Faculty of Medicine

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    Living donor kidney transplantation in a patient with inherited skin fragility disorder in a resource-limited setting: a case report
    (Oxford University Press (OUP), 2025-11-29)
    Dohchev, Sasho
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    Trifunovski, Aleksandar
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    Trajkovski, Dimitar
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    Janchulev, Josif
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    Kidney transplantation in individuals with congenital skin fragility diseases is exceedingly uncommon due to perioperative concerns such as compromised wound healing, respiratory complications, and issues with vascular access. Herein, we report a case of successful living-donor kidney transplantation in a 37-year-old male with dystrophic epidermolysis bullosa and end-stage renal disease. Multidisciplinary planning, customized anesthesia, and protective intraoperative measures are essential to avoid these problems. Epidural anesthesia combined with mild sedation facilitated surgery without the need for airway instrumentation, while meticulous handling maintained skin integrity. The operation and recovery were unremarkable, and the graft function was maintained at 12 months. This case demonstrates that complex transplantation is achievable in environments with limited resources, through personalized perioperative treatment and interdisciplinary cooperation.
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    Urinary Proteomics in Kidney Transplantation
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2021-12-01)
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    Dohcev, Sasho
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    Although kidney transplantation is the best treatment option for end stage kidney disease, it is still associated with long-term graft failure. One of the greater challenges for transplant professionals is the ability to identify grafts with a high risk of failure before initial decline of eGFR with irreversible graft changes. Transplantation medicine is facing an emerging need for novel disease end point-specific biomarkers, with practical application in preventive screening, early diagnostic, and improved prognostic and therapeutic utility. The aim of our review was to evaluate the clinical application of urinary proteomics in kidney transplant recipients at risk for any type of future graft failure.
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    Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date
    (Informa UK Limited, 2022-08)
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    Although early rejection episodes are successfully controlled, the problem of unrecognized production of de novo anti-HLA antibodies and associated chronic rejection still persists.
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    Item type:Publication,
    SUCCESSFUL TREATMENT OF ENDOCARDITIS WITH NONSPECIFIC PRESENTATION IN A KIDNEY TRANSPLANTPATIENT-CASE REPORT
    (Macedonian Association of Anatomists, 2023-11)
    Uspcov, Julijana
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    Kabova Karanfilovikj, Angela
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    Spasovska, Adrijana
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    Infective endocarditis (IE) is a serious complication in patients with transplanted kidney, leading to graft loss and a high mortality rate. We present a case of native valve endocarditis in a 51-year-old male with transplanted kidney that had atypical clinical course. The patient experienced prolonged subfebrile temperature with paroxysmal arrhythmia and development of cardio-pulmonary insufficiency. Transthoracic echocardiography (TTE) set the diagnosis of aortic valve vegetation with severe aortic regurgitation and pulmonary edema. We failed to isolate a microbiological agent, but all blood cultures were taken under antibiotic therapy. The patient was treated with surgical replacement of the native aortic valve with mechanical heart valve with significant clinical improvement. Ten days after the intervention, he was discharged with reduced markers of inflammation and proper function of the kidney graft. Immunosuppressive therapy was gradually reinstated. One year later, the patient was clinically stable and with proper graft function. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft.
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    Item type:Publication,
    Covid infection as devastating post-transplant complication
    (Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020)
    Dohchev, Sasho
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    Trifunovski, Aleksandar
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    Trajkovski, Dimitar
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    Janchulev, Josif
    In march 2020 Covid 19 was declared as a pandemic by World Health Organisation. The marked risk group were older patients and patients with comorbidity such as hypertension, DM, obstructive pulmonary disease and chronic kidney disease. Patients on dialysis and kidney transplant recipients are among highest risk groups to be infected with Corona virus. Since the very beginning, Corona virus pandemic have great impact on the transplant program worldwide. There are recommendations for kidney transplant profe- ssionals that suggest the prioritization of patients for kidney transplantation. We present an expanded criteria donor, and recipient with multiple vascular access problems as an indication for kidney transplantation. In the early posttransplant period vascular problems with implication on the graft function were diagnosed and surgically treated, and cholecystecto- my was performed due to an uncalculous cholecystitis. Unexpected Corona virus infection early post transplan- tation occurred as a devastating complication for our kidney transplant recipient.
