Post-hepatectomy liver failure is a serious complication following liver resection and is associated with high morbidity and mortality. Platelets play a crucial role in liver regeneration due to their rich content of growth factors. However, the comparative effects of platelet-rich plasma (PRP) and concentrated growth factor (CGF) on liver regeneration remain unclear. This study aimed to evaluate and compare the effects of splenectomy (SPx), PRP, and CGF on liver regeneration and function following 70% hepatectomy in rats. Male Wistar rats were randomly divided into six groups: Control, Sham, Hepatectomy (PHx), Hepatectomy + SPx, Hepatectomy + PRP, and PHx + CGF. PRP and CGF were prepared using differential centrifugation and administered via the portal vein after hepatectomy. Liver regeneration was assessed histopathologically, immunohistochemically and biochemically on postoperative day (POD) 5. PRP treatment significantly increased Ki-67 expression, indicating enhanced hepatocyte proliferation. CGF promoted neovascularization and improved hepatocyte morphology but showed lower Ki-67 expression than PRP. SPx did not significantly enhance regeneration compared to PHx alone. Signal Transducer and Activator of Transcription 3 (STAT3) expression was highest in the PHx group, whereas the PRP and CGF groups exhibited moderate levels. PRP and CGF improved liver function biochemically, reducing bilirubin levels. Both PRP and CGF promote liver regeneration, albeit through distinct mechanisms: PRP primarily enhances cellular proliferation, whereas CGF facilitates vascularization and modulates the immune response. SPx did not confer additional benefits in this model. These findings suggest that PRP and CGF may have potential therapeutic applications in preventing post-hepatectomy liver failure.

BACKGROUND:Sarcopenia, characterized by loss of muscle mass and strength, is a common condition in patients with cirrhosis and can influence outcomes after liver transplantation. This study aimed to compare the effects of sarcopenia on postoperative bacteremia, complications, and survival rates in living donor liver transplantation (LDLT) recipients in the Turkish population. METHODS:We conducted a retrospective analysis of 65 adult LDLT recipients from May 2021 to May 2023. Sarcopenia was diagnosed using preoperative abdominal CT by assessing psoas muscle area and psoas muscle index. Recipients were categorized into sarcopenic (Group 1) and nonsarcopenic (Group 2) groups. Demographic data, comorbidities, postoperative complications, and survival rates were analyzed. Statistical analyses included univariate and multivariate Cox regression for survival. RESULTS:The prevalence of sarcopenia was 55%. Major complications occurred in 44% of sarcopenic and 14% of nonsarcopenic recipients (P = .008). The 30-day and 3-month survival rates were significantly lower in sarcopenic recipients (83% versus 100%, P = .023). Although 1-year and overall survival rates showed no significant difference, sarcopenic recipients demonstrated a trend toward lower survival rates. Multivariate analysis revealed that sarcopenia and hypertension significantly impacted overall survival. CONCLUSIONS:Sarcopenia was associated with increased postoperative complications and a tendency for lower short-term survival in LDLT recipients. The findings underscore the clinical importance of early detection and management of sarcopenia in improving outcomes for liver transplant candidates. This study highlights the multifactorial nature of mortality risk in liver transplant recipients, with sarcopenia playing a crucial role.

OBJECTIVES:In this study, we aimed to evaluate the long-term outcomes of renal transplant in patients with rheumatic diseases. MATERIALS AND METHODS:In this retrospective case-control study, we analyzed and compared outcomes of 187 patients who underwent renal transplant because of rheumatic disease-associated renal failure between the years 1994 and 2020 versus a control transplant group (n = 325), matched for age, sex, body mass index, and follow-up duration. RESULTS:Among patients in the rheumatic disease group, AA amyloidosis was the most common renal pathology leading to kidney transplant. Delayed graft function, acute rejection, and mortality were more common in the rheumatic disease group. Survival rates in recipients at 1, 5, 10, and 15 years were lower in the rheumatic disease group than in the control group (log-rank 0.046), whereas graft survival rates were found to be similar (log-rank 0.206). Recipient survival rates at 1, 5, 10, and 15 years in patients in the rheumatic disease group with AA amyloidosis were significantly worse compared with patients in the rheumatic disease group with glomerulonephritis (log-rank 0.006). Advanced recipient age and graft loss were found to be independent risk factors for mortality in the Cox regression analysis. CONCLUSIONS:Delayed graft function, acute rejection, and mortality rates were higher in patients who had kidney transplants because of rheumatic diseases. Patients with secondary amyloidosis associated with rheumatic disease had worse long-term renal transplant outcomes.

