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Clinical Practice and Personalized Medicine in Kidney Transplantation
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Clinical Practice and Personalized Medicine 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: closed (30 April 2025) | Viewed by 999

Special Issue Editors

Dr. Alessio Pecoraro

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Guest Editor
Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, 50134 Florence, Italy
Interests: kidney transplantation; robotic surgery; penile cancer; kidney cancer; prostate cancer; bladder cancer; BPH
Dr. Angelo Territo

E-Mail Website
Guest Editor
Unit of Uro-Oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), 08025 Barcelona, Spain
Interests: kidney transplantation; robotic surgery; kidney cancer; prostate cancer; bladder cancer; BPH
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Romain Boissier

E-Mail Website
Guest Editor
Department of Urology and Renal Transplantation, La Conception University Hospital, 13005 Marseille, France
Interests: kidney transplantation; robotic surgery; kidney cancer; prostate cancer; bladder cancer; BPH
Dr. Thomas Prudhomme

E-Mail Website
Guest Editor
Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, 31400 Toulouse, France
Interests: transplantation; robotic surgery; kidney cancer; prostate cancer; bladder cancer; BPH

Special Issue Information

Dear Colleagues,

This Special Issue is dedicated to exploring the latest advancements and innovations in kidney transplantation, with a special focus on the pivotal role of personalized medicine in improving clinical outcomes. As the field of kidney transplantation continues to progress, there is an increasing need to tailor treatment protocols and post-transplant care to the unique profiles of individual patients, taking into account their genetic predispositions, comorbidities, and lifestyle factors. By embracing a personalized approach, we can potentially enhance graft survival rates, reduce the risk of rejection, and significantly improve overall patient outcomes.

We are excited to invite contributions to this Special Issue, including original research articles, comprehensive reviews, and insightful case studies that address critical challenges in the field. Topics of interest include advancements in minimally invasive surgery for kidney transplantation, and the optimization of donor-recipient matching in both living and deceased donor settings. Additionally, the integration of precision medicine tools into clinical practice is a key area of interest. Submissions that explore emerging technologies, novel therapeutic strategies, and innovative long-term monitoring techniques are particularly welcome. Pre-clinical studies will not be considered for this Special Issue.

Through fostering a multidisciplinary dialogue, this Special Issue aims to pave the way for more individualized, effective, and patient-centered care in kidney transplantation.

Dr. Alessio Pecoraro
Dr. Angelo Territo
Prof. Dr. Romain Boissier
Dr. Thomas Prudhomme
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 transplantation
  • robotic surgery
  • personalized medicine
  • biopsy
  • therapy

