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    Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation
    (Springer, 2019) Harputluoglu, M.; Demirel, U.; Caliskan, A. R.; Selimoglu, A.; Bilgic, Y.; Aladag, M.; Erdogan, M. A.
    Background Studies reporting outcomes of endoscopic treatment methods in children who underwent liver transplantation (LT) is very limited. We present our outcomes, as a high-volume transplant center where endoscopic methods are preferred as the first choice in the treatment of biliary complications in children. Methods Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) as the first treatment approach for biliary complications after LT between 2005 and 2017 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical intervention. Results ERCP was performed in 49 patients who had a duct-to-duct anastomosis (38 living donor liver transplantation (LDLT), 11 deceased donor liver transplantation (DDLT)). The most common biliary complication was stricture. Our endoscopic success rate was 66.7% (18/27) and 75% (6/8) in LDLT and DDLT patients with stricture (p > 0.05), respectively. While our endoscopic success rate was 75% (3/4) in patients with leak alone after LDLT, it was 25% (1/4) in patients with leak and stricture in this group. The endoscopic success rate was 50% in two patients who had leak alone after DDLT. Conclusions ERCP should be considered as a preferential treatment option for the management of biliary complications in pediatric liver transplant patients with duct-to-duct anastomosis, as in adults.
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    Endoscopic treatment of biliary complications after living donor liver transplantation in a high volume transplant center in Turkey; a single-center experience
    (Univ Catholique Louvain-Ucl, 2018) Harputluoglu, M.; Aladag, M.; Demirel, U.; Bilgic, Y.; Dertli, R.; Erdogan, M. A.; Karincaoglu, M.
    Background and aim : Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume. Methods : Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) alter LDLT between 2005 and 2015 were included. Clinical data included patient demographics. ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions. Results : ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture +/- stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only binary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (P'f BI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT. Conclusions : Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment.
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    Relationship between nucleotide-binding oligomerization domain-containing protein 2 variants and severity of acute pancreatitis
    (Univ Catholique Louvain-Ucl, 2019) Harputluoglu, M. M. M.; Ozbek, M.; Demirel, U.; Otlu, B.; Yener, O.; Gursoy, N. C.; Tikici, D.
    Background and aim : Intestinal bat tier dysfunction has been implicated in the development of infectious complications of acute pancreatitis. Nucleotide-Binding Oligomerization Domain- Containing Protein 2 (NOD2) plays an important role in the proper functioning of intestinal defense mechanisms. Here, we investigated the frequency of NOD2 variants in patients with mild and severe acute pancreatitis. Materials and Methods : Groups 1, 2 and 3 comprised healthy participants and patients with mild and severe pancreatitis, respectively. Four NOD2 variants and serum interleukin-6 (IL-6), Tumor Necrosis Factor-a (TNF-a) and lipopolysaccharide-binding protein (LBP) levels were analyzed. Results: Three patients (3/32, 9.4%) in the severe pancreatitis group were positive for the p.R702W valiant. This valiant was negative in other groups. One, three and three patients in the healthy (1/27,3.7%), mild (3/36,8.3%) and severe pancreatitis (3/32, 9.4%) groups tested positive for the 1007fs variant, respectively. No significant difkrences in the frequencies of NOD2 variants were evident among the groups. Serum IL-6, TNF-a and IMP levels were markedly higher in the severe pancreatitis than the healthy and mild pancreatitis groups (all p<0.091). We observed no significant correlation between cytokine levels and NOD2 variants. Conclusion : Our results support an association between the presence of the p.R702W variant and severe pancreatitis.