BACKGROUND AND AIMS:Cystinosis is a rare autosomal recessive lysosomal storage disorder caused by mutations in the CTNS gene, leading to cystine accumulation and progressive multisystem involvement. Renal failure is the clinical outcome, and renal transplantation markedly improves survival. However, long-term post-transplant outcomes remain limited. This study aimed to evaluate long-term graft and patient outcomes in cystinosis patients undergoing renal transplantation. METHODS AND RESULTS:This single-center retrospective case series included 6 male patients with cystinosis who underwent renal transplantation during childhood. The mean age at diagnosis was 3.9 years, and the mean follow-up period after transplantation was 12.3 years. Five patients received kidneys from living donors and one from a deceased donor. All patients were treated with cysteamine. No graft loss was observed during follow-up, and renal function remained stable in all patients. One patient developed antibody-mediated rejection while on cyclosporine, whereas no rejection episodes occurred in patients receiving tacrolimus-based regimens. Extrarenal involvement was predominantly ocular, with occasional thyroid, skeletal, and cardiac manifestations. Growth retardation was evident in all patients despite treatment. CONCLUSION:Renal transplantation provides excellent long-term graft and patient outcomes in cystinosis. Favorable graft survival, even in the presence of HLA mismatch, suggests a potentially protective disease-related effect. Early diagnosis, timely transplantation, and continued cysteamine therapy are essential for optimal long-term outcomes.

PURPOSE:To assess long-term ocular complications and identify factors affecting these complications who have undergone liver transplantation. METHODS:We included 147 patients who had a complete ophthalmologic examination at least 1 year after liver transplantation. The patients were divided into two groups: adult (group 1) and pediatric liver transplant patients (group 2). Data collected included best corrected visual acuity, intraocular pressure (measured with Full Auto Tonometer TX-F; Topcon), refractive error (measured with KR-8900; Topcon, Tokyo, Japan), slit-lamp examination of the anterior segment, and dilated fundus examination for both eyes. Refractive error, lens opacity, eye dryness, pterygium pinguecula, arcus lipoides, corneal calcification, macular drusen, central serous chorioretinopathy, hypertensive retinopathy, and diabetic retinopathy were all recorded. All patients received a maintenance immunosuppressive protocol consisting of combinations of steroids, calcineurin inhibitors, mycophenolate mofetil, and mammalian target of rapamycin inhibitors. RESULTS:Our study included 106 recipients in group 1 and 41 recipients in group 2. In group 1, 8 participants (7.5%); in group 2, 5 participants (12.2%) needed myopic correction. Additionally, 12 participants (11.3%) in group 1 required hyperopic correction, compared to 2 participants (4.9%) in group 2. No statistically significant difference was found between the two groups (P > .05). Regarding anterior segment findings, 18 participants (16%) in group 1 and 1 recipients (2.4%) in group 2 were diagnosed with dry eye, with a statistically significant higher incidence in group 1 (P = .02). The rates of arcus lipoides, pterygium, pinguecula, cataract, and glaucoma were similar in both groups (P > .05). For posterior segment findings were higher in the adult group, no statistically significant difference was found (P > .05). We identified dry eyes and cataracts as the most common ocular complications and more prevalent in group 1. CONCLUSION:Different ocular complications involving the anterior and posterior segments can be seen in the long-term after liver transplantation. The fact that postoperative anterior and posterior segment complications were statistically higher in the adult age group suggests that the risk of postoperative complications may be related to age and age-related systemic diseases such as diabetes, hypertension; or cumulative drug use.

