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New Insights into Kidney Transplantation
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New Insights into 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: closed (23 January 2025) | Viewed by 4191

Special Issue Editor

Dr. Sami Alasfar

E-Mail Website
Guest Editor
Department of Medicine, Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ, USA
Interests: rejection; kidney transplant; outcomes

Special Issue Information

Dear Colleagues,

In this Special Issue, we present a collection of articles exploring the forefront of kidney transplantation. This Special Issue discusses the latest advancements in immunosuppressive therapies, including new drug developments and strategies to enhance patient outcomes and long-term management. We examine the breakthroughs in genomics and biomarkers that are transforming the early detection and personalized treatment of transplant rejection. The Special Issue will extend to the application of artificial intelligence and machine learning in kidney transplantation, highlighting their role in optimizing post-transplant care. Furthermore, this Special Issue covers innovative surgical techniques such as optimization of ogran utilization and preservation and minimally invasive and robotic-assisted procedures that are advancing recovery and reducing complications. Collectively, these articles offer a comprehensive overview of the pioneering efforts in kidney transplant care. They provide valuable perspectives for healthcare professionals and researchers dedicated to improving patient outcomes and addressing the critical challenges of organ shortages.

Dr. Sami Alasfar
Guest Editor

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

  • rejection
  • organ optimization
  • transplantation
  • immunosuppressants
  • biomarkers
  • AI
  • innovation

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Published Papers (4 papers)

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Research

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18 pages, 1592 KiB  
Article
Peritubular and Tubulointerstitial Inflammation as Predictors of Impaired Viral Clearance in Polyomavirus Nephropathy
by Haris Omić, Michael Eder, Tarek A. Schrag, Nicolas Kozakowski, Johannes Kläger, Gregor Bond and Željko Kikić
J. Clin. Med. 2024, 13(19), 5714; https://doi.org/10.3390/jcm13195714 - 25 Sep 2024
Viewed by 806
Abstract
Introduction: Polyomavirus-associated nephropathy (BKPyVAN) is a common complication in kidney transplant recipients. The histological changes in the context of BKPyVAN and their association with the viral load and outcomes are still being investigated. Methods: This retrospective study involved 100 adult patients transplanted between [...] Read more.
Introduction: Polyomavirus-associated nephropathy (BKPyVAN) is a common complication in kidney transplant recipients. The histological changes in the context of BKPyVAN and their association with the viral load and outcomes are still being investigated. Methods: This retrospective study involved 100 adult patients transplanted between 2000 and 2021, with available archived biopsy slides, aiming to analyze associations between viral load clearance in the blood (reduction in BKPyVAN-DNAemia below detection level) and histological features in biopsy-proven BKPyVAN. A kidney pathologist blinded to the clinical data reassessed the BANFF 2019 lesion scores in the BKPyVAN index biopsy. The primary endpoint was viral clearance three months after the diagnosis. Results: The presence of tubulointerstitial inflammation, peritubular capillaritis, and higher PVN Class at the diagnosis was linked to a reduced likelihood of viral clearance three months later (interstitial inflammation OR = 0.2, 95% CI [0.07–0.55], tubulitis OR = 0.39, 95% CI [0.21–0.73], peritubular capillaritis OR = 0.25, 95% CI [0.08–0.82], PVN Score OR = 0.1, 95% CI [0.03–0.4]), independently of other covariates. Combining the four lesions using the ROC analysis enhanced their capability to predict persistent BK viremia after 3 months with an AUC of 0.94. Conclusions: The presence of interstitial inflammation, tubulitis, and peritubular capillaritis, as well as the higher PVN Score, was associated with an up to 90% lower likelihood of viral load clearance three months post-diagnosis. These findings underscore the importance of histological evaluation as a surrogate of subsequent viral clearance and offer valuable insights for the management of BKPyVAN. Full article
(This article belongs to the Special Issue New Insights into Kidney Transplantation)
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Review

