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Life
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Kidney Transplantation: What’s Hot and What’s New
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Kidney Transplantation: What’s Hot and What’s New

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 7745

Special Issue Editors

Dr. Giuseppe Ietto

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Guest Editor
1. Department of Medicine and Innovation Technology (DiMIT), University of Insubria, via Ravasi 2, 21100 Varese, Italy
2. General, Emergency and Transplant Surgery Department, ASST dei Sette Laghi, via Guicciardini 9, 21100 Varese, Italy
Interests: kidney transplantation; robotic surgery; surgical oncology; immunology
Special Issues, Collections and Topics in MDPI journals
Dr. Caterina Di Bella

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Guest Editor
Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
Interests: kidney transplantation; living donor nephrectomy; kidney-paired donation; incompatible living donor kidney transplantation; pancreas transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The development of chronic kidney disease (CKD) and its progression to the terminal stage remains a significant cause of reduction in quality of life and premature mortality. CKD is an invalidating disease, and the standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for renal replacement therapy such as dialysis and kidney transplant. The number of kidney transplants performed has increased in many countries and their outcome has improved substantially in recent years, and tireless efforts have been made to reduce the waiting time for a kidney transplant and minimize the rate of graft loss, improving patient survival.

To increase the number of available kidneys and perform more transplantations, several strategies have been developed:

  • Living donation promotion;
  • Kidney exchange programs (KEP);
  • Desensitization and AB0-incompatible protocols;
  • The expansion of the donor's pool using extended criteria donors (ECDs), non-beating heart donors (NHBDs).

Moreover, nowadays, a deeper understanding of primary non-function (PNF) and delayed graft function (DGF) pathophysiology has been reached. These have led to improvements in the treatment of DGF, the prevention of PNF and the development of novel tools for a more objective, specific, and accurate assessment of the graft quality, such as pulsatile perfusion and graft regeneration and to shed light on regenerative medicine, which could play a pivotal role in the next future.

Finally, to optimize the results of kidney transplantation, significant enhancements have been introduced in immunosuppression through the use of more specific immunosuppressive strategies tailored both to graft and recipient features.

This Special Issue’s purpose is to explore the advances in kidney transplantation, focusing on interesting perspectives from both a clinical perspective and for the scientific community.

Dr. Giuseppe Ietto
Dr. Caterina Di Bella
Guest Editors

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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. Life 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 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
  • immunosuppression
  • graft quality
  • machine perfusion (MP)
  • living donor kidney transplantation

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Published Papers (5 papers)