OBJECTIVES:Postoperative donor care is being improved with newly applied methods. Recently, because of its effectiveness, erector spinae plane blocks have been increasing in popularity. However, its use for laparoscopic living-donor nephrectomy is not fully known. We evaluated the effectiveness of erector spinae plane blocks in laparoscopic living-donor nephrectomy on postoperative pain and total analgesia consumption in the first 24 hours postsurgery. MATERIALS AND METHODS:In this randomized, prospective cohort efficiency study, we included 60 donors scheduled for elective nephrectomy. The control group (n = 30) received analgesic medication according to organ transplant ward protocol for postoperative pain treatment; the erector spinae plane block group (n = 30) underwent an erector spinae plane block application with routine analgesic medication practice. We evaluated the efficacy of postoperative pain treatment and total analgesic consumption at postoperative 1, 6, 12, and 24 hours. RESULTS:Among the 60 donors in the study, there were no differences in the verbal numerical rating scale and the Wong-Baker Faces Pain Rating Scale scores between the groups in the first 24 hours. However, total tramadol consumption in the erector spinae plane block group was less (P = .003) than in the control group. Regression analysis confirmed that block application was associated with tramadol consumption (P = .001). CONCLUSIONS:Although erector spinae plane blocks applied under bilateral ultrasonographic guidance did not have any efficacy for pain relief in the first 24 hours postoperation, a decrease was found in analgesic consumption compared with the nonblock group.

Background. Liver transplantation (LT) is a treatment modality in the pediatric population for several diseases like biliary atresia, metabolic liver disease, hepatoblastoma, and so on. According to the Organ Procurement and Transplantation Network, 5-year survival was reported as 85.4% to 93.5% by age after pediatric liver transplantation (PLT). This study aimed to evaluate our single-center experience of PLT by analyzing long-term results, comparing the outcomes with the literature, and identifying predictors of patient survival. Methods. The data of 40 patients who underwent LT at <18 years of age between June 2015 and June 2021 were studied retrospectively. Recipient characteristics such as age, sex, etiology of liver disease follow-up time, postoperative vascular and biliary complications, and donor characteristics were evaluated. Results. There were 20 (50%) girls and 20 (50%) boys, and the median age was 42 (IQR = 9-117) months. The most common indications of LT were biliary disorders (45%). A whole liver graft was used in 7 (17%), a right lobe graft in 9 (23%), a left lobe graft in 4 (10%), and a left lateral lobe graft in 20 (50%) of the recipients. The 1-, 3-, 5-, and 7-year survival rates were 85%, 82.1%, 82.1%, and 82.1%, respectively. The multivariate survival analysis revealed that the pediatric end-stage liver disease score, hepatic artery thrombosis, and portal vein thrombosis are associated with overall mortality. Conclusion. In conclusion, our long-term survival is similar to the literature, with satisfactory results. However, reducing the vascular complication rates can provide superior results on PLT.

BACKGROUND AND AIMS:The relationship between the Follicular Cytotoxic T cell subgroup and expression levels of PD1/PD-L1 genes and the development of donor specific antibody (DSA) is unknown. In this study, we aimed to examine CD8+CXCR5+PD-1+ follicular cytotoxic T cell levels and expression levels of PD1/PD-L1 genes in peripheral blood lymphocytes in de-novo DSA positive and negative kidney transplant recipients (KTR). METHODS:In our study, expression of PD-1/ PD-L1 genes by Real-Time Quantitative PCR method and CD8+CXCR5+PD-1+ T cell expression levels by flow cytometric method were obtained from peripheral blood samples. 63 participants were included in the study (de-novo DSA positive recipients (n = 22, group 1), de-novo DSA negative recipients (n = 20, group 2) and healthy control (n = 21, group 3). All patients had negative PRA before kidney transplantation. Expression (%) levels of target cells were evaluated by flow cytometry method. IBM SPSS Statistics for Windows Version 22 and R.3.3.2 software were used to evaluate the data. RESULTS:The demographic data of the groups were similar. PD-1 mRNA expression was higher in de-novo DSA positive KTR than negative (respectively, 1.03 ± .29/.82 ± .15, p: .001). CD8+CXCR5+PD-1+ T cell expression levels were found to be higher in the de-novo DSA positive group than in the negative group and similar to the healthy group (respectively, 3.06 ± 1.98/.52 ± .40, p:.001, 3.06 ± 1.98/2.78 ± .59, p:.62). The percentage of CD8+CXCR5+PD-1+ expressing T cells was significantly lower in the HLA-Class II+ group than other groups (HLA CI/II/ I+II, respectively, 3.63 ± 2.72/1.65 ± .50/3.68 ± 1.67, p: .04). CONCLUSIONS:In our study, a significant relationship was found between DSA formation and PD-1 mRNA level and CD8+CXCR5+PD-1+ follicular cytotoxic T cell in KTR.

