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Progress and Recent Advances in Solid Organ 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: closed (31 December 2021) | Viewed by 30573

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Special Issue Editors

Dr. Charat Thongprayoon

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Guest Editor

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Interests: artificial intelligence; machine Learning; nephrology; acute kidney injury; clinical nephrology; kidney transplantation
Special Issues, Collections and Topics in MDPI journals

Dr. Wisit Cheungpasitporn

E-Mail Website
Guest Editor

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Interests: artificial Intelligence; machine learning; meta-analysis; acute kidney injury; clinical nephrology; kidney transplantation
Special Issues, Collections and Topics in MDPI journals

Dr. Wisit Kaewput

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Guest Editor

Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
Interests: machine learning; kidney transplantation; observational studies; statistical analysis; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

There have been significant improvements in the short-term survival of solid organ transplantation patients due to advances in immunosuppression and transplant techniques. However, long-term graft survival has lagged behind and now become one of the main problems in solid organ transplantation.

For this Special Issue, we invite researchers and clinicians to submit studies on solid organ transplantation including issues related to donors, allografts, and patient survival following transplantation that will provide us with additional knowledge and skills and help us ultimately to improve outcomes after solid organ transplantation. Original research papers, review articles, and short communications are welcome.

Potential topics include, but are not limited to:

advances in kidney transplant immunosuppression
advances in pancreas transplant immunosuppression;
advances in liver transplantation;
advances in heart transplantation;
advances in lung transplantation;
advances in kidney procurement and transplantation;
antibody-mediated rejection: new approaches to prevention and management;
APOL1 genotype and kidney transplantation outcomes;
BK virus nephropathy and kidney transplantation;
bone disease after kidney transplantation;
cardiovascular complications after renal transplantation;
cell-free DNA and active rejection in solid organ allografts;
clinical outcomes of kidney transplantation in older end-stage renal disease patients;
donor-specific antibody and graft outcomes in kidney transplant recipients;
evaluation of the living kidney donor candidate;
infectious complications after solid organ transplantation;
combined liver–kidney transplantation;
management of acute rejection of solid organ transplant;
pancreas and kidney transplants;
pediatric kidney transplantation in the new era;
post-transplantation diabetes in solid organ transplant recipients;
post-transplant lymphoproliferative disorder in solid organ transplant recipients;
recent advances in perioperative management for kidney transplantation;
recurrent glomerulonephritis after kidney transplantation;
risks and complications in living kidney donors;
treatment of chronic antibody-mediated rejection after solid organ transplantation.

Dr. Charat Thongprayoon
Dr. Wisit Cheungpasitporn
Dr. Wisit Kaewput
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

transplantation
kidney transplantation
liver transplantation
heart transplantation
pancreas transplantation
lung transplantation
immunosuppression
kidney donor
organ procurement
renal transplantation
post-transplant lymphoproliferative disorder

Related Special Issue

Progress and Recent Advances in Solid Organ Transplantation in Transplantology (9 articles)

Published Papers (14 papers)

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Editorial

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3 pages, 199 KiB

Open AccessEditorial

Progress and Recent Advances in Solid Organ Transplantation

by Charat Thongprayoon, Wisit Kaewput, Pattharawin Pattharanitima and Wisit Cheungpasitporn

J. Clin. Med. 2022, 11(8), 2112; https://doi.org/10.3390/jcm11082112 - 11 Apr 2022

Cited by 5 | Viewed by 1732

Abstract

Over the past decade, the number of organ transplants performed worldwide has significantly increased for patients with advanced organ failure [...] Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

Research

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13 pages, 18802 KiB

Open AccessArticle

Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors

by Nasrin El-Bandar, Markus H. Lerchbaumer, Robert Peters, Andreas Maxeiner, Katja Kotsch, Arne Sattler, Kurt Miller, Thorsten Schlomm, Bernd Hamm, Klemens Budde, Lutz Liefeldt, Thomas Fischer and Frank Friedersdorff

J. Clin. Med. 2022, 11(3), 791; https://doi.org/10.3390/jcm11030791 - 01 Feb 2022

Cited by 5 | Viewed by 3808

Abstract

Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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16 pages, 1665 KiB

Open AccessArticle

The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial

by Ulrich Jehn, Anja Kortenhorn, Katharina Schütte-Nütgen, Gerold Thölking, Florian Westphal, Markus Strauss, Dirk-Oliver Wennmann, Hermann Pavenstädt, Barbara Suwelack, Dennis Görlich and Stefan Reuter

