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Sustaining Success Through Innovation in Kidney Transplantation

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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 January 2026 | Viewed by 3549

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Special Issue Editor

Prof. Dr. Junji Uchida

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Guest Editor

Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
Interests: kidney transplantation; long-term graft survival; immunosuppression; organ preservation; complication after kidney transplantation

Special Issue Information

Dear Colleagues,

Kidney transplantation has undergone remarkable progress in recent decades, with significant improvements supporting both patient survival and quality of life. Nevertheless, the field continues to encounter enduring challenges, such as ensuring long-term graft viability, managing post-transplant complications, and addressing donor organ shortage. These pressing issues necessitate the development of innovative strategies to promote sustainable progress in transplantation.

This Special Issue aims to illuminate recent advancements and explore novel strategies that address these critical challenges in kidney transplantation, offering a comprehensive review of cutting-edge research and clinical innovations that can potentially transform the field of transplantation.

Our focus encompasses a wide spectrum of topics, including advancements in immunosuppressive therapies and the use of biomarkers for effective graft monitoring. Furthermore, we explore the potential of xenotransplantation as a viable solution to organ scarcity. We also examine mechanisms such as donor exchange programs, which offer viable alternatives to expand the donor pool and increase access to transplantation. Additionally, we address key issues related to post-transplant complications, aiming to improve long-term outcomes.

We invite submissions of original research articles and comprehensive review papers that contribute to the advancement of kidney transplantation. Submissions should provide valuable insights into innovative approaches poised to shape the future of transplantation, improving both patient outcomes and graft longevity.

Prof. Dr. Junji Uchida
Guest Editor

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Keywords

kidney transplantation
long-term graft survival
immunosuppression
organ shortage
post-transplant complication

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Published Papers (4 papers)

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Research

14 pages, 2161 KB

Open AccessArticle

The Efficacy of 22 °C Static Subnormothermic Preservation with an Extracellular-Type Solution for 2 h Warm-Ischemic Porcine Kidneys

by Akira Kondo, Masayoshi Okumi, Yuichi Ariyoshi, Mitsuhiro Sekijima, Akihiro Kawai, Takehiro Iwanaga, Kazuhiro Takeuchi, Kohei Miura, Shiori Miura, Akiyuki Iwamoto, Kenya Shimizu, Yurika Ichinari, Akira Shimizu, Mamoru Kusaka and Hisashi Sahara

J. Clin. Med. 2025, 14(17), 6156; https://doi.org/10.3390/jcm14176156 - 31 Aug 2025

Viewed by 653

Abstract

Background: Static cold storage is the standard method of kidney preservation following donation after circulatory death (DCD). A previous study on rodent models demonstrated the efficacy of storing DCD kidneys at 22 °C in an extracellular-type solution (ETK). We evaluated the efficacy of storing warm-ischemic kidneys at 22 °C in MHC-inbred miniature swine. Methods: After 2 h warm ischemia, the kidneys were preserved in ETK for one hour at either 4 °C or 22 °C and then subjected to ex vivo normothermic machine perfusion (NMP) for 2 h (n = 3 in each group). The same warm-ischemic kidneys, preserved in ETK (n = 3 in each group) or intracellular-type solution (UW; n = 2 in each group) at either 4 °C or 22 °C, were transplanted into MHC-matched recipients. Results: Compared with kidneys preserved at 4 °C, those preserved at 22 °C showed significantly better physiological and metabolic indices during ex vivo NMP. Furthermore, renal function was significantly higher in transplanted kidneys, and graft biopsies on postoperative day 4 showed more localized necrosis in the renal tubules when kidneys were stored at 22 °C. In contrast, recipient animals with kidneys stored in UW solution did not survive for more than 7 days. Conclusions: Two-hour warm-ischemic kidneys from miniature swine showed improved preservation at 22 °C than at 4 °C when an extracellular-type solution was used. Full article

(This article belongs to the Special Issue Sustaining Success Through Innovation in Kidney Transplantation)

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20 pages, 1554 KB

Open AccessArticle

Potential of Kidney Exchange Programs (KEPs) in Japan for Donor-Specific Antibody-Positive Kidney Transplants: A Questionnaire Survey on KEPs and a Multi-Institutional Study Conducting Virtual Cross-Matching Simulations

by Taihei Ito, Miki Ito, Naohiro Aida, Kei Kurihara, Akihiro Terao, Yoshihiko Watarai, Mitsuru Saito, Keizo Kaku, Daisuke Ishii, Satoshi Sekiguchi, Tatsuo Yoneda, Kohei Unagami, Masayuki Tasaki, Hitoshi Iwamoto, Motoo Araki, Kazuhiro Takahashi, Kazuaki Yamanaka, Mikio Sugimoto, Kouhei Nishikawa, Chikashi Seto, Masaki Muramatsu, Toshihiro Asai, Daiki Iwami, Yasutoshi Yamada, Shigeyoshi Yamanaga, Tomonori Komatsu, Masayoshi Miura, Takahiro Nohara, Michihiro Maruyama, Yuki Miyauchi, Toshiaki Tanaka, Michio Nakamura, Kiyohiko Hotta and Takashi Kenmochi Show full author list Hide full author list