OBJECTIVE Research comparing patients who received liver transplantation (LT) for hepatocellular carcinoma (HCC) has produced varying outcomes regarding survival and disease-free survival. The objective of this study is to determine the factors that influence the disease-free and overall survivals of those who have undergone LT for HCC and to compare the outcomes of living versus deceased donor liver transplants. MATERIALS AND METHODS We retrospectively analyzed data on patients aged 18 and above who received LT for HCC from 2006 to 2022. Patients with a follow-up period of less than 6 months and who did not meet the University of California San Francisco criteria were excluded. The data from 58 patients were analyzed. We split the patients into living donor liver transplantation (LDLT) (group 1) and deceased donor liver transplantation (DDLT) (group 2). RESULTS The mean age was 56 ± 8.1 years. There were 49 males and 9 females. The median of the alphafetoprotein (AFP) level and model for end-stage liver disease score was 10.1 ng/mL and 11, respectively. The 1-, 3-, 5-, and 10-year disease-free survival rates were 86%, 76.5%, 76.5%, and 76.5%, respectively. The survival rates for the same periods were 94.8%, 74.9%, 70.6%, and 67.4%. The receiver operating characteristic analysis revealed that AFP > 31.8 ng/mL and a total tumor size >3.85 cm raise the likelihood of HCC recurrence post-LT. CONCLUSION Based on the current literature, the overall survival and disease-free survival rates are influenced by factors such as AFP value, total tumor number, and total tumor diameter. In our study, the AFP value and total tumor size had an impact on the recurrence of HCC, and the survival rates were comparable on LDLT and DDLT.

Marfan's syndrome is a collagen tissue disease characterized by aortic aneurysm and dissection. In our study, a case who was diagnosed with Marfan's syndrome had a dissection flap up to the iliac bifurcation level and underwent successful renal transplantation; is presented. A 27-year-old male patient had a history of operations due to 2 aortic dissections. In the physical examination, he had hyperflexible joints, arachnodactyly, a pansystolic murmur in the mitral focus, and severe myopia. Echocardiography revealed enlargement of the aortic root, and a dissection flap extending from the abdominal aorta to the iliac bifurcation was detected in tomographic angiography. Genetic analysis revealed Fibrillin-1 gene exon 66 region c.8384T > C (p.Ile2795Thr) missense heterozygous mutation. The patient, who was diagnosed with Marfan's syndrome, underwent kidney transplantation from his healthy and non-mutated sibling. There were no vascular complications in the 1-year-period after transplantation, and he is followed up with normal kidney function. In our study, it has been shown that successful kidney transplantation can be performed in a patient with Marfan's syndrome who has a dissection flap up to the iliac bifurcation level.

Abstract Background and Aims Donor-specific antibody (DSA) development is mainly responsible for chronic antibody-mediated rejection. The immunological events that cause the development of DSA is not fully elucidated. The relationship between the Follicular Cytotoxic T cell subgroup and the development of DSA is unknown. In this study we aimed to examine CD8+CXCR5+PD-1+ follicular cytotoxic T cell levels and expression levels of PD1/PD-L1 genes in peripheral blood lymphocytes in recipients who de-novo DSA positive or negative after kidney transplantation (KTX). Method In this study, the expression levels of PD-1, PD-L1 genes were determined using the Real-Time Quantitative PCR method from peripheral blood samples of 22 KTX patients with de-novo DSA positive, 20 KTX patients with DSA negative and 21 healthy control (Table 1). Our patient groups were PRA negative before transplantation. Expression (%) levels of target cells were evaluated by flow cytometry method. IBM SPSS Statistics for Windows Version 22 and R.3.3.2 software were used to evaluate the data. Results PD-1 expression level was higher in the KTX patients with de-novo DSA positive compared to the KTX patients with DSA negative group (p:0.006 CT: 0,84±0,23). According to the results of flow cytometry, CD8+CXCR5+PD-1+ cell expression (%) levels were found to be significantly higher in patients (3,06±1,98) compared to the transplant control group (0,52±0,40) (p: 0.001) (Figure 1). Conclusion It shows that there may be a direct correlation between DSA and PD-1 / PDL-1 mRNA level and CXCR5+PD1+CD8+ follicular cytotoxic T cell in transplant patients after kidney transplantation.

