М.О. Досханов

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

Найдено статей: 4

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

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

    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.

    Ключевые слова

    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 (Выпуск № 1, 2025)

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

    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.

    Ключевые слова

    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 (Выпуск № 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
    Аннотация

    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.

    Ключевые слова

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

  • Первый опыт лапароскопического гепатикоеюностомоза при стриктурах желчных протоков (Выпуск № 2, 2024)

    М.О. Досханов, А.А. Хаджиева, Б.Б.. Баймаханов, Ш.А. Каниев, М.А. Сейсембаев, Ж.Р. Оспан, Ш.М. Теипов
    2024-06-28
    50–60
    Аннотация

    Фон. Повреждение желчных протоков - потенциально опасное для жизни состояние, характеризующееся высокой заболеваемостью и смертностью, которое происходит вследствие ошибочной манипуляции во время хирургического вмешательства, такого как неправильная идентификация протоков, неправильное клипирование или термическое воздействие. Целью исследования является изучение эффективности применения лапароскопического гепатикоеюноанастомоза у пациентов с постхолецистэктомическими повреждениями желчных протоков и сравнить его с традиционной открытой техникой. Материал и методы. Проведен ретроспективный анализ результатов лапароскопического и открытого гепатикоеюноанастомоза у пациентов с повреждениями желчных протоков за 2017 - 2023 гг.

    Результаты. Лапароскопически оперировано 28 пациентов, открытым способом – 57 пациентов. Отмечены статистически значимые различия в наличии наружного желчного свища, размерах диаметра анастомоза, в длительности операции, послеоперационных осложнений, послеоперационного периода. Отсутствовали значимые различия в частоте интраоперационных осложнений.

    Заключение. Лапароскопический подход при лечении стриктур желчных протоков по классификации Страсберга Е1 - Е2 безопасен и эффективен.

    Ключевые слова

    Повреждение желчных протоков, холецистэктомия, лапароскопическая гепатикоеюностомия, гепатикоеюноанастомоз