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Impact of COVID-19 pandemic on clinicopathological features of transplant recipients with hepatocellular carcinoma:A case-control study

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World Journal of Clinical Cases 2022年第15期10卷 4785-4798页

作者： sami akbulut Tevfik Tolga Sahin Volkan Ince Sezai Yilmaz Surgery and Liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic had a significant impact on the management of all diseases.Various diseases such as cancer have a higher risk of COVID-19-related death.Despite this fact,any delay or alteration in treatment of cancer may have fatal consequences.Hepatocellular carcinoma(HCC)is an aggressive liver cancer that requires multimodality treatment to improve survival.AIM To evaluate the impact of COVID-19 on the management of patients with HCC by determining changes in demographic,clinical and histopathological variables.METHODS Demographic,clinical and pathological variables of patients with HCC who had undergone liver transplantation between March 2020 and June 2021(Pandemic group,n=48)were retrospectively compared with that of the patients with HCC transplanted between November 2018 and March 2020(Pre-pandemic group,n=61).RESULTS The median age of the patients in the study was 56(interquartile range=15).Ninety-seven patients(89%)were male and 12 were female(11%).The most common etiology of liver disease was hepatitis B virus(n=52,47.7%).According to our results,there was a 21.3% drop in the number of patients transplanted for HCC.There was no difference in the demographic,clinical and pathological characteristics of the patients except blood alkaline phosphatase levels(P=0.029),lymphovascular invasion(P=0.019)and type of the liver graft that was transplanted(P=0.017).CONCLUSION It is important to develop a surveillance strategy for liver transplant centers.The liver transplantation for HCC is justified and safe provided that strict surveillance protocols are applied.

关键词： COVID-19 pandemic Liver transplantation Hepatocellular carcinoma Biological behavior

Autoimmune hepatitis and liver transplantation:Indications,and recurrent and de novo autoimmune hepatitis

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World Journal of Transplantation 2022年第3期12卷 59-64页

作者： Murat Harputluoglu Ali Riza Caliskan sami akbulut Department of Gastroenterology and Transplant Hepatology Inonu University Faculty of MedicineMalatya 44280Turkey Department of Gastroenterology Adiyaman Education and Research HospitalAdıyaman 04120Turkey Liver Transplant Institute Inonu UniversityMalatya 44280Turkey

Autoimmune hepatitis is a chronic inflammatory disease of the liver that is characterized by circulating autoantibodies and elevated serum globulin levels.Liver transplantation may be required for patients with acute liver failure,decompensated cirrhosis,and hepatocellular carcinoma.Recurrence is defined as development of the same disease in the allograft following liver transplantation.Autoimmune hepatitis recurs in 36%-68%of the recipients 5 years after liver transplantation.De novo autoimmune hepatitis is the development of autoimmune hepatitis like clinical and laboratory characteristics in patients who had undergone liver transplantation for causes other than autoimmune hepatitis.Diagnostic work up for recurrent and de novo autoimmune hepatitis is similar to the diagnosis of the original disease,and it is usually difficult.Predniso(lo)ne with or without azathioprine is the main treatment for recurrent and de novo autoimmune hepatitis.Early diagnosis and treatment are vital for patient prognosis because de novo autoimmune hepatitis and recurrent autoimmune hepatitis cause graft loss and result in subsequent retransplantation if medical treatment fails.

关键词： Liver transplantation Autoimmune hepatitis Recurrence autoimmune hepatitis De novo autoimmune hepatitis

Clinical presentation,management,screening and surveillance for colorectal cancer during the COVID-19 pandemic

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World Journal of Clinical Cases 2022年第26期10卷 9228-9240页

作者： sami akbulut Abdirahman Sakulen Hargura Ibrahim Umar Garzali Ali Aloun Cemil Colak Department of Surgery Inonu University Faculty of MedicineMalatya 44280Turkey Biostatistics and Medical Informatics Inonu University Faculty of MedicineMalatya 44280Turkey Department of Surgery Kenyatta University TeachingReferral and Research HospitalNairobi 00100Kenya Department of Surgery Aminu Kano Teaching HospitalKano 700101Nigeria Department of Surgery King Hussein Medical CenterAmman 11855Jordan

Management of colorectal cancer(CRC)was severely affected by the changes implemented during the pandemic,and this resulted in delayed elective presentation,increased emergency presentation,reduced screening and delayed definitive therapy.This review was conducted to analyze the impact of the coronavirus disease 2019(COVID-19)pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic.We performed a literature search in PubMed,Medline,Index Medicus,EMBASE,SCOPUS,Reference Citation Analysis(https://***/)and Google Scholar using the following keywords in various combinations:Colorectal cancer,elective surgery,emergency surgery,stage upgrading,screening,surveillance and the COVID-19 pandemic.Only studies published in English were included.To curtail the spread of COVID-19 infection,there were modifications made in the management of CRC.Screening was limited to high risk individuals,and the screening tests of choice during the pandemic were fecal occult blood test,fecal immunochemical test and stool DNA testing.The use of capsule colonoscopy and open access colonoscopy was also encouraged.Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic.The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation.Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors.The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done,which may require exteriorization by stoma.This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital.There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection.As we gradually come out of the pandemic,we should remember the lessons learned and continue to apply them even after the pandemic passes.