This study aims to reveal the relationship between regulatory B cell (Breg) subsets and chronic-active antibody-mediated rejection (c-aABMR) in renal transplant recipients. Our study involved 3 groups of participants: renal transplant recipients with biopsy-proven c-aABMR as the chronic rejection group (c-aABMR, n = 23), recipients with stable graft functions as the patient control group (PC; n = 11), and healthy volunteers (HV; n = 11). Breg subsets, immature/transitional B cells, plasmablastic cells, B10 cells, and BR1 cells were isolated from venous blood samples by flow cytometry. The median values of Breg frequencies in the total lymphocyte population were analyzed. There were no significant differences between the study groups for immature and/or transitional B cell frequencies. Plasmablastic cell frequencies of the c-aABMR group (7.80 [2.10-27.40]) and the PC group (6.00 [1.80-55.50]) were similar, but both of these values were significantly higher than the HVs' (3.40 [1.20-8.50]), (respectively, P = .005 and P = .039). B10 cell frequencies were also similar, comparing the c-aABMR (4.20 [0.10-7.40]) and the PC groups (4.10 [0.10-5.90]), whereas the HVs (5.90 [2.90-8.50]) had the highest B10 cell fre-quency with an only statistical significance against the PC group (respectively, P = .09 and P = .028). The c-aABMR and the PC groups were similar regarding BR1 cell frequencies. How-ever, the HV group significantly had the highest frequency of BR1 cells (5.50 [2.80-10.80]) than the other groups (P < .001 for both). We demonstrated that frequencies of B10 and BR1 cells were higher in HVs than in transplant recipients, regardless of rejection state. However, there was no significant relation between Breg frequencies and the c-aABMR state.

Mucormycosis can result in serious morbidity and mortality, especially in transplant recipients. In this case report, we present a 3-year-old female patient with maple syrup urine disease who developed mucormycosis infection after deceased donor split liver transplant. Progressive segmental necrosis of the small intestines and new ischemic areas were observed after repeated abdominal surgeries. Microscopic examination of biopsy material revealed mucormycosis. Early recognition is crucial for treatment, and patients with clinical suspicion can be treated empirically with antifungal medicine. However, diagnostic tests with accurate and fast results are needed and more effective therapeutic methods should be developed for better outcomes.

Background and Aims Donor-specific antibody (DSA) development is mainly responsible for chronic antibody-mediated rejection. The immunological events that cause the development of DSA is not fully elucidated. The relationship between the Follicular Cytotoxic T cell subgroup and the development of DSA is unknown. In this study we aimed to examine CD8+CXCR5+PD-1+ follicular cytotoxic T cell levels and expression levels of PD1/PD-L1 genes in peripheral blood lymphocytes in recipients who de-novo DSA positive or negative after kidney transplantation (KTX). Method In this study, the expression levels of PD-1, PD-L1 genes were determined using the Real-Time Quantitative PCR method from peripheral blood samples of 22 KTX patients with de-novo DSA positive, 20 KTX patients with DSA negative and 21 healthy control (Table 1). Our patient groups were PRA negative before transplantation. Expression (%) levels of target cells were evaluated by flow cytometry method. IBM SPSS Statistics for Windows Version 22 and R.3.3.2 software were used to evaluate the data. Results PD-1 expression level was higher in the KTX patients with de-novo DSA positive compared to the KTX patients with DSA negative group (p:0.006 CT: 0,84±0,23). According to the results of flow cytometry, CD8+CXCR5+PD-1+ cell expression (%) levels were found to be significantly higher in patients (3,06±1,98) compared to the transplant control group (0,52±0,40) (p: 0.001) (Figure 1). Conclusion It shows that there may be a direct correlation between DSA and PD-1 / PDL-1 mRNA level and CXCR5+PD1+CD8+ follicular cytotoxic T cell in transplant patients after kidney transplantation.

