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Recent Clinical Perspective in Kidney Transplantation
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Recent Clinical Perspective 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: 29 September 2026 | Viewed by 4119

Editor

Dr. Nikolina Bašić-Jukić

E-Mail Website
Guest Editor
Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
Interests: chronic kidney disease; dialysis; apheresis; kidney transplantation; renal nutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Kidney transplantation remains the gold standard for treating end-stage renal disease, offering superior survival and quality of life compared to dialysis. Despite significant progress in surgical techniques and immunosuppressive therapies, challenges such as chronic graft dysfunction, limited donor availability, immunological barriers, and long-term complications continue to impact outcomes.

This Special Issue invites original research articles and comprehensive reviews that address these challenges and explore innovative solutions. We encourage submissions on topics including donor organ quality and preservation, immunological risk and desensitization strategies, rejection monitoring, personalized immunosuppression, novel biomarkers, infection and malignancy management, surgical advances, and donor pool expansion through ABO-incompatible transplants and paired exchange programs. By promoting interdisciplinary collaboration, this Special Issue aims to enhance understanding and drive advancements in kidney transplantation to improve patient care and long-term graft survival.

Dr. Nikolina Bašić-Jukić
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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized 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
  • outcomes
  • desensitization
  • xenotransplantation
  • transplant nephropathology
  • multiorgan transplantations
  • post-transplant complications
  • inequities in transplantation

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Published Papers (5 papers)