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Research

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12 pages, 746 KiB  
Article
Early Monitoring of Donor-Derived Cell-Free DNA in Kidney Allograft Recipients Followed-Up for Two Years: Experience of One Center
by Carmen Botella, José Antonio Galián, Víctor Jiménez-Coll, Marina Fernández-González, Francisco Morales, Gloria Martínez-Gómez, Rosana González-López, María José Alegría, María Rosa Moya, Helios Martinez-Banaclocha, Alfredo Minguela, Isabel Legaz, Santiago Llorente and Manuel Muro
Life 2024, 14(11), 1491; https://doi.org/10.3390/life14111491 - 16 Nov 2024
Viewed by 1153
Abstract
(1) Background: donor-derived circulating free DNA (dd-cfDNA), an innovative biomarker with great potential for the early identification and prevention of graft damage. (2) Methods: Samples were collected prospectively and the study was performed retrospectively to analyze dd-cfDNA plasma levels in 30 kidney transplant [...] Read more.
(1) Background: donor-derived circulating free DNA (dd-cfDNA), an innovative biomarker with great potential for the early identification and prevention of graft damage. (2) Methods: Samples were collected prospectively and the study was performed retrospectively to analyze dd-cfDNA plasma levels in 30 kidney transplant patients during their post-transplant follow-up (15 days, 3, 6, and 9 months), to determine if the result could be of interest in the identification of possible adverse events, especially rejection. The aim was to verify whether the data on sensitivity, specificity, NPV, and PPV compare with reference values and creatinine values. (3) Results: We observed levels of dd cfDNA > 1% in six of nine patients with active rejection (ABMR or TCMR) and elevated values (>0.5%) in two other patients in this rejection group. Our results show low values of sensitivity = 50%, specificity = 61.11%, rejection NPV = 64.71%, and rejection PPV = 46.13% of the technique compared to reference values previously published. With respect to creatinine, only for TCRM, we observed better results for dd-cfDNA in these parameters than in creatinine. Also, our data suggest that dd-cfDNA could help to differentiate those patients with dnDSAs that are going to through rejection better than creatinine, specially at 15 d post transplant. In this study, this appears to have no positive predictive value for borderline rejection (BR) or TCMR IA. (4) Conclusions: plasma levels of dd-cfDNA could be considered an additional or alternative biomarker for graft rejection monitoring in early post-kidney transplant up to several months before its clinical presentation, especially for patients with suspected TCMR or ABMR. Full article
(This article belongs to the Special Issue Kidney Transplantation: What’s Hot and What’s New)
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11 pages, 1324 KiB  
Article
Open Renal Transplantation in Obese Patients: A Correlation Study between BMI and Early and Late Complications with Implementation of a Prognostic Risk Score
by Sara Marzorati, Domenico Iovino, Davide Inversini, Valentina Iori, Cristiano Parise, Federica Masci, Linda Liepa, Mauro Oltolina, Elia Zani, Caterina Franchi, Marika Morabito, Mattia Gritti, Caterina Di Bella, Silvia Bisogno, Alberto Mangano, Matteo Tozzi, Giulio Carcano and Giuseppe Ietto
Life 2024, 14(7), 915; https://doi.org/10.3390/life14070915 - 22 Jul 2024
Viewed by 1115
Abstract
Background: Obesity is a global epidemic that affects millions worldwide and can be a deterrent to surgical procedures in the population waiting for kidney transplantation. However, the literature on the topic is controversial. This study evaluates the impact of body mass index (BMI) [...] Read more.
Background: Obesity is a global epidemic that affects millions worldwide and can be a deterrent to surgical procedures in the population waiting for kidney transplantation. However, the literature on the topic is controversial. This study evaluates the impact of body mass index (BMI) on complications after renal transplantation, and identifies factors associated with major complications to develop a prognostic risk score. Methods: A correlation analysis between BMI and early and late complications was first performed, followed by a univariate and multivariate logistic regression analysis. The 302 included patients were divided into obese (BMI ≥ 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) groups. Correlation analysis showed that delayed graft function (DGF) was the only obesity-associated complication (p = 0.044). Logistic regression analysis identified female sex, age ≥ 57 years, BMI ≥ 25 and ≥30 kg/m2, previous abdominal and/or urinary system surgery, and Charlson morbidity Score ≥ 3 as risk factors for significant complications. Based on the analyzed data, we developed a nomogram and a prognostic risk score. Results: The model’s area (AUC) was 0.6457 (95% IC: 0.57; 0.72). The percentage of cases correctly identified by this model retrospectively applied to the entire cohort was 73.61%. Conclusions: A high BMI seems to be associated with an increased risk of DGF, but it does not appear to be a risk factor for other complications. Using an easy-to-use model, identification, and stratification of individualized risk factors could help to identify the need for interventions and, thus, improve patient eligibility and transplant outcomes. This could also contribute to maintaining an approach with high ethical standards. Full article
(This article belongs to the Special Issue Kidney Transplantation: What’s Hot and What’s New)
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Review

