Person: DEMİRBAŞ, BAHA TOLGA
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DEMİRBAŞ
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BAHA TOLGA
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Publication Open Access AFP level and histologic differentiation predict the survival of patients with liver transplantation for hepatocellular carcinoma(2012-06-01) DEMİRBAŞ, BAHA TOLGA; Yaprak O., Akyildiz M., Dayangac M., Demirbas B. T., Guler N., Dogusoy G. B., Yuzer Y., Tokat Y.BACKGROUND: In liver transplantation or resection for hepatocellular carcinoma (HCC), patient selection depends on morphological features. In patients with HCC, we performed a clinicopathological analysis of risk factors that affected survival after liver transplantation. METHODS: In 389 liver transplantations performed from 2004 to 2010, 102 were for HCC patients. Data were collected retrospectively from the Organ Transplantation Center Database. Variables were as follows: age, gender, preoperative alpha-fetoprotein (AFP) levels, Child-Pugh and MELD scores, prognostic staging criteria (Milan and UCSF), etiology, number of tumors, the largest tumor size, total tumor size, multifocality, intrahepatic portal vein tumor thrombosis, bilobarity, and histological differentiation. RESULTS: One hundred and two patients were evaluated. The 5-year overall survival rate was 56.5%. According to the UCSF criteria, 63% of the patients were within and 37% were beyond UCSF (P=0.03). Ten patients were excluded (one with fibrolamellary HCC and 9 because of early postoperative death without HCC recurrence), and 92 patients were assessed. The mean age of the patients was 56.5±6.9 years. Sixty-two patients underwent living donor liver transplantations. The mean follow-up time was 29.4±22.6 months. Fifteen patients (16.3%) died in the follow-up period due to HCC recurrence. Univariate analysis showed that AFP level, intrahepatic portal vein tumor thrombosis, histologic differentiation and UCSF criteria were significant factors related to survival and tumor recurrence. The 5-year estimated overall survival rate was 62.2% in all patients. According to the UCSF criteria, and the 5-year overall survival rate was 66.7% within and 52.7% beyond the criteria (P=0.04). Multivariate analysis showed that AFP level and poor differentiation were independent factors. CONCLUSIONS: For proper patient selection in liver transplantation for HCC, prognostic criteria related to tumor biology (especially AFP level and histological differentiation) should be considered. Poor differentiation and higher AFP levels are indicators of poor prognosis after liver transplantation.Publication Open Access Which incision is better for living-donor right hepatectomy? Midline, j-shaped, or mercedes(2013-01-01) DEMİRBAŞ, BAHA TOLGA; Demirbas T., Bulutcu F., Dayangac M., Yaprak O., Guler N., Oklu L., Akyildiz M., Altaca G., Tokat Y., Yuzer Y.Incision-related morbidity for donors is a major concern in living-donor right hepatectomy (LDRH). Open approaches use midline, J-shaped, and Mercedes incisions for LDRH. We retrospectively studied 95 consecutive donors who underwent LDRH between January 2009 and November 2010. They underwent midline (n = 32), J-shaped (n = 28), or Mercedes (n = 35) incisions. We studied resection times, perioperative bleeding, postoperative hospital stay, and postoperative pain assessed by the visual analog scale (VAS) and by analgesic requirements as well as laboratory data and complications. Postoperative analgesic requirements and postoperative VAS scores were significantly lower in the midline group (P < .05) upon univariate but not multivariate analyses. The postoperative complications as well as other parameters were similar between the groups. In conclusion, compared with a J-type shaped or not for Mercedes incision, a donor hepatectomy can be satisfactorily performed via a midline incision by experienced surgeons without increased risk.Publication Open Access Living donor right lobe liver transplantation as a treatment for hepatic alveolar echinococcosis: Report of three cases(2015-01-01) DEMİRBAŞ, BAHA TOLGA; Demirbas T., Akyildiz M., Dayangac M., Yaprak O., Dogusoy G., Bassullu N., Yuzer Y., Tokat Y.Echinococcus alveolaris is a parasite from tenia family which causes tumor-like lesions in the livers of infected people. If it is not diagnosed in the early stage of the disease, it frequently causes multiple cysts in the liver. The clinical importance of the disease is rapid progression, infiltration into different tissues like a malignant tumor and capacity of creating metastatic masses. The disease could be treated either by surgical resection or liver transplantation. The resection of the cystic disease is the preferred treatment method. In cases where resection is not possible, liver transplantation is the choice of treatment. Here we present three cases which were admitted to the hospital with unresectable hepatic alveolar echinococcosis and treated by liver transplantation successfully. Patients for whom surgical resection is not possible, we recommend liver transplantation as the treatment method.Publication Open Access A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors(2012-08-01) DEMİRBAŞ, BAHA TOLGA; Yaprak O., Guler N., Balci N. C., Dayangac M., Demirbas T., Killi R., Tokat Y., Yuzer Y.Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor\"s safety and the complexity of reconstruction in the recipient. We describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein graft. The postoperative course of the recipient was uneventful. Doppler ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein branches. Reconstruction of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy.Publication Open Access Computed tomography findings of primary epiploic appendagitis as an easily misdiagnosed entity: Case series and review of literature(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2017) DEMİRBAŞ, BAHA TOLGA; Ergelen, Rabia; Asadov, Ruslan; Ozdemir, Burcu; Tureli, Derya; Demirbas, Baha Tolga; Tuney, DavutBACKGROUND: Primer epiploic appendagitis (PEA) is an uncommon condition. METHODS: We retrospectively reviewed the clinical records and computed tomography (CT) findings of 45 patients with PEA. RESULTS: On the basis of physical examination and pain localization, presumptive clinical diagnosis was acute appendicitis (n=13), acute cholecystitis (n=2), acute diverticulitis (n=19), renal colic (n=7) and ovarian pathology (n=4). CONCLUSION: Although it has no characteristic clinical and laboratory features, CT is the best modality for accurate diagnosis of PEA.Publication Open Access Ratio of remnant to total liver volume or remnant to body weight: which one is more predictive on donor outcomes(2012-07-01) DEMİRBAŞ, BAHA TOLGA; Yaprak O., Guler N., Altaca G., Dayangac M., Demirbas T., Akyildiz M., Ulusoy L., Tokat Y., Yuzer Y.Backround: Right lobe donations are known to expose the donors to more surgical risks than left lobe donations. In the present study, the effects of remnant volume on donor outcomes after right lobe living donor hepatectomies were investigated. Methods: The data on 262 consecutive living liver donors who had undergone a right hepatectomy from January 2004 to June 2011 were retrospectively analysed. The influence of the remnant on the outcomes was investigated according to the two different definitions. These were: (i) the ratio of the remnant liver volume to total liver volume (RLV/TLV) and (ii) the remnant liver volume to donor body weight ratio (RLV/BWR). For RLV/TLV, the effects of having a percentage of 30% or below and for RLV/BWR, the effects of values lower than 0.6 on the results were investigated. Results: Complication and major complication rates were 44.7% and 13.2% for donors with RLV/TLV of 30%, and 35.9% and 9.4% for donors with RLV/BWR of < 0.6, respectively. In donors with RLV/TLV of 30%, RLV/BWR being below or above 0.6 did not influence the results in terms of liver function tests, complications and hospital stay. The main impact on the outcome was posed by RLV/ TLV of 30%. Conclusion: Remnant volume in a right lobe living donor hepatectomy has adverse effects on donor outcomes when RLV/TLV is 30% independent from the rate of RLV/BWR with a cut-off point of 0.6.Publication Open Access Effects of preoperative drainage on postoperative complications in patients with periampullary tumors(2019) ATICI, ALİ EMRE; Şafak COŞKUN;Tolga Baha DEMİRBAS;Kivilcim Tevfik UPRAK;Ali Emre ATICI;Cumhur Şevket YEGENAim: Preoperative biliary drainage is suggested for patients with jaundice, considering that surgical operations may increasepostoperative complications in the presence of jaundice. The aim of this study was to test the effect of biliary drainage on possibleserious complications, deaths, or period of hospital stay.Material and Methods: Between January 2012 and June 2016, 160 patients with operable and resectable periampullary tumorswho were diagnosed with periampullary tumors underwent pancreaticoduodenectomy (Whipple’s procedure) in Marmara UniversityPendik Training and Research Hospital, Department of General Surgery. The patients’ demographics, accompanying comorbiddiseases, type of biliary drainage, drainage duration, pre- and post-drainage laboratory data, emerging complications and need forre-hospitalization were recorded retrospectively from the accessible files and records.Results: It was observed that out of 158 patients with periampullary tumors, 116 that were operated with drainage had a higheroccurrence of surgical site infections and anastomotic leaks, compared to the 42 patients that were operated without drainage.Similarly, when patient results were classified according to the Clavien-Dindo complication classification, the ratio was againagainst the patients that were operated with drainage. Drainage patients stayed in the hospital for a longer period; however, in termsof pancreatic fistula, re-hospitalization, need for intensive care and relaparotomy ratios, and especially in terms of mortality ratios, adifference between two patient groups was not observed.Conclusion: Investigating the data collected from patients that were operated without drainage, and specifically considering thebilirubin values of the patients who had complications, there was no threshold identified that contributed to a higher likeliness ofcomplications. Consequently, even though there were no results to motivate recommending drainage, it was concluded that applyingdrainage does not create any difference in short-term prognosis, but drainage increases infectious complications.Publication Open Access Mortality after kidney transplantation: 10-year outcomes(2022-03-01) DEMİRBAŞ, BAHA TOLGA; PİŞKİN T., ŞİMŞEK A., Murat-Dogan S., DEMİRBAŞ B. T., ÜNAL B., YILDIRIM İ. O., ALTUNIŞIK TOPLU S., Berktas H. B., Can H., İNCİ COŞKUN E., et al.Objectives: In the past decade, advances in immunological therapy have increased the survival of kidney recipients and their grafts. However, it has not achieved the desired level of improvement. This study aims to reveal the mortality among kidney recipients. Methods: Medical data of the patients, who had undergone kidney transplantation (KT) between November 2010 and December 2020, were retrospectively reviewed. Inclusion criteria were adult kidney recipients, who had died. Exclusion criteria were pediatric recipients, recipients of en bloc and dual KT, recipients with missing data, and recipients with a primary non-functioning graft. The recipients were grouped according to their donor type; Group 1 (from a living donor) and Group 2 (from a deceased donor). Subgroup analyses were done for mortality by time-period post-transplant and for infectious causes of mortality. Results: Of 314 recipients, 35 (11.14%) died. Twenty-nine recipients were included in the study (Group 1: 17 and Group 2: 12). The most common cause of mortality was infection (58.6%), and the second was cardiovascular disease (CVD) (24.1%). Sepsis developed in 29.4% of infection-related deaths, while COVID-19 constituted 23.5% of infection-related deaths. Conclusion: Early diagnosis and treatment of infectious and CVD are important to improve survival in kidney recipients.