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

18 pages, 1569 KiB  
Article
Inefficiency Rates of Biological Immunosuppressive Induction Agents Used in Organ Transplantation: A Pharmacovigilance Study
by Anca Butuca, Laurentiu Stoicescu, Mirela Livia Popa, Carmen Maximiliana Dobrea, Adriana Muntean, Claudiu Morgovan, Corina Pienar, Felicia Gabriela Gligor, Steliana Ghibu, Ioana Rada Popa Ilie and Adina Frum
J. Clin. Med. 2025, 14(10), 3409; https://doi.org/10.3390/jcm14103409 - 13 May 2025
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Abstract
Effective immunosuppressant pharmacotherapy is essential for successful organ transplantation. Background/Objectives: Generally, induction therapy includes basiliximab (BAS) or anti-thymocyte globulin (THY). However, other biological molecules have been used to accelerate firm immunosuppression. A reduced effectiveness of these induction agents increases the risk of [...] Read more.
Effective immunosuppressant pharmacotherapy is essential for successful organ transplantation. Background/Objectives: Generally, induction therapy includes basiliximab (BAS) or anti-thymocyte globulin (THY). However, other biological molecules have been used to accelerate firm immunosuppression. A reduced effectiveness of these induction agents increases the risk of graft rejection. This study aims to evaluate the ineffectiveness rate of biological molecules based on spontaneous reports uploaded to the EudraVigilance database. Methods: Specific topics related to the safety profiles of alemtuzumab, BAS, belatacept, and THY were analyzed. A total of 23 preferred terms describing drug resistance, drug ineffectiveness, and transplant rejection were used as the inclusion criteria. Descriptive and disproportionality analyses were performed. Results: Regarding the four molecules, 18,564 safety reports were communicated, with n = 5089 (27.4%) for THY and n = 3469 (18.7%) for BAS. Most adverse drug reactions (ADRs) for THY, BAS, and belatacept affected the adult male population. As expected, the majority of the ADRs were linked to infections, followed by general disorders. BAS presented higher probabilities of drug resistance and transplant rejection being reported among the four molecules. A higher probability of reporting drug ineffectiveness was noted for THY than for the other molecules. Conclusions: All the molecules showed small frequencies regarding resistance. As expected, transplant rejection was more frequently reported for all molecules (especially for BAS), accompanied by a notable variability in reporting frequencies. However, a causal relationship between the reported adverse reactions and drug efficacy cannot be established based on the present results. Further real-world evidence studies will enhance our understanding of the safety and efficacy of these drugs in transplant patients. Full article
(This article belongs to the Special Issue Clinical Practice and Personalized Medicine in Kidney Transplantation)
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11 pages, 750 KiB  
Article
Risk Factors of Acute Rejection: Impact on Graft Outcomes in a Cohort of Kidney Transplant Recipients
by Valeria Corradetti, Elisa Gessaroli, Federico Bari, Claudia Bini, Valeria Grandinetti, Angelodaniele Napoletano, Vania Cuna, Valeria Pizzuti, Marcello Demetri, Matteo Ravaioli, Michele Provenzano, Gaetano La Manna and Giorgia Comai
J. Clin. Med. 2025, 14(10), 3373; https://doi.org/10.3390/jcm14103373 - 12 May 2025
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Abstract
Background: Acute rejection (AR) in kidney transplant (KT) recipients remains a significant challenge for short- and long-term graft survival even in the most recent years characterized by extended criteria donors and older and more comorbid recipients. Methods: We analyzed risk factors [...] Read more.
Background: Acute rejection (AR) in kidney transplant (KT) recipients remains a significant challenge for short- and long-term graft survival even in the most recent years characterized by extended criteria donors and older and more comorbid recipients. Methods: We analyzed risk factors and outcomes of AR in 339 KT recipients treated at St. Orsola-Malpighi Hospital, Bologna (Italy), between 1 January 2019 and 31 December 2021. Demographic, immunological, and transplant data (type, cold ischemia time, complications) were recorded with a follow-up period of up to 24 months. Key outcomes included estimated glomerular filtration rate (eGFR), 24 h proteinuria, delayed graft function (DGF), biopsy-proven AR, and graft loss. Results: During the first year after transplant, 57 AR episodes occurred: 19 antibody-mediated rejections (AMR), 18 borderline T cell-mediated rejections (TCMR), 18 TCMR, 2 mixed AMR/TCMR, and 11 graft losses. AR was linked to older donor age (59.9 ± 12.8 vs. 55.5 ± 15.1, p = 0.040), longer cold ischemia time (690 vs. 570 min, p = 0.044), higher DGF rates (61.40% vs. 39.57%, p = 0.002), and lower eGFR (39 vs. 52 mL/min, p = 0.003). AR was consistently prevalent in patients who underwent an AB0-incompatible (AB0-i) transplant (8.8% vs. 2.5%, p = 0.020). HLA matching was strongly associated with a reduced risk of AMR (HLA-DR: OR 0.35, HLA-A: OR 0.33, HLA-C: OR 0.35), while DGF was linked to a higher risk (OR 4.04). TCMR risk was associated with donor age (OR 1.05). The development of post-transplant donor-specific antibodies (DSAs) at 24 months showed no significant association with AR (AMR: p = 0.769; TCMR: p = 0.938). The decline in eGFR over time (24 months) did not differ between patients with and without AR (difference, −0.69 mL/min/year; Standard Error, 0.92; p = 0.452). Similarly, 24 h proteinuria change over time did not differ between patients with and without AR (difference, −0.12 g/24 h; Standard Error, 0.28; p = 0.657). Conclusions: Understanding the risk factors of AR is crucial to identifying KTs at more risk of rejection and to guiding targeted therapeutic decisions. In the most recent era of extended criteria donors and more vulnerable recipients, early diagnosis and prompt and tailored treatment of AR play a critical role in stabilizing renal function over time. Full article
(This article belongs to the Special Issue Clinical Practice and Personalized Medicine in Kidney Transplantation)
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