关键词： COVID-19 pandemic Colorectal cancer Screening Surveillance Stage upgrading Elective surgery Emergency surgery

In memoriam of Thomas Earl Starzl,the pioneer of liver transplantation

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World Journal of Transplantation 2022年第3期12卷 55-58页

作者： Sezai Yilmaz sami akbulut Surgery and Liver Transplant Institute Inonu UniversityMalatya 44280Turkey

Starzl’s nearly 3000 publications that contribute to the science of transplantation in every field have been the most important resources for every scientist working in this field.For those of us who work in the liver transplant field,his contributions throughout his life have shaped our career and passion,even for those who have never met,spoken to,or worked with him.If we are able to help patients with liver failure today by offering them the chance of transplantation,it is because of Starzl’s passionate work and efforts.Thanks to Starzl’s scientific legacy,hundreds of scientists serve humanity and thousands of patients can hold on to life.It has been an honor for us to write this article about Professor Starzl.

关键词： Liver transplantation Thomas Earl Starzl Pioneer of liver transplantation

Intussusception due to inflammatory fibroid polyp:A case report and comprehensive literature review

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World Journal of Gastroenterology 2012年第40期18卷 5745-5752页

作者： sami akbulut Department of Surgery Diyarbakir Education and Research Hospital

AIM:To give an overview of the literature on intussusception due to inflammatory fibroid polyp(IFP).METHODS:We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP,accessed via PubMed and Google Scholar databases.For the search,the keywords used were:intussusception,IFP,intussusception and IFP,intussusception due to IFP,and IFP presenting as intussusception.The search covered all articles from 1976 to November 2011.RESULTS:We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain,vomiting,and nausea.Ultrasonography demonstrated small bowel intussusception.An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy.Partial ileal resection and anastomosis were performed.A diagnosis of ileal IFP was made based on the immunohistochemical findings.In addition,a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review.The patients were aged 4 to 81 years(mean,49 ± 16.2 years);44 were women(mean,51.8 ± 14.3 years) and 41 were men(mean,46 ± 17.5 years).According to the location of the IFP,ileal intussusception was found in 63 patients,while 17 had jejunal,three had colonic,and two had ileojejunal intussusception.CONCLUSION:Although IFPs are rare and benign,surgery is the only solution in case of intestinal obstruction.Differential diagnosis should be made via immunohistochemical examination.

关键词：文献综述肠套叠纤维性病例报告关键字搜索 PubMed IFP 肉

Adipose-derived stem cells in the treatment of hepatobiliary diseases and sepsis

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World Journal of Clinical Cases 2022年第14期10卷 4348-4356页

作者： Basri Satilmis Gizem Selen Cicek Egemen Cicek sami akbulut Tevfik Tolga Sahin Sezai Yilmaz Hepatology Research Laboratory Liver Transplant InstituteInonu UniversityMalatya 44000BattalgaziTurkey Department of Biochemistry Faculty of PharmacyInonu UniversityMalatya 44000BattalgaziTurkey Department of Anesthesiology and Reanimation Malatya Training and Research HospitalMalatya 44000YesilyurtTurkey Liver Transplant Institute InonuUniversityMalatya 44000BattalgaziTurkey

Determination of the mesenchymal stem cells is one of the greatest and most exciting achievements that tissue engineering and regenerative medicine have achieved.Adipose-derived mesenchymal stem cells(AD-MSC)are easily isolated and cultured for a long time before losing their stem cell characteristics,which are self-renewal and pluripotency.AD-MSC are mesenchymal stem cells that have pluripotent lineage characteristics.They are easily accessible,and the fraction of stem cells in the adipose tissue lysates is highest among all other sources of mesenchymal stem cells.It is also HLA-DR negative and can be transplanted allogenically without the need for immunosuppression.These advantages have popularized its use in many fields including plastic reconstructive surgery.However,in the field of hepatology and liver transplantation,the progress is slower.AD-MSC have the potential to modulate inflammation,ameliorate ischemia-reperfusion injury,and support liver and biliary tract regeneration.These are very important for the treatment of various hepatobiliary diseases.Furthermore,the anti-inflammatory potential of these cells has paramount importance in the treatment of sepsis.We need alternative therapeutic approaches to treat end-stage liver failure.AD-MSC can provide a means of therapy to bridge to definitive therapeutic alternatives such as liver transplantation.Here we propose to review theoretic applications of AD-MSC in the treatment of hepatobiliary diseases and sepsis.

