal inflammation. Neutrophilic infiltration of the peritumoral portal tracts (n = 18; 30%) was significantly associated with pT4 tumor stage, tumor grade, macrovascular invasion, and pretransplant therapy. Patients with moderate or severe peritumoral sinusoidal dilatation tended to have worse prognosis, albeit not significantly. Peritumoral ballooning degeneration was associated with multifocality, recurrence and recurrence-free survival in both uni- and multivariate analysis. Peritumoral histopathologic changes in CVH-HCC can be classified as: changes related to pathogenesis, changes indirectly affecting prognosis, and changes directly affecting prognosis. Peritumoral prominent ballooning degeneration may be a predictor of recurrence while portal neutrophilic infiltration and sinusoidal dilatation seem to indicate poor prognosis.

Analysis of socioeconomic status and other factors affecting patient-graft survival in patients undergoing liver transplantation.

Background and Aim: Liver transplantation is performed in increasing numbers due to advances in surgical techniques and the introduction of diverse immunosuppressive drugs. The present study aims to analyze the effects of socioeconomic status and education level on patient and graft survival, in addition to all these factors. Material and Methods: All patients aged 18 years and above who underwent consecutive liver transplantation at the Liver Transplantation Unit of Department of General Surgery at the Dokuz Eylül University Hospital and whose data were available were included in this study. Results: Incompliance was noted in 68.3% of the 278 patients. On the other hand, patient compliance did not have a significant effect on graft and patient survival. However, decreased levels in the parameters, such as education status, vocational status and socioeconomic status, were found to be correlated with patient compliance. A significant correlation was not found between these factors and patient and graft survival. Conclusion: Although a direct effect of socioeconomic status on patient and graft survival could not be shown the significant association of vocational status and education status which determine socioeconomic level with parameters other than patient and graft survival may affect the success of liver transplants.

Analysis of Causes and Risk Factors for Late Mortality After Liver Transplant: How Can We Obtain Better Long-Term Survival?

OBJECTIVES: We investigated late mortality causes and risk factors in patients who were undergoing deceased-donor liver transplant. MATERIALS AND METHODS: Patients who had deceased-donor liver transplant from February 1997 to June 2014 in the hepatopancreaticobiliary surgery and liver transplant unit at Dokuz Eylul University Hospital were analyzed. Inclusion criteria were patients over 18 years of age and who survived more than 1 year after liver transplant. Causes of mortality and related risk factors after the first year were analyzed. RESULTS: Of the 157 included patients, 102 patients (72%) received transplant procedures for hepatitis B and C secondary to chronic liver disease. Mean follow-up was 89.85 months (range, 14.4-240 months). Of 157 patients, 20 patients (12.7%) died: 12 patients (60%) died during posttransplant years 2-5 and 8 patients (40%) died after 5 years. Causes of death included malignancy in 8 patients (40%), recurrent hepatitis C infection in 3 patients (15%), infection in 3 patients (15%), coronary artery disease in 2 patients (10%), graft rejection in 2 patients (10%), and biliary complications in 2 patients (10%). Univariate analyses showed that long-term survival was significantly lower in patients older than 50 years (P = .001), when there was presence of hepatocellular carcinoma (P = .011), and when donor age was higher than 38 years (P = .045). Multivariate analyses identified recipient age (P = .007) and presence of hepatocellular carcinoma (P = 0.033) as factors that reduced long-term survival. CONCLUSIONS: The main causes of late mortality in liver transplant are malignancy, recurrence of hepatitis C, infection, coronary artery disease, graft rejection, and biliary complications. Advanced age and hepatocellular carcinoma are independent risk factors that increase late mortality.

The Role of Log Odds of Positive Lymph Nodes in Predicting the Survival after Resection for Ampullary Adenocarcinoma.

Lymph node metastasis is a important factor on survival in ampullary adenocarcinoma. Log odds of positive lymph nodes (LODDS) is a novel prognostic indicator on lymph node status. We aimed to evaluate the prognostic impact of LODDS for the patients with ampullary adenocarcinoma who underwent R0 pancreaticoduodenectomy. The study includes 42 patients.. LODDS was calculated as "log (number of metastatic lymph nodes+0.5)/(number of total harvested nodes - metastatic lymph nodes+0.5)". LODDS subgroups were created based on their LODDS value: LODDS1(LODDS≤ - 1.5), LODDS2(-1.5 < LODDS≤ - 1.0), LODDS3(-1.0 < LODDS≤ - 0.5), LODDS4(LODDS> - 0.5). The mean survival time was 72.7 ± 7.82 months. Survival rates for 1, 3 and 5 years were 93%, 65% and 45%, respectively. The mean LODDS value was -1.0466 ± 0.51. LODDS subgroups show strong correlation with Overall Survival(OS). The mean survival were 114.8, 81.8, 56.6 and 25.6 months in LODDS subgroups 1, 2, 3 and 4, respectively (Log-rank; p = 0.002), in addition LOODS values shows correlation with perineural invasion and micro vascular invasion (p = 0.015 and p = 0.001 respectively). Findings in our patient group support the hypothesis that LODDS subgroups correlate with OS, and that value of LODDS has considerable role in prediction of OS as well.

Do the stump knotting technique and specimen retrieval method effect morbidity in laparoscopic appendectomy?