Objectives: This study aimed to determine the predictive factors of BK virus viremia/nephropathy in kidney transplant recipients and to evaluate the effects of low-dose tacrolimus plus everolimus.Materials and Methods: This study included 3654 kidney transplant recipients. The patients were divided into 2 groups: group 1 were BK virus negative (n = 3525, 96.5%) and group 2 were BK virus positive (n = 129, viremia 3.5%, nephropathy 1%). Predictive factors were determined by receiver operating characteristic curve analysis and logistic regression models. We also divided and analyzed patients with BK virus viremia/nephropathy into 2 groups according to immunosuppressive changes. Group 2a had been switched to low-dose tacrolimus plus everolimus (n = 54, 41.9%), and group 2b had been switched to other immunosuppressive protocols (n = 75, 58.1%).Results: We found that use of anti-T-cell lymphocyte globulin and tacrolimus, deceased donor transplant, and rejection were predictive factors for BK virus viremia/nephropathy. In addition, patients who had low-dose calcineurin inhibitor plus mammalian target of rapamycin inhibitor regimens showed a low rate of BK virus development (only 6.2% of all cases). In Group 2a, both the BK polyomavirus-associated nephropathy rate (n = 23 [42.6%] vs n = 12 [16%] in group 2b; P = .001) and viral load (DNA > 10(4) copies/mL) (n = 49 [90.7%] vs n = 27 [36%] in group 2b; P = .001) were increased versus group 2b. Graft function, graft survival, viral clearance, and rejection rate were similar between the groups after protocol change.Conclusions: BK virus viremia/nephropathy rate was lower in patients who received low-dose calcineurin inhibitor plus mammalian target of rapamycin inhibitor protocols; the low-dose tacrolimus plus everolimus switch protocol after BK virus was more effective and safe than other protocols.

ObjectivesMaple syrup urine disease (MSUD) is an autosomal recessive inherited disorder. Despite the advances in medical nutrition therapies, classical phenotype causes severe neurological disorders and sudden death. It is known that MSUD patients do not experience metabolic attacks despite their free diet after liver transplantation (LT). This study aims to reveal the long-term results, development, mental, motor, intellectual and nutritional status of MSUD patients who underwent LT. MethodsThe data of 12 patients who underwent deceased donor (5 recipients) and living donor liver transplantation (7 recipients) were retrospectively analyzed. The age, genotype, psychometric and mental status, development, BCAA values, type of LT, donor-recipient proximity, complications, and survival were assessed. ResultsThere were 4 (33%) girls and 8 (67%) boys. The mean current age was 9.33 +/- 4.58 years. The mean follow-up time was 3 +/- 2.5 years. The repeated measures of leucine and isoleucine values revealed that there were no significant differences from the pre-LT to post-LT 1-year. The protein-restricted nutrition was switched to a free diet when oral intake was opened after LT. None of the recipients experienced metabolic attacks after the living donor or deceased donor LT. The 1-, 3-, and 5-year survival rate of the patients is 83.3%. There was no significant difference in survival between living and deceased donor liver transplantation. ConclusionsLiver transplantation is a treatment option for MSUD in proper conditions to save the patient life, increase the quality of life, and provide essential amino acids with free diet intake for growth and development.

It is known that vitamin D has positive effects on graft functions (reduce fibrosis, suppress excessive inflammatory response, improve graft functions). In our study, it was aimed to evaluate the effects and predictive roles of vitamin D, the expression of vitamin D receptor (VDR) in lymphocytes, monocytes, natural killer cells on chronic rejection and graft functions in kidney transplant patients. Seventy one people were included in the study and analyses were made by dividing them into 3 groups. Group 1: Healthy control (n = 29), Group 2: Kidney transplant patients with stable kidney function (n = 17), and Group 3: Kidney transplant patients with chronic rejection diagnosis (n = 25). Serum 25-hydroxycholecalciferol, 1.25 dihydroxycholecalciferol levels and VDR percentages in CD4 + , CD8 + , CD14 + , CD56 + cells were measured in 3 groups. ROC analyses and logistic regression models were performed to predict rejection and long-term graft functions. The percentage of VDR expression in CD4 + lymphocytes (p < 0.001) and CD14( +) monocytes (p < 0.001), 25-hydroxycholecalciferol and 1.25 dihydroxycholecalciferol levels were lower in group 3 was detected. In ROC analyses and logistic regression models, VDR expression in CD4( +)T lymphocytes was shown to have a statistically significant value in the development of chronic rejection (Odds ratio 0.86: 0.76–0.92; p = 0.001/AUC = 0.941, p < 0.001) and prediction of 5th-year graft functions (Odds ratio 0.93: 0.88–0.98; p = 0.017/AUC = 0.745, p = 0.007). In our study, it was shown that low vitamin D and VDR expression is associated with poor outcome and VDR expression in CD4( +)T lymphocytes is predictive in terms of graft function and rejection.

