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Biomedicines
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Innovations and Perspectives in Kidney Transplantation
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Innovations and Perspectives in Kidney Transplantation

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Immunology and Immunotherapy".

Deadline for manuscript submissions: 31 March 2026 | Viewed by 3518

Special Issue Editor

Dr. Vassilis Filiopoulos

E-Mail Website
Guest Editor
Department of Nephrology and Kidney Transplantation, School of Medicine, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, 11527 Athens, Greece
Interests: polycystic kidney disease; glomerular disease; kidney transplantation; immunology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to gather publications related to all aspects of kidney transplantation, both experimental and clinical. Kidney transplantation is the treatment of choice for patients with end-stage kidney disease. Over the past year, several new research insights and policy changes have advanced the field of kidney transplantation. Kidney xenotransplantation has reached its first human recipients, previously under-used organs are becoming transplantable with new procurement and preservation approaches, and post-transplant care, including the prevention of complications, has become safer. The field of kidney replacement technology has evolved greatly over the last two decades, with improvements in nanotechnology, cell growth techniques, and bioreactors. Two of the most recent technological advancements in this field are the implantable bioartificial kidney and kidney regeneration technology. Both techniques are in preclinical stages and aim to fully replace normal kidney functionality. Additionally, these technologies may have the potential to address many associated risks of dialysis and kidney transplants, such as potential infections, effects of immunosuppression, and the risk of cancer, specifically renal cancer. Furthermore, transplant tolerance protocols that may help eliminate the long-term need for antirejection drugs and treatment are currently under development and evaluation. The development of stem cell transplant technology is at the forefront of groundbreaking research with the ultimate goal of eliminating the need for immunosuppressive medications and to ameliorate the burdensome side-effects associated with these.

This Special Issue welcomes original articles, communications, and reviews focused on innovations and perspectives in all aspects of kidney transplantation.

Dr. Vassilis Filiopoulos
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • bioartificial kidney
  • immunology
  • immunosuppression
  • kidney transplantation
  • tolerance
  • graft rejection
  • graft survival
  • xenotransplantation
  • kidney regeneration

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Published Papers (4 papers)

