Aim: This study aimed to investigate the effect of preoperative thrombocytopenia and other risk factors on the need for emergency surgery due to complications following living donor liver transplantation (LDLT), and to evaluate the impact of emergency surgery on patient survival.Materials and Methods: The data of 270 patients who underwent LDLT for end-stage liver disease between July 2021 and October 2023 were analyzed retrospectively. Patients were divided into two groups: those requiring postoperative emergency surgery and those who did not. Preoperative demographic findings, etiology, comorbidities, Model for End-Stage Liver Disease (MELD) scores, and laboratory parameters (including platelet counts and INR) were compared between the groups.Results: Postoperative emergency surgery was required in 31 (11%) patients. The most common indications were portal vein thrombosis, intra-abdominal bleeding, and hepatic vein thrombosis. The mean preoperative platelet count was significantly lower (p=0.027) and INR was significantly higher (p=0.047) in the emergency surgery group compared to the non-emergency group. A platelet cut-off value of 81,000/mm³ was identified for predicting reoperation. There was no statistically significant difference between the groups regarding comorbidities or decompensation findings. Emergency surgical intervention significantly shortened patient survival (p

Background: Serologic compatibility, particularly ABO and Rh blood group matching, has long been considered a potential determinant of early outcomes in pediatric liver transplantation. Although the liver possesses unique tolerogenic properties that reduce susceptibility to antibody-mediated injury, the clinical significance of ABO and Rh mismatch in children remains insufficiently defined. Existing literature focuses predominantly on ABO incompatibility, while the impact of Rh disparity—despite its frequent occurrence—has never been systematically examined in a pediatric cohort. Objectives: This study aimed to evaluate the influence of ABO and Rh mismatches on early postoperative outcomes, including biliary complications, EBV seroconversion, and CMV infection, in a contemporary pediatric liver transplant population. Methods: A retrospective single-center cohort of 99 pediatric liver transplant recipients between 2022 and 2025 was analyzed. ABO and Rh compatibility were assessed using standard serologic methods. Early postoperative outcomes—biliary complications, CMV infection, EBV seroconversion, early graft dysfunction, vascular events, and acute rejection—were systematically recorded. Comparative analyses were performed between matched and mismatched groups; Rh mismatch was further evaluated through multivariable logistic regression. Results: Major ABO incompatibility was present in only 1 patient (1.0%), while 11 patients (11.1%) had Rh mismatch. Across all primary and secondary outcomes, neither ABO nor Rh mismatch was associated with increased early postoperative morbidity. Biliary complications occurred in 13 patients (13.1%), but none in the ABO-incompatible or Rh-mismatched groups. EBV seroconversion developed in 14 patients (14.1%); rates were similar between Rh-compatible (68.2%) and Rh-mismatched recipients (72.7%; p = 1.00). CMV infection occurred in 5 patients (5.1%), with no significant difference between groups (p = 1.00). All vascular complications and biopsy-proven rejection episodes occurred exclusively in serologically compatible pairs. Multivariable analysis showed no independent association between Rh mismatch and biliary morbidity, EBV seroconversion, or CMV infection. Early graft and patient survival were 100% in both ABO- and Rh-mismatched recipients. Conclusions: In this pediatric cohort, Rh mismatch demonstrated no adverse clinical impact, and the single ABO-incompatible graft did not experience early complications. These findings support the concept that pediatric liver recipients—owing to developmental immunologic tolerance—may be uniquely resilient to serologic disparities. While ABO incompatibility remains too rare for firm conclusions, Rh incompatibility appears clinically inconsequential and should not limit donor availability in pediatric transplantation. Larger multicenter studies are warranted to confirm these observations and refine allocation strategies.

