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Advances in Kidney Transplantation
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Advances in Kidney Transplantation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 20 August 2025 | Viewed by 2355

Special Issue Editors

Dr. Pedro Ruiz-Esteban

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Guest Editor
Nephrology Department, Hospital Universitario Regional de Málaga, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND, RICORS2040 (RD21/0005/0012), E-29010 Malaga, Spain
Interests: kdney transplantation; immunosuppression; acute rejection; subclinical inflammation; cardiovascular complications; metabolic complications; graft survival
Prof. Dr. Domingo Hernández

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Guest Editor
Nephrology Department, Hospital Universitario de Canarias, Instituto de Tecnologías Biomédicas-Universidad La Laguna, RICORS2040 (RD21/0005/0012), E-38320 Tenerife, Spain
Interests: kidney transplant; immunosuppression; acute rejection; subclinical inflammation; cardiovascular complications; metabolic complications; graft survival
Dr. Veronica López

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Guest Editor
Nephrology Department, Hospital Universitario Regional de Málaga, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma BIONAND, RICORS2040 (RD21/0005/0012), E-29010 Malaga, Spain
Interests: kidney transplant; immunosuppression; acute rejection; subclinical inflammation; cardiovascular complications; metabolic complications; graft survival

Special Issue Information

Dear Colleagues,

The medical practice is moving toward precision medicine in the field of renal transplantation. Advancements in our understanding of the pathophysiology of graft rejection and other post-transplant complications have enabled the identification of implications in clinical features, the development of precise diagnostic methods and targeted therapies, and the accurate prediction of prognosis. Research on biomarkers has revealed new indicators for monitoring graft function and the early detection of rejection and subclinical graft inflammation. These biomarkers are being used as diagnostic tools and therapeutic targets, significantly improving post-transplant outcomes.

Artificial intelligence is being applied to our medical practice for identifying, classifying, and predicting important features of renal transplantation and is expected to have a significant impact on our clinical practice. 

All these efforts have improved the clinician’s approach to diagnosis, treatment, and prognosis prediction in renal transplantation. The aim of this Special Issue is to highlight recent advances in the context of diagnosis, treatment, and prognosis prediction in renal transplantation, emphasizing how these developments are improving long-term outcomes for transplant recipients.

Dr. Pedro Ruiz-Esteban
Prof. Dr. Domingo Hernández
Dr. Veronica López
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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

  • kidney transplant
  • acute rejection
  • biomarkers
  • artificial intelligence
  • post-transplant complications
  • graft survival

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Published Papers (3 papers)