J. Clin. Med. 2022, 11(3), 654; https://doi.org/10.3390/jcm11030654 - 27 Jan 2022

Cited by 1 | Viewed by 1351

Abstract

Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n = 47), only one (2.2%) patient had previously undergone PTX. After adjusting for the known fracture risk factors MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018–0.991, p = 0.049). We observed a reduced risk for pathological fractures in KTx patients who underwent PTX, independent from elevated parathyroid hormone at the time of KTx or afterwards. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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9 pages, 450 KiB

Open AccessArticle

The Relationship between Initial Tacrolimus Metabolism Rate and Recipients Body Composition in Kidney Transplantation

by Aureliusz Kolonko, Patrycja Pokora, Natalia Słabiak-Błaż, Beata Czerwieńska, Henryk Karkoszka, Piotr Kuczera, Grzegorz Piecha and Andrzej Więcek

J. Clin. Med. 2021, 10(24), 5793; https://doi.org/10.3390/jcm10245793 - 10 Dec 2021

Cited by 4 | Viewed by 2136

Abstract

There are several premises that the body composition of kidney transplant recipients may play a role in tacrolimus metabolism early after transplantation. The present study aimed at analyzing the relationship between the body composition parameters assessed by bioimpedance analysis (BIA) and initial tacrolimus metabolism. Immediately prior to transplantation, BIA using InBody 770 device was performed in 122 subjects. Tacrolimus concentration-to-dose (C/D) ratio was calculated based on the first blood trough level measurement. There was no difference in phase angle, visceral fat area, lean body mass index (LBMI) and the proportion of lean mass as a percentage of total body mass between the subgroups of slow and fast metabolizers. However, subjects with LBMI ≥ median value of 18.7 kg/m², despite similar initial tacrolimus dose per kg of body weight, were characterized by a significantly lower tacrolimus C/D ratio (median 1.39 vs. 1.67, respectively; p < 0.05) in comparison with the subgroup of lower LBMI. Multivariate regression analysis confirmed that age (r_partial = 0.322; p < 0.001) and LBMI (r_partial = −0.254; p < 0.01) independently influenced the tacrolimus C/D ratio. A LBMI assessed by BIA may influence the tacrolimus metabolism in the early post-transplant period and can be a useful in the optimization of initial tacrolimus dosing. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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9 pages, 950 KiB

Open AccessArticle

Outcomes of Deceased Donor Kidney Transplantation in the Eurotransplant Senior Program with A Focus on Recipients ≥75 Years

by Ilias Zompolas, Robert Peters, Lutz Liefeldt, Lukas J. Lehner, Klemens Budde, Bernhard Ralla, Irena Goranova, Andreas Maxeiner, Markus H. Lerchbaumer, Stephan R. Marticorena Garcia, Martin Kanne, Thorsten Schlomm, Matthias R. G. Schulz and Frank Friedersdorff

J. Clin. Med. 2021, 10(23), 5633; https://doi.org/10.3390/jcm10235633 - 29 Nov 2021

Cited by 4 | Viewed by 1653

Abstract

To evaluate the outcomes of kidney transplantations (KTs) in the Eurotransplant Senior Program (ESP) with a focus on the very old, defined as recipients ≥75 years. This retrospective clinical study included 85 patients, who under the ESP protocol underwent deceased donor kidney transplantation from January 2010 to July 2018 at the Charité–Universitätsmedizin Berlin in Germany. Recipients were divided in three age groups, i.e., Group 65–69, Group 70–74, Group ≥75, and compared. Prognostic risk factors for short and long-term outcomes of kidney transplantations were investigated. Graft survival at 1 and 5 years were respectively 90.7% and 68.0% for group 65–69, 88.9% and 76.2% for Group 70–74, and 100% and 71.4% for Group ≥75. Patient survival at 1 and 5 years were respectively 92.9% and 68.0% for Group 65–69, 85.7% and 61.5% for Group 70–74 and 100% and 62.5% for Group ≥75. Serum creatinine did not significantly differ between the three groups, with the exception of serum creatinine at 1 year. Increased recipient age and prolonged time on dialysis correlated with increased occurrence of postoperative complication. An increase in BMI, pretransplant diabetes mellitus and prolonged time on dialysis correlated with the occurrence of delayed graft function (DGF). History of smoking was identified as an independent risk factor for events of rejection. Increased human leukocyte antigen mismatches (HLA-MM) and prolonged cold ischemia time (CIT) correlated with higher rates of intensive care unit (ICU) treatment. This study supports kidney transplantations for the very old. End-stage renal disease (ESRD) patients ≥75 years of age who underwent kidney transplantation experienced comparable results to their younger counterparts. A comprehensive evaluation of ESRD patients with consideration of prognostic risk factor is the most suitable mean of identifying adequate kidney transplant candidates. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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13 pages, 714 KiB