OBJECTIVES:The influence of obesity on postoperative outcomes remains controversial. We evaluated the relationship between preoperative body mass index and perioperative and postoperative outcomes in adult recipients of living donor liver transplant. MATERIALS AND METHODS:We retrospectively studied 225 adult patients who underwent living donor liver transplant between November 2019 and June 2024 and grouped patients by preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) into 4 groups. Demographic data, comorbidities, operative parameters, complication rates, and survival outcomes were analyzed across groups. We used multivariable Cox regression analysis to assess independent predictors of mortality. RESULTS:Although Model for End-Stage Liver Disease scores, operative time, and hospital stay did not differ significantly among groups, higher body mass index was associated with significantly increased early postoperative complications (P = .018). Logistic regression revealed early complications as an independent predictor of mortality (odds ratio of ≈9, P < .001). Overall survival differed significantly across body mass index categories (P = .007), with poorest outcomes in morbidly obese patients (body mass index ≥ 40). Cox regression confirmed that obesity (body mass index 35-39.9) was an independent predictor of reduced long-term survival (hazard ratio = 1.65; 95% CI, 1.01-2.70; P = .045), whereas morbid obesity showed a nonsignificant trend toward higher risk. Diabetes, cardiovascular disease, and low graft-to-recipient body weight ratio were also more common in higher body mass index groups and contributed to increased mortality risk. CONCLUSIONS:Elevated body mass index was associated with increased early postoperative risk, particularly in the obese group, with reduced long-term survival posttransplant. These associations remained significant after adjustment for major clinical covariates. Presence of comorbidities and reduced graft-to-recipient weight ratio further compounded risk. Comprehensive preoperative evaluation and individualized management, including metabolic optimization and prehabilitation, may help improve outcomes in this high-risk population.

Background/Objectives: Small intestine and vermiform appendix lengths are critical anatomical parameters with significant implications for bariatric surgery, transplantation, and the management of short bowel syndrome. However, reliable normative data derived from direct in vivo measurements in healthy individuals remain limited. This study aimed to establish reference values in a homogeneous cohort of healthy living liver donors and to investigate the potential anatomical and functional correlation between these two structures based on their shared embryological origin and immunological roles. Methods: Data from 99 healthy living liver donors representing a multi-ethnic population were analyzed. Intraoperative measurements were performed using a standardized surgical technique: small intestine length was measured from the ligament of Treitz to the ileocecal valve, and appendix length from the base to the tip. Relationships between morphometric measurements and anthropometric variables were evaluated. Results: The mean small intestine length was 630 ± 104.7 cm, and the mean appendix length was 84.8 ± 21.1 mm. Small intestine length was significantly greater in males (p = 0.011), while appendix length showed no sex-based difference. A weak but statistically significant positive correlation was found between small intestine length and appendix length (r = 0.237; p = 0.021). Furthermore, an appendix length ≥ 8 cm was associated with a higher probability of having a small intestine length > 600 cm. Notably, the retrocecal appendix position was observed in only 4.0% of donors, a prevalence substantially lower than that reported in appendicitis series, suggesting it may be a risk factor for inflammation. Conclusions: This study reports descriptive measurements of small intestine and appendix lengths in healthy individuals undergoing donor hepatectomy. The relationship between the appendix and the small intestine appeared weak and should be interpreted as exploratory, warranting further investigation without implications for clinical decision-making.

Background Advanced age has traditionally been considered a relative contraindication for liver transplantation (LT) owing to increased perioperative risk and comorbid burden. However, recent evidence suggests that appropriately selected elderly patients can achieve comparable outcomes to younger recipients. Objective To evaluate and compare perioperative outcomes, comorbidities, and survival in live donor liver transplantation (LDLT) recipients aged ≥65 years versus <65 years Methods This retrospective observational study analyzed adult LDLT recipients at a high-volume transplant center between November 2019 and June 2024. Patients were divided into 2 groups based on age at transplantation: <65 years (n = 182) and ≥65 years (n = 43). Demographic data, MELD scores, comorbidities, perioperative complications, and survival rates were compared. Cox regression analysis was used to identify independent predictors of mortality. Results The elderly group had significantly lower MELD scores (15.1 vs. 17.2, p = .02) but higher rates of cardiovascular comorbidity (39.5% vs. 26.4%, p = .018). No significant differences were observed in diabetes prevalence, pulmonary disease, length of hospital stay, or early and late complication rates. One-year survival rates were 83.7% for elderly and 88.7% for younger recipients. Although the mortality risk was higher in the elderly group (HR = 2.13, p = .064), the difference was not statistically significant. Conclusion Advanced age alone should not be considered a contraindication for LDLT. With appropriate candidate selection and individualized perioperative management, elderly recipients can achieve favorable outcomes comparable to younger patients.

