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Special Issue "Recent Advances and Clinical Outcomes of 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: 31 December 2019

Special Issue Editors

Guest Editor
Dr. Charat Thongprayoon

Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
Website | E-Mail
Phone: 507-266-1044
Interests: nephrology; acute kidney injury; clinical nephrology; kidney transplantation
Guest Editor
Dr. Wisit Cheungpasitporn

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Mississippi, USA
Website | E-Mail
Phone: 601-984-5670
Interests: meta-analysis; acute kidney injury; clinical nephrology; and kidney transplantation
Guest Editor
Dr. Napat Leeaphorn

Department of Nephrology, Department of Medicine, Saint Luke's Health System, Kansas City, MO, USA
Website | E-Mail
Phone: 816-932-4655
Interests: kidney transplantation; observational studies; statistical analysis; epidemiology

Special Issue Information

Dear Colleagues,

Advances in immunosuppression and kidney transplant techniques have led to significant improvements in the short-term survival of the renal allograft. Long-term graft survival, however, has relatively lagged behind and has now become one of the main problems in kidney transplantation.

In this Special Issue, we are making a call to action to stimulate researchers and clinicians to submit their invaluable studies on kidney transplantation, including works on issues related to donors, allograft, and patient survival following transplantation that will provide additional knowledge and skills in the field of transplantation research, ultimately to improve outcomes after kidney transplantation. Original investigations, review articles, and short communications are especially welcome.

Potential topics include, but are not limited to, the following:

ABO-Incompatible Kidney Transplant Outcomes
Advances in Renal Transplant Immunosuppression
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 Renal Transplantation
Cardiovascular complications after renal transplantation
Cell-Free DNA and Active Rejection in Renal 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 kidney transplantation
Combined Liver–Kidney Transplantation
Management of acute rejection of kidney allograft
Pancreas and Kidney Transplants: New Lease on Life
Pediatric kidney transplantation in the New Era
Post-transplantation diabetes in kidney transplant recipients
Post-Transplant Lymphoproliferative Disorder in Kidney Transplant Recipients
Recent Advances in Perioperative Management for Kidney Transplantation
Recurrent glomerulonephritis after kidney transplantation
Risks and complications in living kidney donors
Role of Procurement Biopsies in Acceptance Decisions for Kidneys Retrieved for Transplantation
Treatment of Chronic Antibody-Mediated Rejection after Kidney Transplantation

Dr. Charat Thongprayoon
Dr. Wisit Cheungpasitporn
Dr. Napat Leeaphorn
Guest Editor
s

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 papers will be 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 monthly 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 1800 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

  • acute rejection
  • BK virus nephropathy
  • donor-specific antibody
  • immunosuppression
  • kidney donor
  • kidney transplantation
  • organ procurement
  • renal transplantation
  • post-transplant lymphoproliferative disorder
  • transplantation

Published Papers (7 papers)

