Liver Transplant in Patients With Portal Vein Thrombosis: The Experience of 55 Patients.

OBJECTIVES: Portal vein thrombosis is no longer a contraindication for liver transplantation. However, varied outcomes are still reported with regard to patients with complete portal vein thrombosis. MATERIALS AND METHODS: We analyzed data of 505 patients who underwent liver transplant between January 2014 and June 2017. Of 505 patients, 55 (10.9%) had portal vein thrombosis, which included 37 patients (67%) who had living-donor and 18 patients (33%) who had deceased-donor liver transplant. According to Yerdel classification, 5 (9%), 28 (51%), 12 (22%), and 10 patients (18%) had grade I, II, III, and IV portal vein thrombosis, respectively. RESULTS: Thrombectomy was successful in 46 patients (84%). Forty-three patients had patent portal inflow (93.5%), but 3 patients (6.5%) required a second thrombectomy on day 1 posttransplant. Of 10 patients with grade IV portal vein thrombosis, 9 (16%) underwent extra-anatomic portal vein anastomosis. Of these 9 patients, 7 (77.7%) showed patent portal inflow during the early postoperative period. Median follow-up time was 15.5 ± 13.1 months. During this time, portal vein stenosis was detected in 5 patients. Risk of repeat thrombosis was not significantly different between patients with deceased-donor and patients with living-donor liver transplant. Overall patient survival rates for patients with and without portal vein thrombosis were 73% (40/55) and 84% (376/450), respectively, which showed significant difference (P = .05). CONCLUSIONS: In contrast to early-grade portal vein thrombosis, complete portal vein thrombosis still provides a treatment challenge with high risk of morbidity and poor early outcomes in liver transplant recipients.

Effect of Alprazolam on Redox Status in Renal Transplantation Donors and Recipients.

BACKGROUND Benzodiazepines are the most popular premedication drugs thought to act through the GABA/benzodiazepine receptor complex and alprazolam is one of the most potent benzodiazepines that have a quick onset. While there is a growing body of evidence supporting alprazolam in the amelioration of redox status in animals, no study has been performed concerning its antioxidant activity in humans. The purpose of this investigation was to determine the effect of alprazolam on redox status. MATERIAL AND METHODS This study was a four-group randomized controlled trial. Participants were recruited from Acibadem University Acibadem International Hospital and included a convenience sample of 82 donors and recipients undergoing renal transplantation. Patients were randomly divided into four groups. While donors and recipients in experimental groups (G1 and G3) were administered alprazolam 0.5 mg orally one hour before the operation, those in control groups (G2 and G4) were not. Serum advanced oxidative protein products, total thiol, free hemoglobin, ischemic modified albumin, and sialic acid levels at different time points were measured to evaluate the redox status. RESULTS All oxidative stress parameters were higher in the alprazolam premedication groups (G1, G3) at all time points than in the control groups (G2, G4). Basal values of oxidative parameters (at time point T1) in patients with CKD (G3, G4) were lower than in healthy donors (G1, G2). CONCLUSIONS Alprazolam premedication in donors and end-stage renal failure patients undergoing renal transplantation does not improve redox homeostasis but further experimental studies are needed.

Is cephalad-caudad blunt expansion of the low transverse uterine incision really associated with less uncontrolled extensions to decrease intra-operative blood loss? A prospective randomised-controlled trial.

OBJECTIVE: To determine which type of blunt expansion of a low transverse uterine incision during operative delivery is associated with decreased blood loss and intra- and post-operative morbidity for a caesarean section (CS). METHODS: The prospective randomised-controlled trial was conducted at the Department of Obstetrics and Gynecology, Bezmialem University Hospital. The patients were randomly assigned to a group that received a cephalad-caudad (n = 55) or transverse (n = 57) blunt expansion of the low transverse uterine incision. Intra- and post-operative morbidity at caesarean delivery in short-term including blood loss, operating time, post-operative pain with the faces pain rating scale, and post-operative morbidity were analysed. RESULTS: The changes in both haemoglobin (p < 0.01) and haematocrit (p < 0.01) from the pre-operative to post-operative values, estimates of blood loss (p < 0.01) were significantly lower in cephalad-caudad group and the post-operative haematocrit concentrations (p = 0.02) were significantly greater in cephalad-caudad group when compared with the transverse group. The damage of parametrial and uterine vessels into lateral edges were recorded in 11 (19.6%) patients in transverse group and 7 (12.9%) patients in cephalad-caudad group and there is no statistical significance between groups in terms of these parameters (p > 0.05, 95% CI 0.19, 1.63). CONCLUSION: Our findings suggest that cephalad-caudad blunt expansion of the low transverse uterine incision decreases blood loss compared to transverse blunt dissection.