Open AccessArticle

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

by Yuri Battaglia, Luigi Zerbinati, Martino Belvederi Murri, Michele Provenzano, Pasquale Esposito, Michele Andreucci, Alda Storari and Luigi Grassi

J. Clin. Med. 2021, 10(20), 4747; https://doi.org/10.3390/jcm10204747 - 16 Oct 2021

Cited by 9 | Viewed by 1948

Abstract

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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9 pages, 632 KiB

Open AccessArticle

Association of Hematuria with Renal Progression and Survival in Patients Who Underwent Living Donor Liver Transplant

by Kai-Chieh Chang, Yao-Peng Hsieh, Huan-Nung Chao, Chien-Ming Lin, Kuo-Hua Lin, Chun-Chieh Tsai, Chia-En Heish, Pei-Ru Lin, Chew-Teng Kor, Yao-Li Chen and Ping-Fang Chiu

J. Clin. Med. 2021, 10(19), 4345; https://doi.org/10.3390/jcm10194345 - 24 Sep 2021

Cited by 1 | Viewed by 1325

Abstract

Background: This study aimed to determine the association between episodic or persistent hematuria after liver transplantation and long-term renal outcomes. Methods: Patients who underwent living donor liver transplantation between July 2005 and June 2019 were recruited and divided into two groups based on the finding of microscopic or gross hematuria after transplantation. All patients were followed up from the index date until the end date in May 2020. The risks of chronic kidney disease, death, and 30% and 50% declines in estimated glomerular filtration rate (eGFR) were compared between groups. Results: A total of 295 patients underwent urinalysis for various reasons after undergoing transplantation. Hematuria was detected in 100 patients (group A) but was not present in 195 patients (group B). Compared with group B, group A had a higher risk of renal progression, including eGFR decline >50% [aHR = 3.447 (95%CI: 2.24~5.30), p < 0.001] and worse survival. In addition, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) continuously for over seven days within six months before transplant surgery had high risks of rapid renal progression, including a >30% decline in eGFR [aHR = 1.572 (95%CI: 1.12~2.21), p = 0.009)]. Conclusion: Development of hematuria after surgery in patients who underwent living donor liver transplant and were exposed to NSAIDs before surgery were associated with worse long-term renal dysfunction and survival. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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10 pages, 1130 KiB

Open AccessArticle

The Tacrolimus Metabolism Rate and Dyslipidemia after Kidney Transplantation

by Gerold Thölking, Christian Schulte, Ulrich Jehn, Katharina Schütte-Nütgen, Hermann Pavenstädt, Barbara Suwelack and Stefan Reuter

J. Clin. Med. 2021, 10(14), 3066; https://doi.org/10.3390/jcm10143066 - 11 Jul 2021

Cited by 9 | Viewed by 2114

Abstract

Fast tacrolimus (Tac) metabolism is associated with reduced survival rates after renal transplantation (RTx), mainly due to cardiovascular events. Because dyslipidemia is a leading cause of cardiovascular death, we hypothesized that most RTx patients do not achieve recommended target low-density lipoprotein cholesterol (LDL-C) levels (European cardiology society guidelines) and that fast Tac metabolizers have higher dyslipidemia rates. This study included RTx recipients who received initial immunosuppression with immediate-release tacrolimus (IR-Tac), mycophenolate, and prednisolone. Patients were grouped according to their Tac concentration-to-dose ratio (C/D ratio) 3 months after RTx. Dyslipidemia parameters were analyzed at RTx, 3 months, and 12 months after RTx. Statin use and renal function were documented in a 12-month follow-up, and death was documented in a 60-month follow-up. Ninety-six RTx recipients were divided into two groups: 31 fast Tac metabolizers (C/D ratio < 1.05 ng/mL·1/mg) and 65 slow metabolizers (C/D ratio ≥ 1.05 ng/mL·1/mg). There were no differences in triglyceride or cholesterol levels between groups at RTx, 3, and 12 months after RTx. A total of 93.5% of fast and 95.4% of slow metabolizers did not achieve target LDL-C levels (p = 0.657). Fast metabolizers developed lower renal function compared to slow metabolizers 12 months after RTx (p = 0.009). Fast metabolizers showed a 60 month survival rate of 96.8% compared to 94.7% in the slow metabolizer group (p = 0.811). As most RTx recipients do not reach recommended target LDL-C levels, individualized nutritional counseling and lipid-lowering therapy must be intensified. Fast Tac metabolism is associated with lower renal function after RTx, but does not play a significant role in dyslipidemia. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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14 pages, 1430 KiB