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Research

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Open AccessArticle
Epidemiology, Risk Factors, and Outcomes of Opportunistic Infections after Kidney Allograft Transplantation in the Era of Modern Immunosuppression: A Monocentric Cohort Study
J. Clin. Med. 2019, 8(5), 594; https://doi.org/10.3390/jcm8050594
Received: 13 March 2019 / Revised: 16 April 2019 / Accepted: 22 April 2019 / Published: 30 April 2019
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Abstract
Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. [...] Read more.
Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. The control group included all kidney recipients transplanted in the same period, but with no OI. We analyzed 538 kidney transplantations (538 patients). The proportion of OI was 15% (80 and 72 patients). OI occurred 12.8 (6.0–31.2) months after transplantation. Viruses were the leading cause (n = 54, (10%)), followed by fungal (n = 15 (3%)), parasitic (n = 6 (1%)), and bacterial (n = 5 (0.9%)) infections. Independent risk factors for OI were extended criteria donor (2.53 (1.48–4.31), p = 0.0007) and BK viremia (6.38 (3.62–11.23), p < 0.0001). High blood lymphocyte count at the time of transplantation was an independent protective factor (0.60 (0.38–0.94), p = 0.026). OI was an independent risk factor for allograft loss (2.53 (1.29–4.95), p = 0.007) but not for patient survival. Post-kidney transplantation OIs were mostly viral and occurred beyond one year after transplantation. Pre-transplantation lymphopenia and extended criteria donor are independent risk factors for OI, unlike induction therapy, hence the need to adjust immunosuppressive regimens to such transplant candidates. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Open AccessArticle
Fast Tac Metabolizers at Risk—It is Time for a C/D Ratio Calculation
J. Clin. Med. 2019, 8(5), 587; https://doi.org/10.3390/jcm8050587
Received: 31 March 2019 / Revised: 19 April 2019 / Accepted: 26 April 2019 / Published: 28 April 2019
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Abstract
Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation (RTx). However, its metabolism rate is highly variable. A fast Tac metabolism rate, defined by the Tac blood trough concentration (C) divided by the daily dose (D), is associated with [...] Read more.
Tacrolimus (Tac) is a part of the standard immunosuppressive regimen after renal transplantation (RTx). However, its metabolism rate is highly variable. A fast Tac metabolism rate, defined by the Tac blood trough concentration (C) divided by the daily dose (D), is associated with inferior renal function after RTx. Therefore, we hypothesize that the Tac metabolism rate impacts patient and graft survival after RTx. We analyzed all patients who received a RTx between January 2007 and December 2012 and were initially treated with an immunosuppressive regimen containing Tac (Prograf®), mycophenolate mofetil, prednisolone and induction therapy. Patients with a Tac C/D ratio <1.05 ng/mL × 1/mg at three months after RTx were characterized as fast metabolizers and those with a C/D ratio ≥1.05 ng/mL × 1/mg as slow metabolizers. Five-year patient and overall graft survival were noticeably reduced in fast metabolizers. Further, fast metabolizers showed a faster decline of eGFR (estimated glomerular filtration rate) within five years after RTx and a higher rejection rate compared to slow metabolizers. Calculation of the Tac C/D ratio three months after RTx may assist physicians in their daily clinical routine to identify Tac-treated patients at risk for the development of inferior graft function, acute rejections, or even higher mortality. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Open AccessArticle
Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis
J. Clin. Med. 2019, 8(4), 530; https://doi.org/10.3390/jcm8040530
Received: 31 March 2019 / Revised: 13 April 2019 / Accepted: 15 April 2019 / Published: 17 April 2019
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Abstract
Background: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study’s aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. Methods: A literature search [...] Read more.
Background: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study’s aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. Methods: A literature search was conducted using the MEDLINE, EMBASE and Cochrane databases from inception through October 2018. Studies that reported the incidence or mortality of RCC among kidney transplant recipients were included. The pooled incidence and 95% CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO; no. CRD42018108994. Results: A total of 22 observational studies with a total of 320,190 KTx patients were enrolled. Overall, the pooled estimated incidence of RCC after KTx was 0.7% (95% CI: 0.5–0.8%, I2 = 93%). While the pooled estimated incidence of de novo RCC in the native kidney was 0.7% (95% CI: 0.6–0.9%, I2 = 88%), the pooled estimated incidence of RCC in the allograft kidney was 0.2% (95% CI: 0.1–0.4%, I2 = 64%). The pooled estimated mortality rate in KTx recipients with RCC was 15.0% (95% CI: 7.4–28.1%, I2 = 80%) at a mean follow-up time of 42 months after RCC diagnosis. While meta-regression analysis showed a significant negative correlation between year of study and incidence of de novo RCC post-KTx (slopes = −0.05, p = 0.01), there were no significant correlations between the year of study and mortality of patients with RCC (p = 0.50). Egger’s regression asymmetry test was performed and showed no publication bias in all analyses. Conclusions: The overall estimated incidence of RCC after KTX was 0.7%. Although there has been a potential decrease in the incidence of RCC post-KTx, mortality in KTx patients with RCC has not decreased over time. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Open AccessArticle
Subarachnoid Hemorrhage in Hospitalized Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease: A Nationwide Analysis
J. Clin. Med. 2019, 8(4), 524; https://doi.org/10.3390/jcm8040524
Received: 21 March 2019 / Revised: 12 April 2019 / Accepted: 15 April 2019 / Published: 17 April 2019
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Abstract
Background: This study aimed to evaluate the hospitalization rates for subarachnoid hemorrhage (SAH) among renal transplant patients with adult polycystic kidney disease (ADPKD) and its outcomes, when compared to non-ADPKD renal transplant patients. Methods: The 2005–2014 National Inpatient Sample databases were used to [...] Read more.
Background: This study aimed to evaluate the hospitalization rates for subarachnoid hemorrhage (SAH) among renal transplant patients with adult polycystic kidney disease (ADPKD) and its outcomes, when compared to non-ADPKD renal transplant patients. Methods: The 2005–2014 National Inpatient Sample databases were used to identify all hospitalized renal transplant patients. The inpatient prevalence of SAH as a discharge diagnosis between ADPKD and non-ADPKD renal transplant patients was compared. Among SAH patients, the in-hospital mortality, use of aneurysm clipping, hospital length of stay, total hospitalization cost and charges between ADPKD and non-ADPKD patients were compared, adjusting for potential confounders. Results: The inpatient prevalence of SAH in ADPKD was 3.8/1000 admissions, compared to 0.9/1000 admissions in non-ADPKD patients (p < 0.01). Of 833 renal transplant patients with a diagnosis of SAH, 30 had ADPKD. Five (17%) ADPKD renal patients with SAH died in hospitals compared to 188 (23.4%) non-ADPKD renal patients (p = 0.70). In adjusted analysis, there was no statistically significant difference in mortality, use of aneurysm clipping, hospital length of stay, or total hospitalization costs and charges between ADPKD and non-ADPKD patients with SAH. Conclusion: Renal transplant patients with ADPKD had a 4-fold higher inpatient prevalence of SAH than those without ADPKD. Further studies are needed to compare the incidence of overall admissions in ADPKD and non-ADPKD patients. When renal transplant patients developed SAH, inpatient mortality rates were high regardless of ADPKD status. The outcomes, as well as resource utilization, were comparable between the two groups. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
Open AccessArticle
Higher Incidence of BK Virus Nephropathy in Pediatric Kidney Allograft Recipients with Alport Syndrome
J. Clin. Med. 2019, 8(4), 491; https://doi.org/10.3390/jcm8040491
Received: 7 March 2019 / Revised: 28 March 2019 / Accepted: 8 April 2019 / Published: 11 April 2019
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Abstract
A retrospective review was performed to assess the risk factors and outcomes of BK virus infection and nephropathy (BKVN), an early complication in pediatric kidney allograft recipients. The study investigated the incidence, risk factors, and clinical outcomes of BK viremia and BKVN in [...] Read more.
A retrospective review was performed to assess the risk factors and outcomes of BK virus infection and nephropathy (BKVN), an early complication in pediatric kidney allograft recipients. The study investigated the incidence, risk factors, and clinical outcomes of BK viremia and BKVN in a Korean population of pediatric patients who received renal transplantation from 2001–2015 at the Seoul National University Hospital. BKVN was defined as biopsy-proven BKVN or plasma BK viral loads >10,000 copies/mL for >3 weeks. BK viremia was defined as a BK viral load >100 copies/mL in blood. Among 168 patients assessed for BK virus status, 30 patients (17.9%) tested positive for BK viremia at a median of 12.6 months after transplantation. BKVN was diagnosed in six patients (3.6%) at a median of 13.4 months after transplantation. Three of the six BKVN patients had Alport syndrome (p = 0.003), despite this disease comprising only 6% of the study population. Every patient with BK viremia and Alport syndrome developed BKVN, while only 11.1% of patients with BK viremia progressed to BKVN in the absence of Alport syndrome. Multivariate analysis revealed that Alport syndrome was associated with BKVN development (hazard ratio 13.2, p = 0.002). BKVN treatment included the reduction of immunosuppression, leflunomide, and intravenous immunoglobulin. No allografts were lost in the two years following the diagnosis of BKVN. In summary, the incidence of BKVN in pediatric kidney allograft recipients was similar to findings in previous reports, but was higher in patients with underlying Alport syndrome. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Graphical abstract