关键词： Adipose-derived stem cells Hepatobiliary diseases Sepsis Mesenchymal stem cells Theoretic application

Outcome of split liver transplantation vs living donor liver transplantation:A systematic review and meta-analysis

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1522-1531页

作者： Ibrahim Umar Garzali sami akbulut Ali Aloun Motaz Naffa Fuat Aksoy Department of Surgery Aminu Kano Teaching HospitalKano 700101Nigeria Department of Surgery and Liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey Department of Biostatistics and Medical Informatics Inonu University Faculty of MedicineMalatya 44280Turkey Royal Medical Services King Hussein Medical CenterAmman 11855Jordan Department of Surgery Uludag University Faculty of MedicineBursa 16059Turkey

BACKGROUND The outcomes of liver transplantation(LT)from different grafts have been studied individually and in combination,but the reports were conflicting with some researchers finding no difference in both short-term and long-term outcomes between the deceased donor split LT(DD-SLT)and living donor LT(LDLT).AIM To compare the outcomes of DD-SLT and LDLT we performed this systematic review and meta-analysis.METHODS This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.The following databases were searched for articles comparing outcomes of DD-SLT and LDLT:PubMed;Google Scholar;Embase;Cochrane Central Register of Controlled Trials;the Cochrane Database of Systematic Reviews;and Reference Citation Analysis(https://***/).The search terms used were:“liver transplantation;”“liver transplant;”“split liver transplant;”“living donor liver transplant;”“partial liver transplant;”“partial liver graft;”“ex vivo splitting;”and“in vivo splitting.”RESULTS Ten studies were included for the data synthesis and meta-analysis.There were a total of 4836 patients.The overall survival rate at 1 year,3 years and 5 years was superior in patients that received LDLT compared to DD-SLT.At 1 year,the hazard ratios was 1.44(95%confidence interval:1.16-1.78;P=0.001).The graft survival rate at 3 years and 5 years was superior in the LDLT group(3 year hazard ratio:1.28;95%confidence interval:1.01-1.63;P=0.04).CONCLUSION This meta-analysis showed that LDLT has better graft survival and overall survival when compared to DD-SLT.

关键词： Deceased donor liver transplantation Living donor liver transplantation Split liver transplantation Overall survival Graft survival Acute rejection

Graft-versus-host disease after liver transplantation:A comprehensive literature review

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World Journal of Gastroenterology 2012年第37期18卷 5240-5248页

作者： sami akbulut Mehmet Yilmaz Sezai Yilmaz Liver Trans plant Institute Inonu University Faculty of Medicine

AIM:To determine the factors affecting mortality in patients who developed graft-versus-host disease (GvH) after liver transplantation (LT) METHODS:We performed a review of studies of GvH following LT published in the English literature and accessed the PubMed, Medline, EBSCO, EMBASE, and Google Scholar databases Using relevant search phrases, 88 articles were identified. Of these, 61 articles containing most of the study parameters were considered eligible for the study. Risk factors were first examined using a univariate Kaplan-Meier model, and variables with a significant association (P < 0 05) were then subjected to multivariate analyses using a Cox proportional-hazards model RESULTS:The 61 articles reported 87 patients, 58 male and 29 female, mean age, 40.4 ± 15.5 years (range:8 mo to 74 years), who met the inclusion criteria for the present study. Deaths occurred in 59 (67.8%) patients, whereas 28 (32.2%) survived after a mean follow-up period of 280.8 ± 316.2 d (range:27-2285 d). Among the most frequent symptoms were rash (94.2%), fever (66.6%), diarrhea (54%), and pancytopenia (54%). Theaverage time period between LT and first symptom onset was 60.6 ± 190.1 d (range: 2-1865 d). The Kaplan-Meier analysis revealed that pancytopenia (42.8% vs 59.3%,P = 0.03), diarrhea (39.2%vs 61.0%,P = 0 04), age difference between the recipient and the donor (14.6 ± 3.1 yearsvs 22.6 ± 2.7 years,P < 0.0001), and time from first symptom occurrence to diagnosis or treatment (13.3 ± 2.6 mo vs 15.0 ± 2.3 mo, P < 0.0001) were significant factors affecting mortality, whereas age, sex, presence of rash and fever, use of immunosuppressive agents, acute rejection before GvH , etiological causes, time of onset, and donor type were not associated with mortality risk The Cox proportional-hazards model, determined that an age difference between the recipient and donor was an independent risk factor (P = 0 03; hazard ratio, 7.395, 95% confidence interval, 1.2-46.7). CONCLUSION:This study showed that an age difference between the recipien

关键词：移植物抗宿主病肝移植平均年龄文献风险因素风险模型时间周期危险因素

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

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World Journal of Clinical Cases 2022年第29期10卷 10487-10500页

作者： sami akbulut Adem Tuncer Zeki Ogut Tevfik Tolga Sahin Cemalettin Koc Emek Guldogan Ertugrul Karabulut Elif Seren Tanriverdi Ali Ozer Surgery and Liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey Department of Biostatistics and Medical Informatics Inonu University Faculty of MedicineMalatya 44280Turkey Department of Public Health Inonu University Faculty of MedicineMalatya 44280Turkey Department of Surgery Inonu University Faculty of MedicineMalatya 44280Turkey Department of Medical Microbiology Inonu University Medical FacultyMalatya 44280Turkey

BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appen

关键词： SARS-CoV-2 COVID-19 pandemic Acute appendicitis Perforated appendicitis Negative appendectomy