Background/Objectives: Small intestine and vermiform appendix lengths are critical anatomical parameters with significant implications for bariatric surgery, transplantation, and the management of short bowel syndrome. However, reliable normative data derived from direct in vivo measurements in healthy individuals remain limited. This study aimed to establish reference values in a homogeneous cohort of healthy living liver donors and to investigate the potential anatomical and functional correlation between these two structures based on their shared embryological origin and immunological roles. Methods: Data from 99 healthy living liver donors representing a multi-ethnic population were analyzed. Intraoperative measurements were performed using a standardized surgical technique: small intestine length was measured from the ligament of Treitz to the ileocecal valve, and appendix length from the base to the tip. Relationships between morphometric measurements and anthropometric variables were evaluated. Results: The mean small intestine length was 630 ± 104.7 cm, and the mean appendix length was 84.8 ± 21.1 mm. Small intestine length was significantly greater in males (p = 0.011), while appendix length showed no sex-based difference. A weak but statistically significant positive correlation was found between small intestine length and appendix length (r = 0.237; p = 0.021). Furthermore, an appendix length ≥8 cm was associated with a higher probability of having a small intestine length >600 cm. Notably, the retrocecal appendix position was observed in only 4.0% of donors, a prevalence substantially lower than that reported in appendicitis series, suggesting it may be a risk factor for inflammation. Conclusions: This study provides normative reference values derived from healthy individuals, free from the bias of cadaveric changes or inflammation. The novel finding of a correlation between small intestine and appendix lengths supports the hypothesis of a functional "anatomical continuum" within the gut-associated lymphoid tissue (GALT) system. These data may offer practical guidance for surgical planning in procedures requiring precise bowel length estimation.

BACKGROUND Knowledge of the concordance between portal vein (PV) and bile duct (BD) anatomy is essential for planning living donor liver transplantation (LDLT) and hepatobiliary surgery. Unrecognized variants can result in bile leakage, vascular injury, or graft-related complications; therefore, accurate preoperative mapping is mandatory. Because the PV and BD systems develop in parallel during embryogenesis, an anatomical relationship between them has been proposed, but available data remain limited and inconsistent. This retrospective study of 423 living liver donors aimed to evaluate the association between PV and BD types and to determine whether biliary anatomy can be anticipated from preoperative vascular imaging. MATERIAL AND METHODS Donor grafts were categorized as right or left lobe. Portal vein anatomy was assessed with triphasic CT angiography. Intraoperative cholangiography (IOC) was routinely performed for every donor to define BD anatomy. RESULTS A statistically significant association was found between PV and BD types (P=0.0028). BD variations were more frequent in donors with PV Type 2 and Type 3. Notably, 21% of donors with PV Type 1 had BD Type 3. In right-lobe donors, "classical concordance" (PV1-BD1) was observed in 57.7% (n=222), whereas in left-lobe donors it was 34.2% (n=13). Overall "anatomical concordance" (direct PV-BD type match) was 64.9% in right-lobe and 52.6% in left-lobe donors. CONCLUSIONS PV and BD anatomies are significantly related, supporting the concept of parallel embryological development. However, relevant biliary variants can occur even in donors with normal PV anatomy, particularly in left-lobe grafts. Thus, PV type alone is not sufficient to predict biliary complexity, and IOC together with meticulous preoperative evaluation remains essential in LDLT.