Open AccessArticle

Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

by Napat Leeaphorn, Charat Thongprayoon, Pradeep Vaitla, Panupong Hansrivijit, Caroline C. Jadlowiec, Shennen A. Mao, Api Chewcharat, Sreelatha Katari, Pattharawin Pattharanitima, Boonphiphop Boonpheng, Wisit Kaewput, Michael A. Mao, Matthew Cooper and Wisit Cheungpasitporn

J. Clin. Med. 2021, 10(14), 3063; https://doi.org/10.3390/jcm10143063 - 11 Jul 2021

Cited by 7 | Viewed by 2426

Abstract

Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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12 pages, 453 KiB

Open AccessArticle

Exhaled Hydrogen as a Marker of Intestinal Fermentation Is Associated with Diarrhea in Kidney Transplant Recipients

by Fernanda Guedes Rodrigues, J. Casper Swarte, Rianne M. Douwes, Tim J. Knobbe, Camilo G. Sotomayor, Hans Blokzijl, Rinse K. Weersma, Ita P. Heilberg, Stephan J. L. Bakker, Martin H. de Borst and TransplantLines Investigators

J. Clin. Med. 2021, 10(13), 2854; https://doi.org/10.3390/jcm10132854 - 28 Jun 2021

Cited by 1 | Viewed by 1712

Abstract

Background: Diarrhea is common among kidney transplant recipients (KTR). Exhaled hydrogen (H₂) is a surrogate marker of small bowel dysbiosis, which may drive diarrhea. We studied the relationship between exhaled H₂ and diarrhea in KTR, and explored potential clinical and dietary determinants. Methods: Clinical, laboratory, and dietary data were analyzed from 424 KTR participating in the TransplantLines Biobank and Cohort Study (NCT03272841). Fasting exhaled H₂ concentration was measured using a model DP Quintron Gas Chromatograph. Diarrhea was defined as fast transit time (types 6 and 7 according to the Bristol Stool Form Scale, BSFS) of 3 or more episodes per day. We studied the association between exhaled H₂ and diarrhea with multivariable logistic regression analysis, and explored potential determinants using linear regression. Results: KTR (55.4 ± 13.2 years, 60.8% male, mean eGFR 49.8 ± 19.1 mL/min/1.73 m²) had a median exhaled H₂ of 11 (5.0–25.0) ppm. Signs of small intestinal bacterial overgrowth (exhaled H₂ ≥ 20 ppm) were present in 31.6% of the KTR, and 33.0% had diarrhea. Exhaled H₂ was associated with an increased risk of diarrhea (odds ratio 1.51, 95% confidence interval 1.07–2.14 per log₂ ppm, p = 0.02). Polysaccharide intake was independently associated with higher H₂ (std. β 0.24, p = 0.01), and a trend for an association with proton-pump inhibitor use was observed (std. β 0.16 p = 0.05). Conclusion: Higher exhaled H₂ is associated with an increased risk of diarrhea in KTR. Our findings set the stage for further studies investigating the relationship between dietary factors, small bowel dysbiosis, and diarrhea after kidney transplantation. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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12 pages, 568 KiB

Open AccessArticle

The Value of Graft Implantation Sequence in Simultaneous Pancreas-Kidney Transplantation on the Outcome and Graft Survival

by Hans-Michael Hau, Nora Jahn, Sebastian Rademacher, Elisabeth Sucher, Jonas Babel, Matthias Mehdorn, Andri Lederer, Daniel Seehofer, Uwe Scheuermann and Robert Sucher

J. Clin. Med. 2021, 10(8), 1632; https://doi.org/10.3390/jcm10081632 - 12 Apr 2021

Cited by 6 | Viewed by 1830

Abstract

Background/Objectives: The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. Material and methods: 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. Results: Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3–17.1, p = 0.026) and five years (HR 3.7, 2.1–23.4, p = 0.040). Conclusion: Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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9 pages, 255 KiB

Open AccessArticle

The Association between Body Composition Measurements and Surgical Complications after Living Kidney Donation

by Lisa B. Westenberg, Marco van Londen, Camilo G. Sotomayor, Cyril Moers, Robert C. Minnee, Stephan J. L. Bakker and Robert A. Pol

