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Updates on Renal Transplantation and Its Complications
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Updates on Renal Transplantation and Its Complications

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 (20 May 2025) | Viewed by 4593

Special Issue Editors

Prof. Dr. Nada Kanaan

E-Mail Website
Guest Editor
Division of Nephrology, Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 1200 Brussels, Belgium
Interests: kidney transplantation; infections; cancer; genetics; ADPKD; hepatitis; mineral bone disease
Prof. Dr. Arnaud Devresse

E-Mail Website
Guest Editor
1. Surgery and Abdominal Transplant Unit, Department of Surgery, University Clinics Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
2. Department of Nephrology, University Clinics Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
Interests: kidney transplantation; primary hyperoxaluria; infections; mineral bone disease

Special Issue Information

Dear Colleagues,

Despite good short-term results, long-term patient and graft survival after renal transplantation has not improved significantly over the past decades. Physicians and patients still face the challenges of immunological hurdles, infections, cancers and metabolic complications related to the burden of immunosuppression.

For hypersensitized patients, an exciting treatment has emerged with Ig-G-degrading enzymes, enabling them to access kidney transplantation after a long waiting period. Machine perfusion technology has also improved in recent years, leading to the reduction of the negative impact of ischemia-reperfusion injury. New therapeutic agents in the field of diabetes with proven efficacy in slowing the progression of chronic kidney disease are also promising for controlling cardiovascular risk factors and protecting allograft function in kidney transplant recipients.

In this Special Issue, we seek reviews and original articles that highlight the recent advances in the understanding and management of complications encountered after kidney transplantation. Unraveling the pathophysiology and adequate management will help improve long-term outcomes.

Prof. Dr. Nada Kanaan
Prof. Dr. Arnaud Devresse
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

  • cardiovascular complications
  • infections
  • CMV
  • EBV
  • viral hepatitis
  • mineral bone disease
  • cancer
  • rejection
  • post-transplant diabetes
  • immunosuppression

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Published Papers (4 papers)

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Research

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10 pages, 209 KiB  
Article
Evaluation of Risk Factors for Kidney Function Decline and Chronic Kidney Disease in Living Kidney Donors
by Aysegul Oruc, Derya Pekin, Ceren Sevinc Kahraman, Hatice Ortac, Elif Gullulu, Cuma Bulent Gul, Abdulmecit Yıldız, Alparslan Ersoy, Mahmut Yavuz and Mustafa Gullulu
J. Clin. Med. 2025, 14(11), 3873; https://doi.org/10.3390/jcm14113873 - 30 May 2025
Viewed by 283
Abstract
Background/Objectives: Living kidney donors (LKDs) can be at risk of chronic kidney disease (CKD). Several conditions are associated with hyperfiltration, such as solitary kidney, obesity, and high protein consumption. In this regard, we aimed to evaluate the risk factors for kidney function [...] Read more.
Background/Objectives: Living kidney donors (LKDs) can be at risk of chronic kidney disease (CKD). Several conditions are associated with hyperfiltration, such as solitary kidney, obesity, and high protein consumption. In this regard, we aimed to evaluate the risk factors for kidney function decline in LKDs and the effect of daily protein intake. Methods: Data collected from 220 living kidney donors (mean age: 48.35 ± 12.4 years; 55% female) between 2016 and 2023 were evaluated. One-year and long-term outcomes were evaluated following donor nephrectomy, along with the risk factors for GFR decline and the development of CKD. Results: The percentage of eGFR decline was 31.15 (IQR: 19.81–37.5) in the first year and 28.18 (IQR: 18.75–38.16) in the third year after donation. None of the donors had end-stage renal disease during the 31 (IQR: 19–71) months. CKD developed in 31 (23.1%) LKDs. In the first year, the risk factors associated with a decline in eGFR exceeding 30% included male gender (OR: 0.25; 95% CI: 0.11–0.57; p: 0.001) and baseline eGFR value (OR: 0.95; 95% CI: 0.92–0.98; p: 0.002). At the final visit, the risk factors were male gender (OR: 7.19; 95% CI: 3.06–16.94; p < 0.001), age (OR: 1.06; 95% CI: 1.02–1.10; p: 0.001), and BMI (OR: 1.12; 95% CI: 1.01–1.23; p: 0.030). For the development of CKD, the risk factors were male gender (OR: 0.25; 95% CI: 0.09–0.71; p: 0.009) and baseline eGFR (OR: 0.88; 95% CI: 0.83–0.93; p < 0.001). No association was observed between daily protein intake and renal outcomes in LKDs following donor nephrectomy. Conclusions: In the present study, there was no significant unexpected decline in kidney function in donors in the short-term and the medium-term. Age, BMI, and low basal eGFR values should be carefully considered for LKD evaluation. Furthermore, our findings indicated that protein intake does not substantially impact the GFR. Further controlled studies are required to support our findings. Full article
(This article belongs to the Special Issue Updates on Renal Transplantation and Its Complications)
12 pages, 1199 KiB  
Article
Basiliximab vs. No Induction Therapy in Kidney Transplant Recipients with a Low Immunological Risk Profile Receiving Tacrolimus/Mycophenolate/Steroids Maintenance Immunosuppression
by Florian Lacave, Christophe de Terwangne, Tom Darius, Antoine Buemi, Michel Mourad, Yannick France, Joana Cardoso Coelho, Guillaume Fernandes, Eric Goffin, Arnaud Devresse and Nada Kanaan
J. Clin. Med. 2024, 13(20), 6151; https://doi.org/10.3390/jcm13206151 - 16 Oct 2024
Cited by 1 | Viewed by 1707
Abstract
Background: Induction therapy with basiliximab is recommended in kidney transplant (KT) recipients with a low immunological risk (LIR) profile. Whether basiliximab is associated with a decreased risk of acute rejection (AR) and graft loss is controversial. Methods: In our institution, LIR [...] Read more.
Background: Induction therapy with basiliximab is recommended in kidney transplant (KT) recipients with a low immunological risk (LIR) profile. Whether basiliximab is associated with a decreased risk of acute rejection (AR) and graft loss is controversial. Methods: In our institution, LIR patients (absence of anti-HLA antibodies before KT) are inducted with basiliximab in case of living-donor KT, while deceased-donor KT recipients receive no induction. Maintenance immunosuppression is similar, including a combination of tacrolimus (Tac), mycophenolate (MPA) and steroids. In this single-center retrospective study, we included all adult LIR patients who underwent KT between 1 January 2015 and 31 December 2022. Results: Of the 471 patients included, 354 received no induction and 117 received basiliximab. The median (IQR) number of HLA A-B-DR mismatches was 3 (2–3) and 2 (2–4) in the no induction group and the basiliximab group, respectively. The cumulative incidences in the no induction group vs. the basiliximab group of acute rejection and graft loss over 5 years post-KT were similar at 8.9% vs. 7.8% (p = 0.8) and 8.5% vs. 4.2% (p = 0.063), respectively. In multivariable Cox regression analysis, delayed graft function emerged as an independent risk factor for acute rejection (hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.23–6.13, p = 0.014) and graft loss (HR 9.32, CI 4.10–21.1, p < 0.001). Conclusions: Basiliximab did not provide any advantage in terms of rate of acute rejection and graft survival within 5 years post KT compared with a strategy without induction therapy in patients with a low immunological risk profile receiving triple maintenance immunosuppression Tac/MPA/steroids. Full article
(This article belongs to the Special Issue Updates on Renal Transplantation and Its Complications)
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Review

