Browsing by Author "Iakobadze, Zaza"

Now showing 1 - 5 of 5

Citation - WoS: 6
Citation - Scopus: 5
Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation
(Wiley, 2021) Kılıç, Murat; Karaca, Can; Yılmaz, Cahit; Farajov, Rasim; Iakobadze, Zaza; Kilic, Kamil; Aydogdu, Sema
Biliary complications (BCs) are still a major cause of morbidity following liver transplantation despite the advancements in the surgical technique. Although Roux-en-Y (RY) hepaticojejunostomy has been the standard technique for years in pediatric patients, there is a limited number of reports on the feasibility of duct-to-duct (DD) anastomosis, and those reports have controversial outcomes. With the largest number of patients ever reported on the topic, this study aims to discuss the feasibility of the DD biliary reconstruction technique in pediatric living donor liver transplantation (LDLT). After the exclusion of the patients with biliary atresia, patients who received either deceased donor or right lobe grafts, and retransplantation patients, data from 154 pediatric LDLTs were retrospectively analyzed. Patients were grouped according to the applied biliary reconstruction technique, and the groups were compared using BCs as the outcome. The overall BC rate was 13% (n = 20), and the groups showed no significant difference (P = 0.6). Stricture was more frequent in the DD reconstruction group; however, this was not statistically significant (P = 0.6). The rate of bile leak was also similar in both groups (P = 0.6). The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied.
Citation - WoS: 3
Citation - Scopus: 6
Duct-To Biliary Reconstruction in Pediatric Split-Liver Transplantation [letter]
(Wiley, 2018) Yılmaz, Cahit; Karaca, Can A.; Ferecov, Rasim; Iakobadze, Zaza; Kilic, Kamil; Tosun, Adnan; Kılıç, Murat
[Abstract Not Available]
Citation - WoS: 1
Hepatic Venous Outflow Reconstruction Directly Into the Right Atrium
(Baskent Univ, 2025) Karaca, Can A.; Yilmaz, Cahit; Farajov, Rasim; Iakobadze, Zaza; Kilic, Kamil; Buket, Suat; Kilic, Murat
Objectives: Living-donor liver transplant for Budd-Chiari syndrome is particularly challenging because of the need for venous outflow reconstruction as grafts from living donors lack vena cava. In addition, recipient vena cava may be thrombotic and fibrotic to such an extent that it would not allow graft venous outflow reconstruction. Under these circumstances, the right atrium provides an easily accessible alternative for venous outflow reconstruction, omitting the need for vena cava replacement. Materials and Methods: Data from 3 patients who were treated using this technique were collected and evaluated with regard to surgical technique and outcomes. Results: All patients were alive without vascular complications after a mean follow-up of 67 months. The applied surgical technique was similar except with regard to vena cava preservation. Conclusions: During the natural course of the disease, venous collaterals form as chronic thrombosis extends into the vena cava. The vena cava can be safely resected in these patients to facilitate hepatectomy through dense adhesions, which is another common clinical problem in this disease. Consequently, venous outflow reconstruction to the right atrium creates the feasible opportunity of draining the graft liver without having to replace the vena cava.
Citation - WoS: 9
Citation - Scopus: 11
Live Donor Liver Transplantation for Type 1 Tyrosinemia: an Analysis of 15 Patients
(Wiley, 2019) Karaca, Can; Yılmaz, Cahit; Farajov, Rasim; Iakobadze, Zaza; Aydogdu, Sema; Kılıç, Murat
Type 1 tyrosinemia is a rare metabolic disorder of the tyrosine degradation pathway. Due to the rarity of the disease, the best evidence literature offers is limited to guidelines based on expert opinions and optimal treatment is still a debate. LT serves as a definitive treatment of the defective metabolic pathway in the liver along with other serious disease manifestations such as LF and HCC. Nitisinone is a relatively new agent that is currently recommended for the medical management of the disease. Its mechanism of action is well understood, and efficacy is well established when started presymptomatically. This study aims to evaluate outcomes of 15 patients with type 1 tyrosinemia who underwent LT in nitisinone era and discuss its effect on prevention of HCC. A LT database of 1037 patients was reviewed. Data from 15 patients with type 1 tyrosinemia were retrospectively analyzed. All the patients except one were treated with nitisinone prior to LT. Most common indications for LT were LF and suspicious nodules. Seven patients had HCC. Mortality rate was 20% (n = 3). Nitisinone treatment has opened new horizons in the management of type 1 tyrosinemia, but LT still remains the only option for the patients developing LF and in the event of HCC. Neonatal screening programs utilizing blood succinyl acetone as the marker should be encouraged especially in the countries, such as Turkey, with high prevalence of consanguineous marriages.
Citation - WoS: 2
Citation - Scopus: 1
Portal Vein Pull-Through Technique and Thrombectomy for Extensive Portal Vein Thrombosis
(Elsevier Science Inc, 2023) Kılıç, Murat; Farajov, Rasim; Iakobadze, Zaza; Akcalar, Seray; Camli, Dilsat; Kilic, Kamil; Yılmaz, Cahit; Karaca, Can A.
Background. Herein, a different technique is presented describing complete dissection of the entire portal vein (PV), superior mesenteric vein (SMV), and splenic vein, thus enabling a complete thrombectomy without the risk of uncontrolled hemorrhage due to blind thrombectomy. Methods. In cases where a thrombectomy would not be an option because of extensive thrombosis involving the confluence of the PV and SMV, small branches of the SMV, including the inferior mesenteric vein, were divided. Both the SMV and splenic vein were encircled separately. Then, the side branches of the PV above the pancreas, left gastric vein on the left side, and superior pancreatoduodenal vein on the right side were divided. The lateral and posterior part of the PV were dissected within the pancreas both from above and below, allowing the main PV completely free from attachments. At this point, the splenic vein and SMV were clamped, and the main PV was divided above the pancreas and then pulled back through the pancreatic tunnel. The thrombus was easily dissected of the vein under direct visualization, and afterward the PV was redirected to its original position. Then, the liver transplant was carried out in a regular fashion. Results. This technique was applied to 2 patients. The first was a 43-year-old man who underwent a right lobe living donor liver transplant because of hepatitis B virus-related cirrhosis. The patient is still alive and well with stable liver function after 15 years of follow-up. The second was a 69-year-old woman who underwent a right lobe living donor liver transplant because of hepatitis C virus and hepatocellular carcinoma. She survived the procedure and her liver function was entirely normal afterward. She died of pneumonia and sepsis 5 months after transplant. Conclusions. This technique enables complete dissection of the entire PV, SMV, and splenic vein. Thus, complete thrombectomy under direct visualization without the risk of uncontrolled hemorrhage can be performed.