In living donor liver transplant, it is vital to perceive the hepatic artery anatomy and its variants. In the normal hepatic artery pattern, the common hepatic artery originates from the celiac artery to form the proper hepatic artery and gastroduodenal artery. The proper hepatic artery divides into right and left branches that supply the right and left lobes of the liver, respectively. Here, we report a rare variation of the right hepatic artery that was detected during a living liver right lobe hepatectomy. A 59-year-old man with alcoholic liver cirrhosis underwent living donor liver transplant. The patient's niece (a 47-year-old woman) volunteered to be a living donor. During the hilar dissection, we noticed that the anterior and posterior branches of the right hepatic artery passed through points anterior and posterior to the common hepatic duct, respectively. The right anterior hepatic artery and the right hepatic artery were divided separately. Although previously defined classifications have described anatomical variations of origin, branching, and course of hepatic artery, the topographical relationship of the anterior right hepatic artery and the posterior right hepatic artery versus the common hepatic duct has not been a matter of concern. Awareness must be maintained of this rare anatomical course of the right hepatic artery, especially in living liver right lobe donors. In the event of donors with rare variations, living donor liver transplant should be performed by an experienced team.

Introduction: Splenic artery steal syndrome is a phenomenon which cause graft ischaemia and dysfunction after liver transplantation. Case Presentation: A 31 year old women underwent living donor liver transplantation (LDLT) with a diagnosis of cryptogenic liver cirrhosis. In postoperative follow-up liver enzymes were elevated. Dynamic computed tomography and digital subtraction angiography revealed splenic artery steal syndrome. Splenic artery ligation was performed for treatment. Discussion: The diagnosis of splenic artery steal syndrome is made by the presence of slowed hepatic artery flow compared to the splenic artery without hepatic artery thrombosis or stenosis on digital subtraction angiography. Conclusion: Although interventional radiological procedures are the first-line treatment method, surgical treatment methods (splenectomy, splenic artery ligation) are successful in increasing hepatic artery flow.

INTRODUCTION:In this study, it was aimed to compare scintigraphic split renal function (SRF) and computed tomographic (CT) kidney volumes by semiautomatic segmentation method in predicting graft functions after kidney transplantation.METHODS:One hundred and twelve patients (77 males, 35 females) who had a living-donor kidney transplant between 2015 and 2017 in our centre were included in the study. While SRF was calculated with technetium-99m-diethylenetriaminepentaacetic acid (99m Tc-DTPA) scintigraphy, CT angiography was used for volumetric calculations.RESULTS:CT-volumetric measurements, especially renal cortical volume (RCV: 103.8 ± 20 ml) and ratio to body mass index (RCV/BMI: 4.45 ± 1.3) were found to be more significant than 99m Tc-DTPA-SRF in predicting graft functions. The correlations between SRF and RCV with 6th-month estimated glomerular filtration rate (eGFR) (rSRF: 0.052, rRCV: 0.317, p = 0.041) and 1st-year eGFR (rSRF: 0.104, rRCV: 0.374, p = 0.033) were found to be more significant in favour of RCV. The correlation between SRF/BMI and RCV/BMI with 1st-, 6th- and 12th-month eGFR (respectively, p = 0.02/0.048/0.024) were found to be more significant in favour of RCV/BMI. Although univariate analysis showed a significant relationship between most volumetric measurements and 1st-year graft functions, in multivariate analysis only RCV [odds ratio (OR): 1.04 (1.01-1.07), p = 0.023] and RCV/BMI [OR: 2.5 (1.27-5.39), p = 0.013] showed a significant relationship between graft functions.CONCLUSION:In our study, it was shown that CT-based renal volumetric measurements, especially RCV and RCV/BMI, predicted graft functions more strongly than scintigraphic 99m Tc-DTPA-SRF.