Laparoscopic-Assisted Live Donor Nephrectomy: A Comparison of Conventional and Transvaginal Routes for Kidney Extraction.

BACKGROUND: Laparoscopic approach has become the standard procedure for living donor nephrectomy in many transplant centers. Because the conventional approach results in cosmetic problems and pain during laparoscopic live donor nephrectomy, transvaginal extraction of an intact kidney has been recently introduced as a minimally invasive technique. Here, we aimed to investigate whether transvaginal extraction of an intact kidney during laparoscopic live donor nephrectomy is associated with decreased postoperative pain, nausea and vomiting, and morphine consumption. MATERIAL AND METHODS: This prospective data analysis included a total of 27 female donors who underwent laparoscopic removal of a single kidney for living donor nephrectomy through conventional or transvaginal route. Data collected included age, body mass index, ASA scores, histocompatibility, additional medical disorders, peri- and postoperative complications, postoperative pain scores with visual analogue pain scores (VAS), length of postoperative stay, morphine consumption, degree of nausea and vomiting, level of sedation, and pruritus. RESULTS: No significant differences between the transvaginal and conventional groups were observed in VAS scores and morphine consumption at postoperative 1, 3, 6, 12, and 24 hours. Although not reaching statistical significance, according to analysis of morphine consumption, there was a trend toward decreasing analgesic requirements in the transvaginal group at postoperative 12 and 24 hours. There were no significant differences between the groups in terms of degree of nausea or vomiting, or length of postoperative hospital stay. CONCLUSIONS: We suggest that with a more desirable cosmetic result, transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy (TVNALDN) is a suitable new minimally invasive laparoscopic technique associated with reduced postoperative pain and analgesic requirements in select women.

Ultrasound/Laparoscopic Camera-Guided Transversus Abdominis Plane Block for Renal Transplant Donors: A Randomized Controlled Trial.

BACKGROUND: The most common treatment modality for postoperative pain relief following laparoscopic surgery is multimodal, using nonsteroidal antiinflammatory drugs (NSAID), opioids, and infiltration of local anesthetics. Because NSAIDs are nephrotoxic, local infiltration does not relieve deep tissue pain, and opioids have an adverse effects profile including pruritus, nausea, vomiting, oversedation, apnea, and decreased gastrointestinal motility. Therefore, the use of a regional analgesic technique can lead to an improved quality of recovery. The aim of this prospective, randomized, placebo-controlled study was to evaluate the effect of TAP block on postoperative verbal analog scale (VAS) scores and total morphine requirements in the first 24 hours after laparoscopic live donor nephrectomy. MATERIAL AND METHODS: After obtaining approval from the hospital ethics committee and written informed consent from the patients, 49 ASA I-II patients undergoing laparoscopic donor nephrectomy, aged 18 years or over, were included in this prospective, randomized, controlled study. In this clinical trial patients were divided into 2 groups: TAP block group (group T) and placebo group (group P). The demographic variables, pain scores, morphine consumption, level of sedation, presence of postoperative nausea, vomiting, pruritus, and average length of postoperative stay were reviewed. RESULTS: The pain scores were significantly lower after TAP block with bupivacaine at most but not all time points. Patients receiving the TAP block with bupivacaine required less morphine up to 24 hours after surgery compared with the saline group. CONCLUSIONS: USG-guided TAP block as part of a balanced analgesia regimen is of benefit in reducing postoperative pain and morphine consumption after laparoscopic donor nephrectomy.