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14 pages, 938 KB  
Article
The Burden of BK Polyomavirus in Pediatric Renal Transplantation: A Belgian Experience
by Pauline Guillaume-Gentil, Benedetta Chiodini, Brigitte Adams, Jean Herman, Maria Van Dyck and Khalid Ismaili
Biomedicines 2026, 14(2), 429; https://doi.org/10.3390/biomedicines14020429 - 13 Feb 2026
Viewed by 281
Abstract
Background/Objectives: To evaluate the outcome of developing BKPyV-DNAemia and presumptive BKPyV-nephropathy (BKPyV-DNAemia ≥ 104 copies/mL for more than 2 weeks) within the first 2 years post-transplant in a Belgian population of renal transplanted children. Methods: All children transplanted between 1 [...] Read more.
Background/Objectives: To evaluate the outcome of developing BKPyV-DNAemia and presumptive BKPyV-nephropathy (BKPyV-DNAemia ≥ 104 copies/mL for more than 2 weeks) within the first 2 years post-transplant in a Belgian population of renal transplanted children. Methods: All children transplanted between 1 January 2010 and 31 December 2022 at Queen Fabiola Children’s University Hospital, Brussels (HUDERF) and at University Hospitals Leuven (UHL) were included in this retrospective study and 86 were followed for at least 2 years post-transplantation. Results: Within the first 2 years, 11/86 (13%) patients developed BKPyV-DNAemia ≥ 104 copies/mL (82% within the first 6 months). Among the 11 patients, 7 underwent a biopsy, of whom 4 were confirmed to have biopsy-proven BKPyV-nephropathy. Of those 11 patients, 4 (36%) developed an acute cellular rejection following immunosuppression reduction. The median eGFR at 2 years post-transplantation was 69 mL/min/1.73 m2 (IQR: 59–79) in the seven patients with presumptive BKPyV-nephropathy and 40 mL/min/1.73 m2 (IQR: 39–41) in the four with biopsy-proven BKPyV-nephropathy. At last follow-up visit, the median eGFR was 65 mL/min/1.73 m2 (IQR: 59–71) in the children with presumptive BKPyV-nephropathy, and 28 mL/min/1.73 m2 (IQR: 20–34) in the patients with biopsy-proven BKPyV-nephropathy. No risk factors for developing BKPyV-DNAemia were identified. Conclusions: Our study confirms that while BKPyV-DNAemia monitoring is essential in pediatric kidney transplant recipients, decisions based solely on viral load risk overtreatment and immunological complications. A personalized approach integrating viral, clinical, and immunological markers is urgently needed to balance infection control with graft preservation. Full article
(This article belongs to the Special Issue Innovations and Perspectives in Kidney Transplantation)
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11 pages, 918 KB  
Article
Decreasing Tacrolimus Concentrations in Routine Therapeutic Drug Monitoring Data Indicate Adherence to Updated Therapeutic Goals
by Anders Larsson, Johan Saldeen, Jonathan Cedernaes, Mats B. Eriksson, Mathias Karlsson and Anna-Karin Hamberg
Biomedicines 2026, 14(1), 94; https://doi.org/10.3390/biomedicines14010094 - 2 Jan 2026
Viewed by 719
Abstract
Background: Tacrolimus is a key immunosuppressive drug used to prevent organ rejection after transplantation. Its narrow therapeutic window and high interindividual pharmacokinetic variability make therapeutic drug monitoring (TDM) essential. This study aimed to (1) characterize long-term trends in tacrolimus concentrations; (2) assess potential [...] Read more.
Background: Tacrolimus is a key immunosuppressive drug used to prevent organ rejection after transplantation. Its narrow therapeutic window and high interindividual pharmacokinetic variability make therapeutic drug monitoring (TDM) essential. This study aimed to (1) characterize long-term trends in tacrolimus concentrations; (2) assess potential seasonal variation; and (3) evaluate the suitability of patient medians as a tool for laboratory quality monitoring. Methods: A retrospective analysis was conducted on 113,735 tacrolimus whole-blood results obtained between 2006 and 2024 at Uppsala University Hospital, Sweden. Samples were analyzed using immunoassays on the Hitachi 912 (Microgenics) until 2008, the Abbott Architect until 2021, and the Roche Cobas Pro e 801 thereafter. Annual patient medians and percentiles (10th, 25th, 50th, 75th, and 90th) were calculated. Seasonal variation was assessed by comparing monthly test volumes and concentration distributions. Results: The annual number of tacrolimus results increased from 5616 in 2006 to 7320 in 2024, comprising 67,133 male and 46,602 female patient results. All distribution metrics declined steadily over the study period, with median tacrolimus concentrations decreasing by 20–30%. The July test volume was approximately 15% lower than in other months, but no meaningful seasonal variation in tacrolimus concentrations was observed; monthly medians and percentiles remained stable throughout the year. Conclusions: Tacrolimus concentrations at the population level have decreased consistently over nearly two decades. These findings likely reflect evolving clinical practice, including dose minimization strategies to reduce toxicity. Patient medians proved robust over time and may serve as a useful adjunct to conventional quality control, particularly when commercial control materials do not fully mimic patient sample behavior. Full article
(This article belongs to the Special Issue Innovations and Perspectives in Kidney Transplantation)