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28 pages, 435 KiB  
Review
Surgical and Infectious Complications Following Kidney Transplantation: A Contemporary Review
by Kazuaki Yamanaka, Yoichi Kakuta, Shigeaki Nakazawa, Kenichi Kobayashi, Norio Nonomura and Susumu Kageyama
J. Clin. Med. 2025, 14(10), 3307; https://doi.org/10.3390/jcm14103307 - 9 May 2025
Viewed by 575
Abstract
Kidney transplantation significantly improves outcomes in patients with end-stage renal disease; however, postoperative complications remain a substantial concern. This review summarizes the incidence, risk factors, and management strategies for common complications after kidney transplantation. Reported incidence varies widely due to differences in definitions, [...] Read more.
Kidney transplantation significantly improves outcomes in patients with end-stage renal disease; however, postoperative complications remain a substantial concern. This review summarizes the incidence, risk factors, and management strategies for common complications after kidney transplantation. Reported incidence varies widely due to differences in definitions, diagnostic methods, and study designs. Ureteral stenosis occurs in 2.8–18.0% of recipients, vesicoureteral reflux in 0.5–86%, and urinary leakage in 1.1–7.2%. Lymphatic complications, including lymphocele and lymphorrhea, range from 0.6% to 35.2%, with one-third of complications requiring intervention. The incidence of urinary tract infections ranges from 20 to 43%, while asymptomatic bacteriuria is reported in up to 53% of recipients. Surgical site infections have a median incidence of 3.7%, and incisional hernias develop in 2.5–10% of cases, depending on follow-up duration. Vascular complications affect approximately 10% of recipients, with renal artery stenosis and thrombosis being the most prevalent. Neurologic complications, such as femoral nerve palsy and immunosuppression-related neurotoxicity, though less frequent, can impair recovery. Management strategies vary depending on severity, ranging from observation to surgical intervention. Preventive measures—including optimized ureteral stenting protocols, early catheter removal, careful immunosuppression, and appropriate antimicrobial use—play a crucial role in reducing complication risk. Despite advances in transplantation techniques and perioperative care, these complications continue to affect graft survival and patient outcomes. Further research is needed to standardize definitions and establish evidence-based protocols. Full article
(This article belongs to the Special Issue Updates on Renal Transplantation and Its Complications)
11 pages, 1227 KiB  
Review
Recent Insights in Noninvasive Diagnostic for the Assessment of Kidney and Cardiovascular Outcome in Kidney Transplant Recipients
by Peyman Falahat, Uta Scheidt, Daniel Pörner and Sebastian Schwab
J. Clin. Med. 2024, 13(13), 3778; https://doi.org/10.3390/jcm13133778 - 27 Jun 2024
Viewed by 1326
Abstract
Kidney transplantation improves quality of life and prolongs survival of patients with end-stage kidney disease. However, kidney transplant recipients present a higher risk for cardiovascular events compared to the general population. Risk assessment for graft failure as well as cardiovascular events is still [...] Read more.
Kidney transplantation improves quality of life and prolongs survival of patients with end-stage kidney disease. However, kidney transplant recipients present a higher risk for cardiovascular events compared to the general population. Risk assessment for graft failure as well as cardiovascular events is still based on invasive procedures. Biomarkers in blood and urine, but also new diagnostic approaches like genetic or molecular testing, can be useful tools to monitor graft function and to identify patients of high cardiovascular risk. Many biomarkers have been introduced, whereas most of these biomarkers have not been implemented in clinical routine. Here, we discuss recent developments in biomarkers and diagnostic models in kidney transplant recipients. Because many factors impact graft function and cardiovascular risk, it is most likely that no biomarker will meet the highest demands and standards. We advocate to shift focus to the identification of patients benefitting from molecular and genetic testing as well as from analysis of more specific biomarkers instead of finding one biomarker fitting to all patients. Full article
(This article belongs to the Special Issue Updates on Renal Transplantation and Its Complications)
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