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Research

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13 pages, 1538 KiB  
Article
Exploring Net Immunosuppressive Status with Torque Teno Virus Viral Load in Kidney Transplant Recipients with High Molecular Injury
by Emilio Rodrigo, Elena González-López, Javier Gonzalo Ocejo-Vinyals, Enrique Pasache, Cristina García-Majado, Covadonga López del Moral, Ana García-Santiago, Adalberto Benito-Hernández, María Victoria Francia and Juan Carlos Ruiz
J. Clin. Med. 2025, 14(7), 2417; https://doi.org/10.3390/jcm14072417 - 1 Apr 2025
Viewed by 340
Abstract
Background/Objectives: New monitoring methods are being developed to improve the kidney transplant outcome. Among them, the measurement of Torque Teno virus load (TTV load) has been associated with the overall immunosuppressive status and the percentage of donor-derived circulating free DNA (dd-cfDNA) with [...] Read more.
Background/Objectives: New monitoring methods are being developed to improve the kidney transplant outcome. Among them, the measurement of Torque Teno virus load (TTV load) has been associated with the overall immunosuppressive status and the percentage of donor-derived circulating free DNA (dd-cfDNA) with molecular graft injury, mainly related to antibody-mediated rejection (AbMR). Both methods provide complementary information, but they have not been previously used together for the monitoring of kidney transplant recipients (KTx). Methods: A prospective study including 42 KTx performed in our centre was conducted, in which we monitored dd-cfDNA using a targeted NGS assay (AlloSeq cfDNA) in the first month and the TTV load with in-house PCR in the first and third months. Results: Eleven KTx with high molecular injury defined by dd-cfDNA ≥ 1.0% were selected. The TTV load showed a non-significant trend of being lower in AbMR patients (2.91, IQR 4.18 vs. 3.48, IQR 1.47 log10 copies/mL, p = 0.788). No overimmunosuppressed patient developed AbMR, whereas 40% of non-overimmunosuppressed patients showed AbMR (p = 0.428). The TTV load increased more in the AbMR-treated KTx (0.00, IQR 4.71 vs. +6.58, IQR 4.04 log10 copies/mL, p = 0.042) from months one to three, with all AbMR-treated KTx becoming overimmunosuppressed. KTx with opportunistic infections showed higher TTV loads in the third month (5.18, IQR 5.92 vs. 11.53, IQR 3.54 log10 copies/mL, p = 0.024). Conclusions: KTx with molecular injury secondary to rejection tended to be less immunosuppressed, as indicated by a low TTV load. After AbMR therapy, all KTx became overimmunosuppressed and suffered a higher risk of opportunistic infections. Dual monitoring provides useful complementary information for the follow-up of kidney transplant recipients. Full article
(This article belongs to the Special Issue Advances in Kidney Transplantation)
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13 pages, 1050 KiB  
Article
Efficacy of the Once-Daily Tacrolimus Formulation LCPT Compared to the Immediate-Release Formulation in Preventing Early Post-Transplant Diabetes in High-Risk Kidney Transplant Patients: A Randomized, Controlled, Open-Label Pilot Study (EUDRACT: 2017-000718-52)
by Armando Torres, Concepción Rodríguez-Adanero, Constantino Fernández-Rivera, Domingo Marrero-Miranda, Eduardo de Bonis-Redondo, Aurelio P. Rodríguez-Hernández, Lourdes Pérez-Tamajón, Ana González-Rinne, Diego Álvarez-Sosa, Alejandra Álvarez-González, Nuria Sanchez-Dorta, Estefanía Pérez-Carreño, Laura Díaz-Martín, Sergio Luis-Lima, Ana E. Rodríguez-Rodríguez, Antonia María de Vera González, Cristina Romero-Delgado, María Calvo-Rodríguez, Rocío Seijo-Bestilleiro, Consuelo Rodríguez-Jiménez, Manuel Arturo Prieto López, Antonio Manuel Rivero-González, Domingo Hernández-Marrero and Esteban Porriniadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(24), 7802; https://doi.org/10.3390/jcm13247802 - 20 Dec 2024
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Abstract
Background/Objectives: Post-transplant diabetes mellitus (PTDM) and prediabetes (PreDM) are common after renal transplantation and increase the risk of cardiovascular events and mortality. Compared to immediate-release tacrolimus (IR-Tac), the LCPT formulation, with delayed absorption, offers higher bioavailability and a smoother time–concentration curve, potentially [...] Read more.
Background/Objectives: Post-transplant diabetes mellitus (PTDM) and prediabetes (PreDM) are common after renal transplantation and increase the risk of cardiovascular events and mortality. Compared to immediate-release tacrolimus (IR-Tac), the LCPT formulation, with delayed absorption, offers higher bioavailability and a smoother time–concentration curve, potentially reducing beta-cell stress. Methods: This randomized pilot trial compared de novo immunosuppression with IR-Tac (twice daily) and LCPT (once daily). At-risk recipients (age ≥ 60 years or 18–59 years with metabolic syndrome) were enrolled and followed for 3 months. The primary and secondary outcomes were the incidence of PTDM and PreDM, respectively. Results: 27 patients were randomized to IR-Tac and 25 to LCPT. The incidence of PTDM was comparable between groups [IR Tac: 18.5% (95% CI: 8.2–36.7%) vs. LCPT: 24% (95% CI: 11.5–43.4%); p = 0.7]. Although not statistically significant, the LCPT group exhibited a trend toward a reduction in PreDM incidence [IR-Tac: 40.7% (95% CI: 25–59%) vs. LCPT: 20% (95% CI: 9–39%); p = 0.1]. A sensitivity analysis showed similar results, with no significant differences in cumulative corticosteroid doses or baseline body mass index (BMI) between groups. The LCPT group showed a trend toward higher tacrolimus exposure at the end of the study [trough levels: IR-Tac group 8.3 (6.9–9.2) vs. LCPT group 9.4 (7.4–11.4) ng/mL; p = 0.05)], as well as fewer acute rejection episodes (none vs. three). Delayed graft function was more common in the IR-Tac group (37% vs. 8%; p = 0.01), and the eGFR was lower. Adverse events were comparable between groups. Conclusions: The potential biological activity of LCPT in preventing glucose metabolic alterations in at-risk patients warrants further investigation. Full article
(This article belongs to the Special Issue Advances in Kidney Transplantation)
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Review

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21 pages, 703 KiB  
Review
Compatibility of Post-Kidney Transplant Immunosuppression Therapy with Lactation
by Gema Gomez-Casado, Juana Alonso-Titos, Ernesto Gonzalez-Mesa and Almudena Ortega-Gomez
J. Clin. Med. 2025, 14(7), 2364; https://doi.org/10.3390/jcm14072364 - 29 Mar 2025
Viewed by 450
Abstract
Breastfeeding after kidney transplantation remains a complex and underexplored topic, primarily due to concerns regarding the safety of immunosuppressive therapies during lactation. Individuals who have received kidney transplants face a higher likelihood of delivering preterm infants and giving birth to babies with a [...] Read more.
Breastfeeding after kidney transplantation remains a complex and underexplored topic, primarily due to concerns regarding the safety of immunosuppressive therapies during lactation. Individuals who have received kidney transplants face a higher likelihood of delivering preterm infants and giving birth to babies with a low birth weight when compared with the general population. In this context, breastfeeding is increasingly important because of its advantages for preterm infants. Despite the well-established benefits of breastfeeding for both the mother and infant, the traditional recommendation has been to avoid nursing due to potential drug transmission through breast milk. However, emerging evidence suggests that certain immunosuppressants may be compatible with breastfeeding, challenging long-standing clinical guidelines. In this review, we examine the current literature on the pharmacokinetics, safety profiles, and clinical outcomes associated with key immunosuppressive agents, including cyclosporine, tacrolimus, everolimus, azathioprine, corticosteroids, and belatacept. Our work highlights that all published reports to date on the studied treatments indicate that the amount of the drug reaching breast milk is considered safe for the child’s health. These conclusions, however, are derived from very short-term measurements and small numbers of patients. Therefore, we emphasize the need to design structured prospective studies to assess safety in the medium and long term. Our review aims to equip clinicians with the most up-to-date evidence on this topic, enabling them to make informed decisions regarding the compatibility of post-kidney transplant treatments with breastfeeding. Full article
(This article belongs to the Special Issue Advances in Kidney Transplantation)
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