Open AccessArticle
Plasma Malondialdehyde and Risk of New-Onset Diabetes after Transplantation in Renal Transplant Recipients: A Prospective Cohort Study
J. Clin. Med. 2019, 8(4), 453; https://doi.org/10.3390/jcm8040453
Received: 17 February 2019 / Revised: 29 March 2019 / Accepted: 30 March 2019 / Published: 4 April 2019
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Abstract
New-onset diabetes after transplantation (NODAT) is a frequent complication in renal transplant recipients (RTR). Although oxidative stress has been associated with diabetes mellitus, data regarding NODAT are limited. We aimed to prospectively investigate the long-term association between the oxidative stress biomarker malondialdehyde (measured [...] Read more.
New-onset diabetes after transplantation (NODAT) is a frequent complication in renal transplant recipients (RTR). Although oxidative stress has been associated with diabetes mellitus, data regarding NODAT are limited. We aimed to prospectively investigate the long-term association between the oxidative stress biomarker malondialdehyde (measured by high-performance liquid chromatography) and NODAT in an extensively phenotyped cohort of non-diabetic RTR with a functioning graft ≥1 year. We included 516 RTR (51 ± 13 years-old, 57% male). Median plasma malondialdehyde (MDA) was 2.55 (IQR, 1.92–3.66) µmol/L. During a median follow-up of 5.3 (IQR, 4.6–6.0) years, 56 (11%) RTR developed NODAT. In Cox proportional-hazards regression analyses, MDA was inversely associated with NODAT, independent of immunosuppressive therapy, transplant-specific covariates, lifestyle, inflammation, and metabolism parameters (HR, 0.55; 95% CI, 0.36–0.83 per 1-SD increase; p < 0.01). Dietary antioxidants intake (e.g., vitamin E, α-lipoic acid, and linoleic acid) were effect-modifiers of the association between MDA and NODAT, with particularly strong inverse associations within the subgroup of RTR with relatively higher dietary antioxidants intake. In conclusion, plasma MDA concentration is inversely and independently associated with long-term risk of NODAT in RTR. Our findings support a potential underrecognized role of oxidative stress in post-transplantation glucose homeostasis. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Review

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Open AccessReview
Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis
J. Clin. Med. 2019, 8(5), 689; https://doi.org/10.3390/jcm8050689
Received: 23 April 2019 / Revised: 10 May 2019 / Accepted: 13 May 2019 / Published: 16 May 2019
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Abstract
Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal [...] Read more.
Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively. Full article
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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