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Research

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11 pages, 412 KB  
Article
Association of Serum P-Cresyl Sulfate Level with Peripheral Artery Disease in Kidney Transplantation Patients
by Hsiao-Hui Yang, Yen-Cheng Chen, Chin-Hung Liu and Bang-Gee Hsu
J. Clin. Med. 2026, 15(9), 3302; https://doi.org/10.3390/jcm15093302 - 26 Apr 2026
Viewed by 349
Abstract
Background: p-Cresyl sulfate (PCS) has been linked to vascular dysfunction through endothelial injury and vascular remodeling. Peripheral artery disease (PAD), identified by a low ankle–brachial index (ABI), is associated with increased mortality in kidney transplant (KT) recipients. This study investigated the [...] Read more.
Background: p-Cresyl sulfate (PCS) has been linked to vascular dysfunction through endothelial injury and vascular remodeling. Peripheral artery disease (PAD), identified by a low ankle–brachial index (ABI), is associated with increased mortality in kidney transplant (KT) recipients. This study investigated the association between serum PCS levels and PAD (as defined by ABI) in KT recipients. Methods: This cross-sectional, single-center study included 90 KT recipients. Serum total PCS levels were quantified using liquid chromatography–mass spectrometry. ABI was measured using an automated oscillometric device, and PAD was defined as ABI < 0.9. Results: Among the 90 KT recipients, 20 (22.2%) met the ABI for PAD. Patients with ABI-defined PAD had a significantly higher prevalence of diabetes mellitus (p = 0.036) and serum PCS levels (p = 0.001). Multivariate logistic regression analysis adjusting for potential confounders revealed that serum PCS levels remained independently associated with PAD (odds ratio 1.254, 95% confidence interval 1.108–1.419; p < 0.001). PCS levels were inversely correlated with both left (r = −0.339, p = 0.001) and right (r = −0.357, p < 0.001) ABIs. The association remained consistent in penalized regression models. Conclusions: Higher serum PCS levels were independently associated with ABI-defined PAD in KT recipients. The findings indicate that residual uremic toxin burden may contribute to peripheral vascular disease despite the restoration of renal function following transplantation. Full article
(This article belongs to the Special Issue Recent Clinical Perspective in Kidney Transplantation)
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13 pages, 521 KB  
Article
Percutaneous Biopsy Under Deep Intravenous or Oral Conscious Sedation: Which Is the Best Option for Pediatric Renal Transplant Recipients?
by Nicola Bertazza Partigiani, Anna Zanin, Beatrice Martini, Benedetta Antoniello, Susanna Negrisolo, Maria Sangermano, Franca Benini and Elisa Benetti
J. Clin. Med. 2025, 14(20), 7361; https://doi.org/10.3390/jcm14207361 - 17 Oct 2025
Viewed by 1054
Abstract
Background: Renal allograft biopsy is essential in the follow-up of pediatric kidney transplant recipients, but the optimal sedation strategy remains uncertain. Methods: We retrospectively reviewed 711 ultrasound-guided biopsies in 251 children and adolescents (2009–2024), comparing oral conscious sedation with midazolam to deep intravenous [...] Read more.
Background: Renal allograft biopsy is essential in the follow-up of pediatric kidney transplant recipients, but the optimal sedation strategy remains uncertain. Methods: We retrospectively reviewed 711 ultrasound-guided biopsies in 251 children and adolescents (2009–2024), comparing oral conscious sedation with midazolam to deep intravenous (IV) sedation with propofol, midazolam, and ketamine. Outcomes included tissue yield, diagnostic success, complications, and cost-effectiveness. Results: IV sedation was used in 77.1% of procedures and was associated with longer cortical cores (median 1.8 vs. 1.5 cm, p < 0.001) and more glomeruli (16 vs. 8, p < 0.001), improving tissue yield and consequently increasing diagnostic success from 75% to 88.5% (p < 0.001; OR 2.6). Biopsy-related complications occurred in 12.9% of cases, with no difference between groups. Sedation-related complications, all mild or moderate, occurred only with IV sedation (4.9%). The improved tissue yield reduced the cost per successful diagnosis (EUR 1243 vs. EUR 1467), making IV sedation the dominant strategy. Conclusions: IV sedation enhances the diagnostic quality and cost-effectiveness of pediatric kidney allograft biopsies without increasing overall risk, though prospective studies should also assess patient anxiety and comfort. Full article
(This article belongs to the Special Issue Recent Clinical Perspective in Kidney Transplantation)
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20 pages, 1677 KB  
Article
Changes in Body Composition Compartments After Kidney Transplantation: A One-Year Prospective Study
by Emilia Ferrer-López, Raúl López-Blasco, Francisco Javier Rubio-Castañeda, Víctor Cantín-Lahoz, Juan José Aguilón-Leiva, María García-Magán, Carlos Navas-Ferrer, Isabel Blázquez-Ornat, María Teresa Fernández-Rodrigo, Isabel Antón-Solanas and Fernando Urcola-Pardo
J. Clin. Med. 2025, 14(20), 7131; https://doi.org/10.3390/jcm14207131 - 10 Oct 2025
Cited by 1 | Viewed by 1540
Abstract
Background/Objectives: Weight gain after kidney transplantation is frequent but heterogeneous, often accompanied by changes in body composition that influence long-term outcomes. This study analysed one-year changes in body compartments and their demographic and clinical determinants. Methods: A prospective cohort of 112 [...] Read more.
Background/Objectives: Weight gain after kidney transplantation is frequent but heterogeneous, often accompanied by changes in body composition that influence long-term outcomes. This study analysed one-year changes in body compartments and their demographic and clinical determinants. Methods: A prospective cohort of 112 adult kidney recipients transplanted between September 2020 and June 2022 at a Spanish tertiary hospital was followed. Body weight, muscle mass, fat mass, visceral fat and total body water were assessed by multi-frequency bioelectrical impedance at discharge, and at 3, 6 and 12 months. Associations with sociodemographic, clinical and comorbidity variables were examined using repeated-measures ANOVA and comparative tests. Results: At 12 months, mean weight gain was 3.6 ± 6.5 kg (5.1%). Increases were greater in men, younger patients, non-dialysis candidates, those with previous transplantation and living donor grafts. Muscle mass rose during the first three months and then stabilised, with greater gains in men and haemodialysis patients. Fat mass decreased initially and then increased, particularly in women, younger recipients and living donor transplants. Visceral fat progressively increased after three months, with higher levels in men and older patients. Total body water declined in women, younger recipients and first transplant patients. Patients with new-onset diabetes gained less weight, while smokers gained more. Conclusions: Post-transplant body composition is shaped by sex, age, BMI, comorbidities and donor type. Monitoring compartments beyond body weight may allow early detection of adverse metabolic trajectories. Tailored nutritional and lifestyle interventions are needed to optimise long-term outcomes. Full article
(This article belongs to the Special Issue Recent Clinical Perspective in Kidney Transplantation)
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Review