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    Item type:Publication,
    Challenges of Deceased Kidney Transplantation in a Patient with Iliac Vein Thrombosis:
    (Incorporating Proceedings of the BANTAO Association, 2021)
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    Dohchev, S
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    Item type:Publication,
    Renal resistive index and arterial stiffness in kidney transplanted patients
    (Macedonian Association of Anatomists, 2019)
    Pavleska Kuzmanoska, Svetlana
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    Item type:Publication,
    SUCCESSFUL KIDNEY TRANSPLANTATION IN A PATIENT WITH MULTIPLE PERIOPERATIVE RENAL TRANSPLANT COMPLICATIONS. CASE REPORT
    (Macedonian Academy of Sciences and Arts / Sciendo, 2016-11-01)
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    Zjogovska Elizabeta
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    Dohchev Sasho
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    Josifov Aleksandar
    Kidney transplantations have become common surgical procedures that are associated with high success rates. Nevertheless, the detection, accurate diagnosis and timely management of the perioperative surgical complications sometimes require multidisciplinary team approach for some of the complications may result in significant morbidity, risk of graft loss and/or mortality of the recipient. A case of a 24-year old male patient that developed a number of different surgical complications is reported. The complications included venous graft thrombosis, urinary fistula, wound infection, wound dehiscence and a completely exteriorized transplanted kidney. Despite the various complications and, accordingly, a couple of revisions, finally the patient was discharged with a regular kidney function.
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    POSTOPERATIVE SERUM CREATININ LEVEL IN TWO DIFERENT HYDRATION REGIMES IN LIVING DONOR KYDNEY TRANSPLANATATION
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia, 2017-04)
    Mojsova Mijovska, Maja
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    Introduction: Early graft function is very important and can be achieved with adequate intraopeartive perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting central venous pressure (CVP) on early graft function. Material and methods: After approval of Ethical committee of the Medical Faculty-Skopje, we obtained inform consent of 60 patients, ASA 2-3 undergoing renal transplantation of livingrelated person in the Clinic of Urology – Skopje. A prospective clinical study was performed in the period of 2 years. Patients were divided into 2 groups of thirty patients : group A receiving normal saline intraoperatively targeting for CVP to 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. We recorded lactate at the end of the surgery, onset of diuresis and total urine output from unclamping the renal vessels to the end of the surgery in both groups and postoperative serum creatinine in 3times (3, 12, 36 hours). Results: The onset of diuresis in seconds was insignificantly longer in group B p>0,05 (p=o,31). The average value of postoperative levels of the lactate showed that in group B the levels of the lactate were significantly higher for Z=-5,79 and p<0,001 (p=0,000). We didn’t find any statistical differences in postoperative serum creatinine in both groups. Conclusion: Our study didn’t show any benefit from targeting CVP to 15 mmHg. We couldn’t find any significant difference on onset of diuresis and urine output after the unclamping the vessels. However, in the constant infusion group (group B) the level of the lactate was higher CVP. In postoperative biochemical parameters we had no statistical difference between the average values of serum cratinine.
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    Item type:Publication,
    The impact of intraoperative targeting of the central venous pressure on the onset of diuresis in living donor kidney transplantation
    (Macedonian Association of Anatomists and Morphologists, 2016)
    Mojsova Mijovska, Maja
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    Introduction: Early graft function is very important and can be achieved with an adequate intraoperative perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting CVP on the onset of diuresis in kidney transplantation. Material and methods: The patients were divided in 2 groups of thirty patients: group A receiving normal saline intraoperatively, targeting for CVP 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. The hemodynamic changes were recorded as systolic, diastolic and mean arterial pressure in 4 times: T0 before the induction, T1 after induction, T2 before the clamping the vessels and T3 after unclamping. We also recorded the duration of surgery, the duration of cold and warm ischemia, and the amount of normal saline until the unclamping of the vessels, lactates at the end of the surgery and total urine output from unclamping the renal vessels to the end of the surgery in both groups. We were monitoring the administration of plasma expander, dopamine and furosemide (if higher than 40mg) and we were inspecting if any tissue edema occurred. Results: There were no statistically significant differences in intraoperative hemodynamic parameters between both groups. The onset of diuresis in seconds was insignificantly longer in group B p>0.05 (p=0.31). The average value of postoperative levels of the lactate showed that in group B the level of the lactate were significantly higher for Z=-5.79 and p<0.001 (p=0.000). Conclusion: CVP as a guide for volume substitution is still highly recommended in kidney transplantation. The fact that in group B (the constant infusion group) we had 5 (16.7%) patients in whom we didn’t achieved urine output at the end of the surgery and the level of lactate was higher in group B gives us the right to conclude that targeting higher CVP, promotes diuresis and better urine output at the end of the surgery.