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15 pages, 596 KB  
Article
Risk Factors for the Development of Malignancies Post-Transplantation in Kidney Transplant Recipients
by Kalliopi Vallianou, Ioannis Bellos, Vassilis Filiopoulos, Chrysanthi Skalioti, Pagona Lagiou, Vassiliki Benetou and Smaragdi Marinaki
Biomedicines 2025, 13(10), 2346; https://doi.org/10.3390/biomedicines13102346 - 25 Sep 2025
Cited by 2 | Viewed by 1281
Abstract
Background/Objectives: Malignancies constitute a major cause of death among kidney transplant recipients, and their incidence is increasing globally. We aimed to estimate the frequency of de novo malignancies and identify factors associated with their occurrence among kidney transplant recipients. Methods: Data [...] Read more.
Background/Objectives: Malignancies constitute a major cause of death among kidney transplant recipients, and their incidence is increasing globally. We aimed to estimate the frequency of de novo malignancies and identify factors associated with their occurrence among kidney transplant recipients. Methods: Data were derived from the medical records of patients who received a kidney transplant between January 1979 and December 2023 in “Laiko” University Hospital in Athens, Greece. Κidney transplant recipients with a diagnosis of de novo malignancy were compared with recipients without malignancy and were matched for age, sex and year of transplantation. Demographic and clinical characteristics, data on immunosuppression and cancer type were recorded. Multivariate logistic regression was employed to identify possible risk factors for cancer occurrence. Results: Out of 2986 recipients, 268 (8.98%) developed malignancies within a median time of 8 (interquartile range—IQR: 4–16) years after transplantation. Of them, 59.3% were males, the median age at transplantation was 48 (IQR: 39–57) years and the median dialysis vintage was 31.5 (IQR: 9.5–70) months. In addition, 17.2% had a history of rejection. The majority (66.7%) received a combination of mycophenolate and a calcineurin inhibitor with or without steroids. The most frequent malignancies were lung cancer (13%) and post-transplant lymphoproliferative disease (13%), followed by Kaposi sarcoma (8.2%). At diagnosis, 37% had generalized end-stage disease and 19% had aggressive disease with poor prognosis. In multivariate analysis, a history of rejection (odds ratio—OR = 1.75, 95% CI = 1.04–2.94) and glomerulonephritis as primary kidney disease (OR = 2.23, 95% CI = 1.06–4.67) were both significantly associated with malignancy development, whereas immunosuppressive medication was not. Conclusions: Cancer occurrence among kidney transplant recipients was related to the cumulative burden of immunosuppression rather than a specific immunosuppressant. Full article
(This article belongs to the Special Issue Innovations and Perspectives in Kidney Transplantation)
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9 pages, 1043 KB  
Viewpoint
Immunosuppressive Therapy in Pediatric Kidney Transplantation: Evolution, Current Practices, and Future Directions
by Mohamed S. Al Riyami, Badria Al Gaithi, Naifain Al Kalbani and Suleiman Al Saidi
Biomedicines 2025, 13(12), 3084; https://doi.org/10.3390/biomedicines13123084 - 14 Dec 2025
Viewed by 786
Abstract
Pediatric kidney transplantation (KTx) offers the best outcomes for children with end-stage renal disease (ESRD), offering dramatic improvements in survival, quality of life, growth, and developmental outcomes compared to dialysis. Modern regimens centered on tacrolimus, mycophenolate mofetil, and risk-adapted induction have substantially reduced [...] Read more.
Pediatric kidney transplantation (KTx) offers the best outcomes for children with end-stage renal disease (ESRD), offering dramatic improvements in survival, quality of life, growth, and developmental outcomes compared to dialysis. Modern regimens centered on tacrolimus, mycophenolate mofetil, and risk-adapted induction have substantially reduced acute rejection and improved graft survival. This viewpoint summarizes the evolution of pediatric immunosuppression, current practice trends, and emerging strategies aimed at minimizing toxicity while preserving long-term graft function. Recent data show increasing use of T-cell-depleting induction, selective application of IL-2 receptor antagonists, and gradual adoption of steroid-sparing and mTOR-based protocols. Nevertheless, progress is limited by a scarcity of pediatric randomized trials, continued reliance on extrapolated adult evidence, infection risk, long-term metabolic complications, and adherence challenges during adolescence. Insights from recent trials including steroid minimization, everolimus-based regimens, and selective Belatacept use highlight opportunities for more individualized, risk-adapted therapy. Future efforts must prioritize precision approaches supported by biomarkers, multicenter collaboration, and long-term follow-up. Overall, contemporary trends support a shift toward tailored immunosuppression that balances efficacy with safety to optimize outcomes in pediatric KTx recipients. Full article
(This article belongs to the Special Issue Innovations and Perspectives in Kidney Transplantation)
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