Mehmet Haberal

PURPOSE This study aimed to evaluate the feasibility, safety, and long-term outcomes of a percutaneous technique using tandem modified plastic biliary stents (MPBSs) for benign duct-to-duct biliary anastomotic strictures after liver transplantation (LT). METHODS This retrospective single-center…

Objective: Pulmonary thromboembolism (PTE) and pulmonary hypertension (PH) are significant complications in patients undergoing renal transplantation (RT). The impact of preoperative PH on postoperative PTE risk remains unclear. The aim in this study was to determine the prevalence of newly developed PTE detected by CT in the follow-up of patients with a risk of PH according to tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary arterial hypertension (sPAP), TAPSE/sPAP values among transthoracic echocardiography (TTE) findings in the preoperative period in patients undergoing RT, and to determine whether there is an increase in the risk of PTE. Methods: In this retrospective cohort study, 279 RT patients were evaluated. Patients were classified according to preoperative sPAP measured by TTE. The relationship between the development of acute PTE and TTE findings in these patients and TAPSE was examined. Results: Pulmonary thromboembolism was detected in 6 patients (2.15%). The incidence of PTE was 1.7% in patients without PH and 3.2% in those with PH (P = .42). No significant difference was observed in PTE incidence across PH severity groups. Transthoracic echocardiography measurements of TAPSE showed that the TAPSE values in the normal PH group were significantly higher compared to the severe PH group (P = .008). Similarly, TAPSE values in the mild PH group were significantly higher than those in the severe PH group (P = .01). Conclusions: Although a numerically higher incidence of PTE was observed in patients with PH, this association was not statistically significant. Larger studies are needed to clarify the relationship between PH and thromboembolic risk in renal transplant recipients. Cite this article as: Yağdıran B, Karakaya E, Kiriş.i B, et al. Computed tomography–detected pulmonary thromboembolism in renal transplant recipients at risk of echocardiographic pulmonary hypertension. Cerrahpaşa Med J 2026, 50, 0075, doi: 10.5152/cjm.2026.26075.

Renal artery stenosis is a rare but important cause of renovascular hypertension in children that may lead to malignant hypertension and renal failure. A 13-year-old girl presented with malignant hypertension and acute kidney injury, and imaging demonstrated occlusion of both renal arteries. Endovascular recanalization was unsuccessful because of complete, heavily fibrotic occlusions involving a long segment of the right renal artery extending to the hilum, leaving no suitable distal artery for reconstruction, and a 7.3-mm segment of the left renal artery at its aortic origin. To preserve renal function, surgical revascularization was performed by in situ reimplantation of the left renal artery into the aorta, without autotransplantation. Postoperatively, renal function recovered, the proteinuria present at admission regressed, and the patient became normotensive without antihypertensive medication.

Purpose To investigate structural imaging features of non-occlusive hepatic artery hypoperfusion syndrome (NHAHS) in pediatric liver transplant recipients. Methods This retrospective single-center study included 78 pediatric liver transplant recipients, divided into NHAHS (n = 17) and non-NHAHS (n = 61) groups. Preoperative and postoperative multidetector CT was used to assess arterial and portal venous parameters, splenic size, and vascular ratios. Doppler ultrasonography was used to evaluate portal venous flow velocity. NHAHS diagnosis was confirmed by digital subtraction angiography. Interobserver agreement was assessed using intraclass correlation coefficients. ROC curve analysis was performed to evaluate the discriminatory performance of imaging parameters for identifying NHAHS. Results Patients with NHAHS had significantly larger preoperative splenic artery diameter and splenic volume (p = 0.044 and p = 0.024, respectively). Although portal venous diameters did not differ significantly between groups, the distribution of portal vein thrombosis subtypes and portosystemic shunt types differed significantly, with chronic thrombosis and splenoportosystemic shunts more frequent in the NHAHS group (p = 0.020 and p < 0.001, respectively). Postoperatively, recipient hepatic artery diameter and portal vein flow velocity were significantly higher in patients with NHAHS (p = 0.010 and p = 0.021, respectively). On preoperative donor CT, the donor hepatic artery and donor portal vein diameters were significantly smaller in the NHAHS group (p = 0.024 and p < 0.001, respectively). ROC analysis showed that postoperative recipient hepatic artery diameter had moderate discriminatory performance for identifying NHAHS (AUC = 0.716; 95% CI 0.555–0.878, p = 0.007), yielding a sensitivity of 64.70% and specificity of 83.60% at a cutoff of > 3.5 mm. In multivariable analysis, preoperative splenic volume remained independently associated with NHAHS (OR = 1.157 per 100 mL increase, 95% CI 1.004–1.333, p = 0.044), whereas postoperative recipient hepatic artery diameter did not (p = 0.234). Conclusion NHAHS in pediatric liver transplant recipients appears to reflect complex portal-hepatic hemodynamic interactions rather than isolated anatomical abnormalities. In multivariable analysis, preoperative splenic volume was the only parameter independently associated with NHAHS, whereas postoperative recipient hepatic artery diameter was significant only in univariable comparison. These imaging features may support closer postoperative surveillance in selected patients but should be considered supportive rather than definitive markers; given the limited number of events, these exploratory findings require validation in larger multicenter cohorts.

Pulmonary hypertension (PH) is a complex systemic disease. There are insufficient studies in the literature regarding its effect on renal hemodynamics following transplantation. This retrospective cohort study included 244 kidney transplant (KT) recipients. Patients were classified according to the severity of preoperative pulmonary hypertension based on echocardiographic systolic pulmonary artery pressure. Renal Doppler ultrasound (USG) parameters (resistive index [RI] and peak systolic velocity [PSV]) were measured at standard time points (day 3, week 1, month 1, month 3, and month 6) that have long been routinely used. Generalized estimating equations were used in longitudinal analyses to account for repeated measurements within each patient. Additionally, the relationship between PH severity and biopsy-confirmed rejection was examined. Pretransplant PH severity was significantly associated with posttransplant renal Doppler USG findings, particularly RI measurements. Patients with moderate and severe PH had consistently higher RI values during follow-up compared with the other groups. Although RI values generally decreased over time after KT, they remained relatively higher in patients with increasing PH severity. No significant association was observed between PH severity and clinically indicated biopsy-proven rejection. PSV findings showed greater variability and less consistent associations during follow-up. Increased pretransplant PH severity was associated with higher posttransplant RI values, independent of clinically indicated biopsy-proven rejection. These findings suggest that elevated RI values in patients with PH may reflect systemic and graft-related hemodynamic changes rather than rejection alone. Therefore, Doppler USG findings should be interpreted carefully in KT recipients with preexisting PH. Not applicable.

Pulmonary hypertension (PH) is associated with systemic hemodynamic changes that may influence graft perfusion following liver transplantation (LT). In thi