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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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    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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    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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    А PREVALENCE AND RISK FACTORS FOR INSULIN RESISTANCE AND DYSGLYCEMIA AFTER KIDNEY TRANSPLANTATION IN PATIENTS ON CYCLOSPORINE-A BASED IMMUNOSUPPRESSION
    (Macedonian Association of Anatomists, 2022)
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    Berat-Huseini Afrodita
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    Glucose disorders and insulin resistance are major factors affecting cardiovascular morbidity after renal transplantation. We analyzed the prevalence of pre-diabetes, increased insulin resistance, the factors for their occurrence, as well as the consequences on graft function in kidney transplant patients who are on a cyclosporine-A based immunosuppressive protocol. 59 non-diabetic living donor kidney recipients were included in this cross-sectional and prospective study. All patients were on the same triple immunosuppressive therapy in maintenance doses. OGTT and indices of insulin resistance were analyzed at least 6 months after transplantation, as well as factors for their occurrence. According to the OGTT results, the patients were divided into two groups: a group with dysglycemia and a group of normoglycemic patients. Graft function was controlled after a period of follow-up. The prevalence of dysglycemia and insulin resistance was 33.9% (20/59) and 86.44% (51/59), respectively. In the group with dysglycemia, insulin resistance was more prevalent 95% (19/20), than beta-cell hypofunction 40% (8/20). The insulin resistance index in the dysglycemic group was significantly higher (3.139 ± 1.11) versus the normoglycemic group (2.264±1.00), p ˂0.01. The most significant risk factors for increased insulin resistance in the dysglycemic group were: shorter transplant period, higher doses of cyclosporin-A, postload insulin, and insulin secretion index. In this group of patients, a significant decrease in e-GFR was observed after an average of 18 months of follow-up. Insulin resistance is very prevalent after renal transplantation, and especially high in dysglycemic patients, and the associated risk factors are potentially modifiable. OGTT is an important diagnostic tool for assessing the prevalence of occult diabetes and insulin resistance, and its routine application may contribute to reducing their prevalence.
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    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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    Renal resistive index and arterial stiffness in kidney transplanted patients
    (Macedonian Association of Anatomists, 2019)
    Pavleska Kuzmanoska, Svetlana
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    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.