J. Clin. Med. 2025, 14(17), 6122; https://doi.org/10.3390/jcm14176122 - 29 Aug 2025

Cited by 1 | Viewed by 803

Abstract

Objectives: To clarify the need for a kidney exchange program (KEP) in Japan by conducting a questionnaire survey on KEPs and simulated KEPs by virtual cross-matching based on past cases of transplantation avoidance. Methods: In addition to the content regarding KEPs, an electronic survey was conducted to investigate the number of cases of kidney transplant abandonment due to “immunological” reasons over the past 10 years (2012–2021). Virtual cross-matching was conducted to simulate the feasibility of avoiding immunological risks and enabling kidney transplantation in patients who were previously unable to undergo the procedure. Results: The survey received responses from 107 facilities (response rate: 81.7%). In response to the question about the necessity of a KEP in Japan, 71 facilities (66.4%) indicated that KEPs are necessary. In addition, 251 living-donor kidney transplants were abandoned for “immunological” reasons over the past decade (2012–2021). Among the 80 pairs for which detailed information was available, virtual cross-matching simulations showed that 37/80 pairs (46.3%) were donor-specific antibody (DSA)-negative for blood type-matched combinations, and 41/80 pairs (51.3%) were DSA-negative for blood type-incompatible transplants. Conclusions: The need for a KEP in Japan and its potential usefulness were demonstrated. Full article

(This article belongs to the Special Issue Sustaining Success Through Innovation in Kidney Transplantation)

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9 pages, 736 KB

Open AccessArticle

Comparative Analysis Between Insulated Gel Bags and Direct Cooling for Temperature Management During Kidney Transplant Vascular Anastomosis

by Yuichi Machida, Tomoaki Iwai, Kazuya Kabei and Junji Uchida

J. Clin. Med. 2025, 14(7), 2368; https://doi.org/10.3390/jcm14072368 - 29 Mar 2025

Viewed by 691

Abstract

Background/Objectives: Ischemic time plays a crucial role in graft function and survival during kidney transplantation. Cooling methods, including cold perfusion and ice slush, are predominantly applied to preserve the kidney, but they may cause uneven cooling and complications. The Organ Pocket^®, an insulated gel bag, has been introduced as an alternative cooling method. However, no studies have compared renal temperature changes between the Organ Pocket^® and conventional cooling methods. Methods: We retrospectively analyzed 49 cases of living-donor kidney transplantation. Among these, 33 received kidney grafts preserved with the Organ Pocket^® (OP group), and 16 underwent conventional cooling (control group). Renal surface temperatures were recorded at 5 min intervals during vascular anastomosis using thermography. Postoperative renal function was assessed with estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and liver-type fatty acid-binding protein (L-FABP) levels. Results: The OP group demonstrated significantly higher renal surface temperatures than the control group during vascular anastomosis (p < 0.05). Renal surface temperature before reperfusion was 20.4 °C ± 2.5 °C and 17.2 °C ± 2.5 °C in the OP and control groups, respectively. No significant differences in postoperative eGFR, sCr, and L-FABP levels; delayed graft function (DGF); or acute rejection rates were observed between the groups. Conclusions: The Organ Pocket^® effectively stabilized renal temperatures during vascular anastomosis without direct cooling, thereby reducing continuous manual cooling requirements. Short-term renal function outcomes were comparable between groups; however, the Organ Pocket^® may improve surgical efficiency and be particularly beneficial in robot-assisted kidney transplantation. Further studies are warranted to investigate its long-term benefits. Full article

(This article belongs to the Special Issue Sustaining Success Through Innovation in Kidney Transplantation)

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20 pages, 6028 KB

Open AccessArticle

Immunosuppressant-Induced Alteration of Gut Microbiota Causes Loss of Skeletal Muscle Mass: Evidence from Animal Experiments Using Mice and Observational Study on Humans

by Mitsuru Tomizawa, Shunta Hori, Tatsuo Yoneda, Fumisato Maesaka, Sayuri Onishi, Takuto Shimizu, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Kazumasa Torimoto, Nobumichi Tanaka and Kiyohide Fujimoto

J. Clin. Med. 2025, 14(5), 1628; https://doi.org/10.3390/jcm14051628 - 27 Feb 2025

Viewed by 903

Abstract

Background/Objectives: The number of older adults requiring a kidney transplant (KT) is increasing; hence, postoperative sarcopenia prevention is necessary. KT recipients require permanent oral immunosuppressants (ISs), and the gut microbiota (GM) plays a role in various systemic diseases. However, few studies have evaluated post-kidney transplantation frailty and the associations among ISs, GM, and muscle mass alterations. Therefore, we investigated the effects of ISs on GM and skeletal muscle mass in mice and human KT recipients. Methods: Mice were treated with six different ISs, and their skeletal muscle mass, GM diversity, and colonic mucosal function were assessed. Human KT recipients and donors were monitored before and after surgery for 1 year, and GM diversity was evaluated before and 1 month after surgery. Results: The abundance of Akkermansia, crypt depth, and mucin 2 expression were lower in tacrolimus- and prednisolone-treated mice. The psoas muscle volume changes at 1 month and 1 year after surgery were lower in KT recipients than in donors. Furthermore, the beta diversity was significantly different between the operative groups (p = 0.001), and the KT group showed the lowest Shannon index. Conclusions: The findings of this study indicate potential links among ISs, GM, and muscle mass decline. Further investigation is required to improve therapeutic strategies and patient outcomes. Full article

(This article belongs to the Special Issue Sustaining Success Through Innovation in Kidney Transplantation)

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