M. Doskhanov

https://orcid.org/0000-0002-8578-8567

Articles found: 4

  • Fatty liver disease after pancreatoduodenectomy and total pancreatectomy (Issue № 1, 2025)

    S. Tileuov, A. Dzhumabekov, B. Baimakhanov, M. Doskhanov, S. Kaniyev, J. Ospan, Y. Yenin, M. Tursynbai
    2025-03-31
    20–28
    Abstract

    Pancreatoduodenectomy is the only treatment method for patients with pancreatic head and periampullary region tumors. It is known that some long-lived patients develop exocrine pancreatic insufficiency after surgery. One of the consequences of exocrine pancreatic insufficiency is fatty liver disease, which has been reported to occur in 7.8% to 40.0% of patients after pancreatoduodenectomy. We reported two clinical cases of patients who underwent pancreatoduodenectomy and total pancreatectomy for pancreatic head cancer and intraductal papillary mucinous neoplasm of the main pancreatic duct. After surgery, they developed rapidly progressive fatty liver disease with no history of liver disease, leading to death from liver failure 20 days and 3 months after surgery. Severe malnutrition caused by exocrine pancreatic insufficiency, postoperative eating disorders, and exacerbation of diabetes mellitus were the main factors contributing to the rapid deterioration of the condition. This clinical case highlights the possibility of developing life-threatening fatty liver disease with severe fibrosis after pancreatoduodenectomy and total pancreatectomy. Careful monitoring of liver status, regular nutritional assessment of patients, prophylactic replacement of pancreatic enzymes, and ensuring adequate nutrition are important.

    Keywords

    pancreatoduodenectomy, fatty liver disease, pancreatic cancer, liver failure, exocrine pancreatic insufficiency

  • Genetic determinants of tacrolimus metabolism associated with CYP3A5 in kidney transplantation: a literature review (Issue № 1, 2025)

    A. Aubakirova, I. Madadov, B. Rgebayev, V. Kumar, M. Doskhanov
    2025-03-31
    4–13
    Abstract

    Background. Kidney transplantation is the most effective treatment for end-stage chronic kidney disease, improving quality of life and reducing mortality compared with dialysis. The success of transplantation depends on HLA compatibility, immune sensitization, immune status and immunosuppressive therapy. Tacrolimus, a key immunosuppressant, prevents graft rejection by suppressing T-cell activity and is metabolized by CYP3A4 and CYP3A5 enzymes. CYP3A5 gene polymorphisms influence enzyme activity and tacrolimus metabolism.

    Methods. The review analyzed 46 of 141 publications from PubMed, MEDLINE, Embase, Scopus, and Cochrane Library databases that met the inclusion criteria and focused on the role of CYP3A5 gene polymorphisms in tacrolimus metabolism in renal transplant patients.

    Results. CYP3A5 gene polymorphisms significantly affect tacrolimus pharmacokinetics. Carriers of the *1 allele (expressers) demonstrated accelerated metabolism requiring higher doses, while patients with the *3/*3 genotype (non-expressers) exhibited slower metabolism, allowing for reduced doses but increasing the risk of toxicity, including nephrotoxicity. An analysis of 46 publications and randomized studies confirmed that CYP3A5 genotyping enables personalized tacrolimus dosing. For expressers, genotyping facilitated faster achievement of therapeutic concentrations, while for non-expressers, it reduced the risk of toxic effects. However, long-term differences in clinical outcomes between groups with and without genotyping remain statistically insignificant, emphasizing the need for larger-scale studies to validate the efficacy of this approach.

    Conclusion. CYP3A5 polymorphisms play a key role in the personalization of immunosuppressive therapy. Genotyping optimizes tacrolimus dosing and reduces the risk of rejection and toxicity. Integration of pharmacogenetic testing into clinical practice may improve transplantation outcomes.

    Keywords

    tacrolimus, CYP3A5 gene, kidney transplantation, immunosuppression, genotyping

  • The effectiveness of the functioning of reconstructed hepatic veins using various types of materials in transplantation of the right lobe of the liver from a living donor (Issue № 3, 2024)

    Z.R. Ospan, M.О. Doskhanov, B.B. Baimakhanov, S.A. Kaniyev, M.S. Nagasbekov, S.T. Tileuov, M.U. Suierkulov
    2024-09-30
    38–45
    Abstract

    Background. In adult living donor liver transplantation with the right lobe, the venous outflow of the anterior sector is typically restored during the procedure to form a neo-middle hepatic vein. Restoring the middle hepatic vein for the drainage of the anterior sector is critically important for achieving optimal graft function. Various conduits are used for this reconstruction, such as synthetic and biological grafts (e.g., the recipient's portal vein, vessels from a deceased donor, and modified great saphenous vein). However, the selection of the best option remains a topic of discussion. This study evaluates the effectiveness of using biological and synthetic grafts for MHV reconstruction.

    Materials and methods. A retrospective analysis of outcomes was conducted in patients who underwent transplantation of a modified right liver lobe due to end-stage liver disease from 2011 to 2024.

    Results. A transplantation of modified right liver lobes was performed on 80 patients. In 69 cases, the reconstruction of the hepatic veins was carried out using a biological graft, while in 11 cases, a synthetic graft was used. Statistically significant differences were noted in mortality and the postoperative period. No significant differences were found in the frequency of intraoperative complications.

    Conclusion. Our study demonstrates that the use of a biological graft for the reconstruction of the hepatic veins of segments 5 and 8 is more effective than the application of a vascular prosthesis.

    Keywords

    Living donor liver transplantation, Hepatic vein, Vascular graft, Venous reconstruction models

  • FIRST EXPERIENCE OF LAPAROSCOPIC HEPATICOJEJUNOSTOMY FOR BILE DUCT STRICTURES (Issue № 2, 2024)

    M. Doskhanov, A. Khajiyeva, B. Baimakhanov, S. Kaniyev, M. Seisembaev, Z. Ospan, S. Teipov
    2024-06-28
    50–60
    Abstract

    Background. Bile duct injury is a potentially life-threatening condition characterized by high morbidity and mortality, which occurs as a result of erroneous manipulation during surgical intervention, such as incorrect identification of the ducts, improper clipping, or thermal injury. The aim of the study is to investigate the effectiveness of laparoscopic hepaticojejunostomy in patients with post-cholecystectomy bile duct injuries and compare it with traditional open techniques. Materials and

    Methods. A retrospective analysis of the results of laparoscopic and open hepaticojejunostomy in patients with bile duct injuries from 2017 to 2023 was conducted.

    Results. Laparoscopic surgery was performed on 28 patients, while open surgery was performed on 57 patients. Statistically significant differences were noted in the presence of external biliary fistula, diameter of the anastomosis, duration of the operation, postoperative complications, and postoperative period. There were no significant differences in the frequency of intraoperative complications.

    Conclusion. The laparoscopic approach in treating bile duct strictures classified as Strasberg E1 - E2 is safe and effective.

    Keywords

    Bile duct injury, cholecystectomy, laparoscopic hepaticoejunostomy, hepaticoejunoanastomosis