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15 pages, 1098 KB  
Review
The Impact of Chronic Kidney Disease on Oral Health: A Narrative Review
by Petra Magdalena Kes, Anđela Krndelj, Stella Jurić, Ena Hadžović, Nikolina Bašić Jukić and Vlaho Brailo
J. Clin. Med. 2026, 15(13), 4940; https://doi.org/10.3390/jcm15134940 (registering DOI) - 25 Jun 2026
Abstract
Background/Objectives: Chronic kidney disease (CKD) is associated with numerous oral manifestations that may negatively affect quality of life, nutrition, and overall health. This narrative review aimed to summarize current evidence regarding oral manifestations of CKD and kidney transplantation, examine their proposed underlying [...] Read more.
Background/Objectives: Chronic kidney disease (CKD) is associated with numerous oral manifestations that may negatively affect quality of life, nutrition, and overall health. This narrative review aimed to summarize current evidence regarding oral manifestations of CKD and kidney transplantation, examine their proposed underlying mechanisms, and discuss implications for dental management. Methods: A structured literature search of PubMed/MEDLINE was conducted for English-language publications from January 2000 to March 2026. Original studies, systematic reviews, meta-analyses, clinical guidelines, and relevant narrative reviews were included. Additional references were identified through manual screening of bibliographies. Results: Oral manifestations associated with CKD include xerostomia, periodontal disease, oral infections, anemia-related mucosal pallor, developmental enamel defects, and medication-related gingival overgrowth. Kidney transplant recipients are additionally at risk of opportunistic infections and oral malignancies related to long-term immunosuppressive therapy. While oral diseases, particularly periodontal disease and oral infections, may contribute to systemic inflammation, much of the available evidence remains observational. Similarly, many recommendations for dental management are based on expert consensus and clinical experience rather than high-quality interventional studies. Conclusions: Oral complications are common throughout the CKD continuum and warrant regular assessment and preventive care. Multidisciplinary collaboration is essential, while further prospective studies are needed to strengthen the evidence base for clinical management. Full article
(This article belongs to the Special Issue Recent Clinical Perspective in Kidney Transplantation)
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Other

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8 pages, 1508 KB  
Case Report
Can BKPyV Infection Affect Neoplasm Transformation Among Kidney Transplant Recipients? A Case Series Study Report
by Paweł Poznański, Maciej Wenta, Hanna Augustyniak-Bartosik, Dagna Rukasz, Agnieszka Hałoń, Katarzyna Kościelska-Kasprzak, Dorota Kamińska and Magdalena Krajewska
J. Clin. Med. 2025, 14(23), 8550; https://doi.org/10.3390/jcm14238550 - 2 Dec 2025
Viewed by 703
Abstract
Background: There is a great deal of knowledge regarding the development of polyomavirus-associated nephropathy and polyomavirus-associated hemorrhagic cystitis in transplant recipients with active BKPyV infection. However, recent studies have revealed a potential association between BKPyV reactivation and certain malignancies, including transitional cell carcinoma, [...] Read more.
Background: There is a great deal of knowledge regarding the development of polyomavirus-associated nephropathy and polyomavirus-associated hemorrhagic cystitis in transplant recipients with active BKPyV infection. However, recent studies have revealed a potential association between BKPyV reactivation and certain malignancies, including transitional cell carcinoma, malignant melanoma, colorectal cancer, and prostate cancer. This study aimed to identify a potential link between BKPyV infection and oncogenic transformation in kidney transplant recipients. Methods: Presentation of a case series of kidney transplant recipients diagnosed with polyomavirus-associated nephropathy who developed neoplasms after transplantation. Results: Positive immunohistochemical reactions confirmed the presence of polyomavirus large T antigen in tissue samples from all three patients’ cancers. Furthermore, a case of chromophobe renal cell carcinoma presenting BKPyV proteins in cancer cells was observed for the first time in the literature. Conclusions: BKPyV reactivation was found to be associated with the development of both urothelial cancer, which originates directly from the BKPyV-infected site, and colorectal cancer. Full article
(This article belongs to the Special Issue Recent Clinical Perspective in Kidney Transplantation)
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