Background and Objectives: Living donor hepatectomy is an essential component of liver transplantation programs, with donor safety representing the foremost priority. This study aimed to evaluate early postoperative complications in living liver donors and to identify clinical and demographic factors associated with complication risk using the Clavien–Dindo classification. Materials and Methods: A retrospective analysis was conducted on 502 consecutive living liver donors who underwent hepatectomy between August 2021 and May 2025. Donors received standardized preoperative evaluation, surgical management, and postoperative follow-up. Demographic characteristics, graft-related variables, remnant liver ratio, and clinical outcomes were recorded. Postoperative complications were graded using the Clavien–Dindo classification, with Grade ≥ IIIa defined as major complications. Univariable and multivariable logistic regression analyses were performed. Results: Postoperative complications occurred in 58 donors (11.6%; 95% CI: 9.0–14.6%), the majority of which were mild to moderate (Grades I and II). Biliary complications were the most frequent cause of morbidity. Major complications (≥Grade IIIa) were observed in 17 donors, while no Grade IV and V complications or mortalities were recorded. Donors with complications had significantly longer hospital stays (p = 0.0002). Although crude complication rates were higher among Turkish donors than foreign donors (13.9% vs. 7.5%, p = 0.043), this association did not remain statistically significant after multivariable adjustment. No independent associations were identified between complication risk and graft type, remnant liver ratio, graft volume, or BMI. Conclusions: Living donor hepatectomy was associated with a low rate of severe early postoperative complications under standardized protocols. However, given the retrospective design and limited structured long-term follow-up, these findings primarily reflect early postoperative safety. Biliary complications remain the most common postoperative issue. Further multicenter prospective studies with extended follow-up are needed to comprehensively assess long-term donor outcomes.

OBJECTIVE:Liver transplantation is currently the most treatment for fulminant hepatitis, end-stage liver failure, hepatocellular carcinoma, and liver-originated metabolic diseases in children. With technological advances, improvements in surgical techniques and immunosuppressive therapy protocols have increased 1-year survival rates to 80%-90%. Our center successfully performs both living donor and cadaveric liver transplants in children. This study retrospectively analyzed the preoperative and postoperative data of 72 pediatric patients who underwent liver transplantation between July 2022 and July 2024. METHODS:We included 72 patients who underwent liver transplantation between July 1, 2022, and July 1, 2024. Cases were evaluated based on demographic data, liver failure etiology, and postoperative complications. RESULTS:Of the cases, 37 were female (58%) and 35 male (42%), with a mean age of 6.6 years (ranging from 5 months to 17 years and 11 months). Indications included biliary atresia (25), autoimmune hepatitis (9), cryptogenic cirrhosis (7), PFIC (7), congenital hepatic fibrosis (1), Caroli disease (2), Wilson's disease (4), Alagille syndrome (3), hepatocellular carcinoma (2), primary hyperoxaluria type 1 (2), Crigler Najjar syndrome type 1 (3), Budd-Chiari syndrome (1), glycogen storage disease type 3 (1), portal vein thrombosis (1), and acute fulminant hepatitis (4). Mean PELD score for patients under 12 years was 18 (range 0-37), and MELD score for patients over 12 years was 19.3 (range 11-40). A total of 69 patients received orthotopic liver transplantation from living donors. Two patients received combined liver and kidney transplants, and 1 received a cadaveric liver transplant. Donors included 40 females and 32 males. Left lobe transplants were performed in 58 patients, and right lobe in 14. Immunosuppression included Tacrolimus + MMF in 70 patients and Cyclosporine in 2. Postoperative complications included biliary anastomosis stenosis (3), bile leakage (2), hepatic vein thrombosis (1), portal vein thrombosis (4), intestinal perforation secondary to Bogota syndrome (5), PRES syndrome due to Tacrolimus toxicity (1), primary graft dysfunction (1), and postoperative bleeding (2). Within the first month, 12 patients (16.6%) died, and 3 (4%) died between 1 month and 1 year postoperatively. The most common early cause of death was sepsis and multiorgan failure. One patient developed chronic rejection but recovered with steroid immunosuppression without the need for re-transplantation. CONCLUSION:Liver transplantation is a high-risk procedure requiring lifelong medication and follow-up. It is, however, the most effective treatment method for several severe pediatric liver conditions.