J. Clin. Med. 2021, 10(1), 155; https://doi.org/10.3390/jcm10010155 - 05 Jan 2021

Cited by 6 | Viewed by 2126

Abstract

Obesity is considered a risk factor for peri- and postoperative complications. Little is known about this risk in overweight living kidney donors. The aim of this study was to assess if anthropometric body measures and/or surgical determinants are associated with an increased incidence of peri- and postoperative complications after nephrectomy. We included 776 living kidney donors who donated between 2008 and 2018 at the University Medical Center Groningen. Prenephrectomy measures of body composition were body mass index (BMI), body surface area (BSA), waist circumference, weight, and waist–hip ratio. Incidence and severity of peri- and postoperative complications were assessed using the Comprehensive Complication Index. Mean donor age was 53 ± 11 years; 382 (49%) were male, and mean BMI at donor screening was 26.2 ± 3.41 kg/m². In total, 77 donors (10%) experienced peri- and postoperative complications following donor nephrectomy. Male sex was significantly associated with fewer surgical complications (OR 0.59, 0.37–0.96 95%CI, p = 0.03) in binomial logistic regression analyses. Older age (OR: 1.03, 1.01–1.05 95%CI, p = 0.02) and a longer duration of surgery (OR: 1.01, 1.00–1.01 95%CI, p = 0.02) were significantly associated with more surgical complications in binomial logistic regression analyses. Multinomial logistic regression analyses did not identify any prenephrectomy measure of body composition associated with a higher risk of surgical complications. This study shows that higher prenephrectomy BMI and other anthropometric measures of body composition are not significantly associated with peri- and postoperative complications following living donor nephrectomy. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

Review

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30 pages, 454 KiB

Open AccessReview

Antibody-Mediated Rejection and Recurrent Primary Disease: Two Main Obstacles in Abdominal Kidney, Liver, and Pancreas Transplants

by Tsukasa Nakamura and Takayuki Shirouzu

J. Clin. Med. 2021, 10(22), 5417; https://doi.org/10.3390/jcm10225417 - 19 Nov 2021

Cited by 6 | Viewed by 2743

Abstract

The advances in acute phase care have firmly established the practice of organ transplantation in the last several decades. Then, the next issues that loom large in the field of transplantation include antibody-mediated rejection (ABMR) and recurrent primary disease. Acute ABMR is a daunting hurdle in the performance of organ transplantation. The recent progress in desensitization and preoperative monitoring of donor-specific antibodies enables us to increase positive outcomes. However, chronic active ABMR is one of the most significant problems we currently face. On the other hand, recurrent primary disease is problematic for many recipients. Notably, some recipients, unfortunately, lost their vital organs due to this recurrence. Although some progress has been achieved in these two areas, many other factors remain largely obscure. In this review, these two topics will be discussed in light of recent discoveries. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

9 pages, 252 KiB

Open AccessReview

Tocilizumab and Desensitization in Kidney Transplant Candidates: Personal Experience and Literature Review

by Jules Weinhard, Johan Noble, Thomas Jouve, Paolo Malvezzi and Lionel Rostaing

J. Clin. Med. 2021, 10(19), 4359; https://doi.org/10.3390/jcm10194359 - 24 Sep 2021

Cited by 10 | Viewed by 1805

Abstract

Desensitization (DES) allows kidney transplantation for highly HLA-sensitized subjects. Due to the central role of IL-6 in the immunological response, tocilizumab may improve DES efficacy. Thus, we conducted a PubMed systematic review using the MeSH terms tocilizumab, interleukin-6, kidney transplantation, and desensitization. Tocilizumab (TCZ) was first studied for DES as the second-line treatment after failure of a standard DES protocol (SP) (apheresis, rituximab +/− IVIg). Although TCZ (as a monotherapy) attenuated anti-HLA antibody rates, it did not permit transplantation. However, lymphocyte immuno-phenotyping has shown that TCZ hinders B-cell maturation and thus could improve the long-term efficacy of DES by limiting anti-HLA rebound and so avoid antibody-mediated rejection. This hypothesis is supported by a recent study where clazakizumab, a monoclonal antibody directed against IL-6, was continued after kidney transplantation in association with an SP. Nine out of ten patients were then eligible for transplantation, and there were no donor-specific antibodies at 6 months post-transplantation. In association with an SP, tocilizumab does not seem to significantly improve kidney-allograft access (short-term efficacy) vs. a SP only. However, it could improve the long-term prognosis of HLA-incompatible transplantation by hindering B-cell maturation and, thereby, avoiding donor-specific antibody rebounds post-transplantation. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

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