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14 pages, 642 KiB  
Review
Maintenance Immunosuppression in Kidney Transplantation: A Review of the Current Status and Future Directions
by Muhammad Ali Khan, Alessandra Hanna, Srilekha Sridhara, Harshad Chaudhari, Hay Me Me, Rose Mary Attieh and Bassam G. Abu Jawdeh
J. Clin. Med. 2025, 14(6), 1821; https://doi.org/10.3390/jcm14061821 - 8 Mar 2025
Viewed by 1137
Abstract
Kidney transplantation remains the gold standard for managing end-stage kidney disease, providing superior survival and quality-of-life outcomes compared to dialysis. Despite the ongoing gap between organ availability and demand, it is inevitable that kidney transplantation will continue to grow. This is owed to [...] Read more.
Kidney transplantation remains the gold standard for managing end-stage kidney disease, providing superior survival and quality-of-life outcomes compared to dialysis. Despite the ongoing gap between organ availability and demand, it is inevitable that kidney transplantation will continue to grow. This is owed to broader organ sharing, increased comfort of transplant programs with marginal kidney utilization, and the expansion of paired exchange among living donor kidneys. The evolution of kidney transplantation could not have been possible without the availability of effective immunosuppressive regimens that prevent rejection and maintain graft function. Mycophenolic acid and calcineurin inhibitors continue to serve as the foundation of modern maintenance immunosuppression. While these agents have markedly reduced acute rejection rates, their long-term efficacy in graft survival remains suboptimal. Alternative immunosuppressive therapies, including belatacept and mammalian target of rapamycin inhibitors, have demonstrated potential benefits. However, concerns regarding an increased risk of rejection have limited their widespread adoption as primary treatment options. In addition to ongoing efforts to refine steroid- and calcineurin inhibitor-sparing strategies, the identification of practical and quantifiable biomarkers for predicting long-term graft survival remains a critical objective. This review evaluates contemporary immunosuppressive protocols, highlights existing challenges, and explores future directions for optimizing long-term transplant outcomes. Full article
(This article belongs to the Special Issue New Insights into Kidney Transplantation)
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19 pages, 1481 KiB  
Review
Development of the Crossmatch Test in Kidney Transplantation Up to the Virtual Level
by Nataša Katalinić, Tajana Crnić Marčetić, Zlatko Trobonjača, Franco Barin-Turica and Sanja Balen
J. Clin. Med. 2025, 14(4), 1288; https://doi.org/10.3390/jcm14041288 - 15 Feb 2025
Viewed by 1053
Abstract
The Human Leukocyte Antigen (HLA) system forms the central part of the immune system and is crucial in the recognition and elimination of “non-self” antigens. While this role of the HLA system is essential in the effective defense of the organism against pathogens, [...] Read more.
The Human Leukocyte Antigen (HLA) system forms the central part of the immune system and is crucial in the recognition and elimination of “non-self” antigens. While this role of the HLA system is essential in the effective defense of the organism against pathogens, it is undesirable in organ and tissue transplantation because it enables the recognition of mismatched HLA molecules of the donor as being foreign and stimulates the graft rejection reaction. Organ transplantation involves the introduction of antigens that are more or less mismatched to the recipient; therefore, in order to achieve the best possible match in the HLA system between the recipient and the donor, a whole series of immunogenetic tests is performed, including crossmatching (XM). If performed before kidney transplantation, it represents the final in vitro test to rule out the presence of donor-specific antibodies, which may cause graft rejection and which may not have been detected by earlier serum screening. The beginning of XM was marked by the complement-dependent cytotoxicity (CDC) method developed by Terasaki and colleagues in 1964. Later, as a result of advances in technology and the need for methods that overcome the limitations of CDC, flow cytometry and Luminex XM assays were developed. The introduction of solid-phase technology brought a new dimension to the detection of low-level HLA antibodies and the determination of their specificities, which enabled the development and implementation of the virtual XM test (vXM). It is an in silico test that assesses the immunological match between the recipient and the organ donor based on the analysis of the specificity of the antibodies present in the recipient’s serum and the HLA typing of the organ donor. Each method has its own advantages and limitations, which are described below and need to be taken into account, considering their significant impact on clinical application in kidney transplantation. Full article
(This article belongs to the Special Issue New Insights into Kidney Transplantation)
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Other

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24 pages, 702 KiB  
Systematic Review
Predictors of Treatment Adherence in Kidney Transplant Patients: A Systematic Review of the Literature
by Edoardo Melilli, María Isabel Díaz, Mar Gomis-Pastor, Esther González, Alex Gutierrez-Dalmau, Enriqueta Isabel Nuño, Ana María Pérez, Inmaculada Plasencia, Ana Sangrador, Esther Lázaro, Nuria Montero and Cristina Soria
J. Clin. Med. 2025, 14(5), 1622; https://doi.org/10.3390/jcm14051622 - 27 Feb 2025
Viewed by 652
Abstract
Background: Kidney transplantation (KTx) is a safe procedure that improves the life expectancy and quality of life of patients requiring it. However, despite the known benefits for patients who receive a kidney transplant, non-adherence to immunosuppressive medication is an unsolved problem, reflected mainly [...] Read more.
Background: Kidney transplantation (KTx) is a safe procedure that improves the life expectancy and quality of life of patients requiring it. However, despite the known benefits for patients who receive a kidney transplant, non-adherence to immunosuppressive medication is an unsolved problem, reflected mainly by graft rejection. Objective: The aim of this study is to systematically review the existing literature on adherence factors to medication after renal transplantation. Methods: A systematic literature review of studies published since 2010 was conducted in three databases. Records for the search were limited to publications from 2010 to 2024, available in full-text. The search was carried out in July 2024. In total, 2632 abstracts were downloaded from the different databases. Inclusion criteria were papers of any type (quantitative or qualitative) whose objective was the identification of predictors of adherence for patients who were prescribed immunosuppressive medication after kidney transplantation. Results: The predictors of adherence to treatment found in the systematic review were grouped into the following categories of the World Health Organization classification: socio-economic factors, factors related to the treatment/therapy, patient-related factors, disease-related factors, and health care system factors. Most of the studies were excluded, and in the end, 30 were included in the final analysis. According to these studies, a set of strong predictors was identified, but discrepancies among the variables of gender in young patients, pre-emptive transplantation, and the time of the transplantation were detected. Conclusions: In this study, we identified specific predictors and directions for the association of those predictors with adherence to immunosuppressive medication for patients after KTx. Further research should consider conducting reviews for different patient sub-groups on medication adherence and the development and validation of a screening instrument for adherence/non-adherence factors that clinicians could use as a detection tool for subjects at risk of low adherence. Full article
(This article belongs to the Special Issue New Insights into Kidney Transplantation)
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