OBJECTIVE:Despite advancements in surgical techniques, biliary complications remain a significant concern in liver transplantation. This study evaluated the effectiveness of applying a variceal band to the cystic duct stump in preventing bile leakage in patients with a trans-cystic feeding catheter. METHODS:The medical records of 328 liver transplant recipients between April 2022 and June 2024 were retrospectively reviewed. A total of 170 patients with trans-cystic external catheters were included in the study. Of these, 116 patients underwent variceal band application to the cystic duct stump, while 54 did not. The 2 groups were compared regarding demographic characteristics, graft weight, number of bile ducts, presence of bile leakage, and MELD scores. RESULTS:Among the 170 patients who underwent living-donor liver transplantation (LDLT), 58.8% were male, and 41.2% were female. Graft weight was significantly higher in the group with the variceal band application (p < .05). Bile leakage from the cystic duct stump occurred in 2 patients in the group without variceal banding, whereas no bile leakage was observed in the variceal band group. These 2 cases were successfully treated with percutaneous catheter placement under radiologic guidance. CONCLUSION:The variceal band application is an effective and promising method for reducing bile leakage in LDLT patients utilizing a trans-cystic feeding catheter. However, multicenter studies with larger patient cohorts are necessary to more definitively assess the safety and efficacy of this technique.

BACKGROUND:Selecting the appropriate graft for living donor liver transplantation requires accurate calculation of estimated graft volume. PURPOSE:To investigate the error rate in graft volume calculation in the preoperative evaluation of donor liver and the contribution of donor portal vein type to the error margin. MATERIAL AND METHODS:The study included 197 right lobe liver donors. Estimated graft volume calculations based on preoperative radiological images of donors were retrospectively reviewed. Demographic data of the donors and liver portal vein type were recorded. The proportional differences between the weight of the right lobe graft removed during transplantation and the estimated volume were calculated separately according to the portal vein groups. The margin of error in the estimated graft volume measurement and the effect of portal vein type were statistically evaluated. RESULTS:Considering all donors, estimated preoperative volume was calculated to be 6.877% higher than actual graft weight on average. Preoperative estimated graft volume was on average 5.746% higher for Type 1, 8.311% higher for Type 2, and finally 17.883% higher for Type 3 portal vein variant. It was shown that, as the portal vein anatomy in the donor becomes more complex, the negatively proportional difference in preoperative volume estimation increases. CONCLUSION:Volume estimation showed a negative proportional difference for all three variants of the portal vein. Especially, the presence of a Type 3 portal vein in the liver graft may cause more errors in preoperative graft volume calculation.

Acute liver failure (ALF) caused by hepatic vascular injury during cholecystectomy is a rare but serious indication of liver transplantation (LT). We present a case of acute liver failure secondary to portal vein, hepatic artery, and common bile duct injury during laparoscopic cholecystectomy, requiring a same-day emergency living donor liver transplantation (LDLT). A 57-year-old man underwent elective laparoscopic cholecystectomy at an external facility. During the operation, uncontrolled bleeding from the liver hilum led to conversion to open surgery. Despite attempts to control the bleeding with sutures, the patient developed abnormal liver enzymes postoperatively. A computed tomography scan revealed necrosis of the right liver lobe and hypoplasia of the left lobe, leading to the patient to be transferred to our center. Upon admission, the patient was found to have encephalopathy, coagulopathy, hypotension, and oliguria, with elevated transaminase levels. Based on these findings, an emergency LT was deemed necessary. Due to the unavailability of a cadaveric organ, the patient's daughter was prepared as a living donor. Exploratory laparotomy revealed a necrotic right liver lobe, atrophic left lobe, transection of the right hepatic artery and common bile duct, and a thrombosed right portal vein. The patient successfully underwent LDLT from his daughter within 24 hours. At the seventh-month follow-up, he had no complications. Hepatic vascular injury during laparoscopic cholecystectomy can lead to ALF, which carries a high mortality risk. In such cases, LDLT may be a life-saving strategy. Early referral of a patient with ALF to a transplant center is life-saving.