BACKGROUND: Stump closure is the most important part of a laparoscopic appendectomy (LA). Closing the appendix base with knot tying is the most cost-effective method. The defined risk factor for surgical site infection (SSI) after LA is the contamination of trocar entry area by inflamed appendicitis. This study aims to compare the single and double knot technique for stump control and specimen removal methods in LA. METHODS: The data of patients who underwent LA between January 2015 and January 2017 were obtained from prospectively collected database. Single and double knot technique, specimen removal method, operation duration, hospital stay, and perioperative-postoperative complications were compared. RESULTS: Extracorporeal double knot was used in 134 patients (63%), and single knot was used in 79 patients (37%). There was no difference between operation duration in the two groups (p=0.97). No stump leakage was observed in any patient. Intraabdominal abscess developed in three patients (1.4%). Appendix was removed from the abdomen directly in 101 patients (47%) and using specimen retrieval bag in 112 (53%). SSI developed in five patients (2.3%), and appendices of all of these five patients were removed from abdomen without using specimen retrieval bag. No SSI was detected in the group that used the specimen retrieval bag (p=0.02). CONCLUSION: Single or double knot(s) tying can be defined as safe and cost-effective stump closure method. The risk of developing SSI can be reduced using specimen retrieval bag.

De Novo Malignancies After Liver Transplantation: A Single Institution Experience.

OBJECTIVES: Our objective was to analyze characteristics, risk factors, and incidence of de novo malignancies after liver transplant. MATERIALS AND METHODS: The hospital records of 557 patients who underwent liver transplant were analyzed from the point of de novo malignancy development. We evaluated the demographic features and survival of these patients retrospectively. RESULTS: The research covered 429 patients, 9 (2%) of whom developed de novo malignancy. All of these patients were male (100%), and their mean (SD) age was 51.33 (4.69) years (range, 45-65 y). Indications for transplant included alcohol related in 4 cases, chronic hepatitis B in 2 cases, chronic hepatitis B and C in 1 case, chronic hepatitis B and D in 1 case, and chronic hepatitis C and alcohol-related cirrhosis in 1 case. The mean (SD) time from transplant to cancer diagnosis was 63.41 (37.10) months (range, 17-122 mo). The types of tumors were lung cancer, lymphoma, neuroendocrine tumor of lung, nasopharyngeal cancer, and squamous cell carcinoma of the skin. Seven cases received chemotherapy with or without radiotherapy. Two cases received surgery and radiotherapy. One patient underwent surgical treatment. One patient died before treatment was started. CONCLUSIONS: In recent years, improvements in surgical techniques and immunosuppressive therapies have helped prolong survival of patients who undergo liver transplant. However, this also has led to a rise in the incidence of long-term complications such as de novo malignancy. These patients are more likely to develop de novo malignancy than the general population, for which chronic immunosuppression is identified as a major risk factor. Early diagnosis and treatment of de novo malignancies can help obtain better prognosis and higher survival rates in these patients.

Liver Transplant in Patients with Primary Sclerosing Cholangitis: Long-Term Experience of a Single Center.

OBJECTIVES: Primary sclerosing cholangitis is a chronic inflammatory disease of the intrahepatic and extrahepatic bile ducts. More than half of the patients will face end-stage liver disease and require liver transplant. Here, we describe the long-term outcomes of liver transplant in patients with primary sclerosing cholangitis at our center. MATERIALS AND METHODS: For this retrospective, observational study, we investigated all patients who underwent liver transplant for primary sclerosing cholangitis between January 2005 and June 2013 at the Dokuz Eylul University Hospital. Patient data were obtained from hospital records. Our inclusion criteria were patients over 18 years old and diagnosed with primary sclerosing cholangitis. RESULTS: Of 11 patients included the study, 6 (54.5%) were male and 5 (45.5%) were female. Mean age was 40.6 ± 11.0 years (range, 23-60 y). All patients had cirrhosis due to primary sclerosing cholangitis. With regard to Child-Turcot-Pugh classification, 2 patients (18.2%) were classified as having Child-Turcot-Pugh A cirrhosis, 7 patients (63.6%) were classified as having B cirrhosis, and 2 patients (18.2%) were classified as having C cirrhosis. Mean Modified End-Stage Liver Disease score was 17.5 ± 6.1 (range, 7-25). Cholangiocarcinoma was not detected in explant pathologic examinations. Primary sclerosing cholangitis recurrence developed in 2 patients (18.1%). Three patients (27.2%) died during the follow-up period. CONCLUSIONS: Liver transplant is a good therapeutic option for primary sclerosing cholangitis with satisfactory long-term outcomes. Liver transplant should be reserved for patients with end-stage liver disease and other conditions that significantly impair quality of life.

A Novel Technique for Managing Pancreaticojejunal Anastomotic Leak after Pancreaticoduodenectomy.

Pancreaticoduodenectomy (Whipple's procedure) remains the only definitive treatment option for tumors of the periampullary region. The most common and life-threatening complications following the procedure are pancreatic anastomotic leakage and subsequent fistula formation. When these complications occur, treatment strategy depends on the severity of anastomotic leakage, with patients with severe leakages requiring reoperation. The optimal surgical method used for reoperation is selected from among different options such as wide drainage, definitive demolition of the pancreaticojejunal anastomosis and performing a new one, or completion pancreatectomy. Here we present a novel, simple technique to manage severe pancreatic leakage via ligamentum teres hepatis patch.

Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.