BACKGROUND:Portal vein thrombosis (PVT) is a significant vascular complication in liver transplant candidates, necessitating modifications in surgical techniques and increasing the risk of postoperative complications. This study aimed to evaluate postoperative thrombotic complications, the need for reoperation, survival, and mortality rates after living donor liver transplantation (LDLT) in patients with preoperative PVT. METHODS:Forty-nine patients diagnosed with preoperative PVT undergoing LDLT between July 2021 and August 2024 at our center were retrospectively reviewed. Patients were classified according to the Yerdel classification. Surgical techniques, portal vein reconstruction, associated diseases, MELD/PELD scores, postoperative PVT occurrence, the need for reoperation, and survival data were analyzed. RESULTS:Postoperative PVT developed in 6 patients (12.2%); 3 of these patients (6.1%) required reoperation. Overall, mortality occurred in 13 patients (26.5%); 3 cases were due to non-PVT-related reasons (sepsis following ERCP/PTC or sudden cardiac arrest). The PVT-related mortality rate was 20.4% (10 patients). Mortality was observed in 4 (66.7%) patients with postoperative PVT. Among 8 patients with Yerdel Grade 3-4 PVT, postoperative PVT occurred in 2 patients (25%). Thrombosis occurred in 2 of 6 patients (33.3%) who underwent graft reconstruction; 1 required reoperation. Portal flow was successfully restored in 83.3% of reconstructed cases. Patients developing postoperative PVT had a higher mean MELD/PELD score (22.5 vs. 19.2), an average age of 48.8 years, and equal gender distribution. The mean follow-up period was 14.2 months overall and 7.7 months in patients with postoperative PVT. Comorbidities (diabetes, hypertension, cardiac, or pulmonary pathology) were present in approximately 50% of patients with postoperative PVT and 62% of those who died. The most common preoperative diagnoses were cryptogenic cirrhosis (22.4%), NASH (18.3%), and HBV infection (16.3%). CONCLUSION:Preoperative PVT significantly correlates with postoperative PVT development and mortality following LDLT. Advanced Yerdel stages, high MELD/PELD scores, and the necessity for portal vein reconstruction increase this risk. Early diagnosis, close imaging follow-up, and proper anticoagulation management postoperatively are crucial. Our findings highlight the importance of a multidisciplinary approach in surgical planning and lay the groundwork for prospective, multi-center studies.

Purpose: Hepatic artery provides blood supply to the biliary tract of the graft, one of the causes of the biliary complications that may occur in the post-transplant period may be the problems of the recipient's hepatic artery. We examined the effect of post-transplant biliary complications according to the type and number of recipient hepatic artery. Materials and Methods: One hundred eighty five patients older than 18 years of age who underwent right lobe LDLT for end-stage liver cirrhosis were included in the study. The recipient's right hepatic artery (RHA), left hepatic artery (LHA), propria hepatic artery (PHA) and common hepatic artery (CHA), which were anastomosed to the graft artery and double hepatic artery anastomoses formed of the right and left hepatic arteries, were examined. Biliary complications were analyzed statistically in terms of single or double artery anastomosis and anastomoses with the right or the other hepatic arteries. Results: There was no statistically significant difference between single and dual artery anastomoses in terms of bile duct stricture or leakage (p=0.767). No statistically significant difference was observed between RHA, LHA, PHA, CHA, and between single and dual arteries in the evaluation of artery selection between those with and without biliary tract complications (p=0.445) Conclusion: Hepatic artery type selection and number of the recipient does not change the biliary tract complication.

OBJECTIVE:It was aimed to examine the overall role of cold ischemia time and anhepatic phase durations in terms of peroperative blood transfusion needs, hospital stay conditions and postoperative charges, and survival in recipients. MATERIAL AND METHODS:One hundred forty-eight adult living donor liver transplant recipients (18 years and older) were included in the study. Whether the anhepatic phase and cold ischemia duration have an effect on the rates of surgery time, blood product transfusion, total hospital and intensive care unit stay, postoperative biliary complications, hepatic vein thrombosis, portal vein thrombosis, early postoperative bleeding, sepsis, and primary graft dysfunction. Was analyzed statistically. In addition, the effect of the anhepatic phase and cold ischemia time on graft survival was statistically examined by creating an average of the patient follow-up period. RESULTS:It was observed that the operation time increased statistically as the cold ischemia time increased (P = .000). No statistically significant relationship was found between other findings and cold ischemia time and anhepatic phase. CONCLUSION:Prolonged surgery time due to increased cold ischemia time may be an important finding in terms of peroperative and postoperative results of the graft.

Giriş ve Amaç: Steatoz, greft fonksiyonunu değişen derecelerde etkileyen ve marjinal greft yetmezliğine neden olan günümüzün önemli ve yaygın donör karaciğer problemlerinden biridir. Çalışmamızda, greft steatozunun postoperatif komplikasyonlara etkisini inceledik. Gereç ve Yöntem: Çalışmaya 148 donör ve transplantasyon yapılan yetişkin canlı donör karaciğer nakli alıcısı dahil edildi. Perioperatif kan ürünü transfüzyonu, postoperatif safra komplikasyonları, hepatik ven trombozu, portal ven trombozu, postoperatif kanama, sepsis ve primer greft disfonksiyonu sayıları ve oranları istatistiksel olarak analiz edildi. Bulgular: Ameliyat sonrası erken dönemde intraabdominal kanamanın yağlı greftlerde oran olarak, yağsız greftlere göre daha sık olduğu görüldü. Donör greft steatozu olan ve olmayanlar arasında tüm parametreler açısından istatistiksel olarak anlamlı fark yoktu. Sonuç: İstatistiksel olarak anlamlı olmasa da yağlı greftlerde ameliyat sonrası intraabdominal kanama oranının yüksek olması önemli bir bulgu olabilir.

Objective: This study presents the causes of death-censored graft loss among kidney transplant recipients. Materials and Methods: Medical records of the patients, who had undergone kidney transplantation at a tertiary center between November 2010 and December 2018, were retrospectively reviewed. Death-censored graft loss was described as an irreversible graft failure signified by return to long-term dialysis (or re-transplantation). Inclusion criteria were: patients who had undergone kidney transplantation, and subsequently lost their first graft, and a follow-up of more than one year after kidney transplantation. Results: Of 269 kidney transplant recipients, 33 recipients with a mean age of 33.54 ± 15.37 years (17 male and 16 female) were included in the study. The rate of death-censored graft loss was 12.26%. Of graft failures, 3.03% occurred in the hyperacute phase, 18.18% in the acute phase, and 78.78% in the chronic phase. Chronic allograft nephropathy was the leading cause of graft failure (48.48%). Other causes were medical problems (18.18), immunological problems (18.18%) and surgical complications (15.15%). Conclusion: Identification of the true causes of graft failure described under the heading chronic allograft nephropathy is noteworthy. Comprehensive biochemical, physiological, pathological, immunological, and genetic research should be implemented to remove the obstacles in kidney transplantations.

Neuroendocrine tumors (NETs) arising from extrahepatic bile ducts are very rare. We present a patient with perihilar NET who was operated on with a preoperative diagnosis of Klatskin tumor. A 58-year-old female patient was admitted with abdominal pain and jaundice. Laboratory data showed elevated serum bilirubin levels and liver function tests. Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) findings were consistent with perihilar bile duct tumor. The patient was operated on with a diagnosis of Klatskin tumor. She underwent right hepatectomy, resection of the extrahepatic bile duct, portal lymphadenectomy and Roux-en-Y hepaticojejunostomy. The final pathologic examination of the resected specimen demonstrated a well differentiated neuroendocrine tumor (Grade 1). NETs originating from perihilar bile ducts are extremely rare, and preoperative definite diagnosis is very difficult. It should be kept in mind that NET may be one of the rare causes of perihilar bile duct obstruction.

Background and Aims: We aimed to investigate the effect of the high MELD score on perioperative recipient/graft ischemia times and postoperative complications. Materials and Method: One hundred and seventy-two patients who underwent living-donor liver transplantation for end stage liver cirrhosis were included in the study. The patients were grouped and examined according to their MELD score under and above 20. Anhepatic phase, cold ischemia time, operation time, blood product transfusion, total hospital and intensive care unit staying time rates, biliary complications, hepatic vein thrombosis, portal vein thrombosis, postoperative hemorrhage, sepsis, and primary graft dysfunction were analyzed statistically. Results: Cold ischemia time (p = 0.046) was statistically longer in patients with MELD >20. A result very close to the statistically significant P value regarding perioperative blood transfusion was obtained. Conclusion: Cold ischemia time increases with increasing MELD. The MELD score must be taken into consideration when preparing the patient and making a treatment plan.