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9 pages, 1392 KiB  
Review
The Evolution of Kidney Graft Preservation Through the Years
by Andres Calva Lopez, Jose Enrique Robles Garcia, Carlos Andres Yanez Ruiz, Mario Daniel Tapia Tapia, Vanessa Talavera Cobo, Carmina Alejandra Muñoz Bastidas, Daniel Sanchez Zalabardo and Bernardino Miñana Lopez
Life 2024, 14(12), 1647; https://doi.org/10.3390/life14121647 - 11 Dec 2024
Viewed by 793
Abstract
Chronic kidney disease (CKD) is a prevalent disease affecting almost 10% of the world’s population, with many cases progressing to end-stage kidney disease (ESKD). Kidney transplantation (KT) is the gold-standard treatment for ESKD. Due to growing KT waitlists, the deceased kidney donor (DKDs) [...] Read more.
Chronic kidney disease (CKD) is a prevalent disease affecting almost 10% of the world’s population, with many cases progressing to end-stage kidney disease (ESKD). Kidney transplantation (KT) is the gold-standard treatment for ESKD. Due to growing KT waitlists, the deceased kidney donor (DKDs) criteria have expanded to increase the number of available kidney grafts. Kidney graft preservation ensures optimal graft function after KT. Static cold storage (SCS) as a preservation method is still widely used. Hypothermic machine perfusion (HMP) has proven to decrease delayed graft function (DGF) and increase graft survival. Most recent studies advocate for the use of HMP regardless of donor type. However, emerging technologies, such as hypothermic oxygenated machine perfusion (HOPE) and normothermic machine perfusion (NMP), have shown promising results in specific scenarios. This review aims to provide a summary of the well-established kidney graft preservation methods and their outcomes, as well as novel technological advances that allow for newer preservation strategies. Full article
(This article belongs to the Special Issue Kidney Transplantation: What’s Hot and What’s New)
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12 pages, 1085 KiB  
Review
The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective
by Albino Eccher, Jan Ulrich Becker, Fabio Pagni, Giorgio Cazzaniga, Mattia Rossi, Giovanni Gambaro, Vincenzo L’Imperio and Stefano Marletta
Life 2024, 14(2), 254; https://doi.org/10.3390/life14020254 - 15 Feb 2024
Cited by 2 | Viewed by 1783
Abstract
Kidney transplantation is the best treatment for end-stage renal disease since it offers the greatest survival benefit compared to dialysis. The gap between the number of renal transplants performed and the number of patients awaiting renal transplants leads to a steadily increasing pressure [...] Read more.
Kidney transplantation is the best treatment for end-stage renal disease since it offers the greatest survival benefit compared to dialysis. The gap between the number of renal transplants performed and the number of patients awaiting renal transplants leads to a steadily increasing pressure on the scientific community. Kidney preimplantation biopsy is used as a component of the evaluation of organ quality before acceptance for transplantation. However, the reliability and predictive value of biopsy data are controversial. Most of the previously proposed predictive models were not associated with graft survival, but what has to be reaffirmed is that histologic examination of kidney tissue can provide an objective window on the state of the organ that cannot be deduced from clinical records and renal functional studies. The balance of evidence indicates that reliable decisions about donor suitability must be made based on the overall picture. This work discusses recent trends that can reduce diagnostic timing and variability among players in the decision-making process that lead to kidney transplants, from the pathologist’s perspective. Full article
(This article belongs to the Special Issue Kidney Transplantation: What’s Hot and What’s New)
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Other

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20 pages, 4360 KiB  
Systematic Review
Outcomes of Kidney Transplantation in Highly HLA-Sensitized Patients Treated with Intravenous Immuno-Globulin, Plasmapheresis and Rituximab: A Meta-Analysis
by Deepak Chandramohan, Oluwadamilola Adisa, Devansh Patel, Erin Ware, Navya Eleti and Gaurav Agarwal
Life 2024, 14(8), 998; https://doi.org/10.3390/life14080998 - 10 Aug 2024
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Abstract
(1) Background: We aimed to investigate the outcomes of human leukocyte antigen (HLA)-incompatible transplantation for patients who received desensitization with intravenous immunoglobulins (IVIg), plasmapheresis, and rituximab. (2) Methods: A comprehensive search of multiple electronic databases to identify studies that utilized desensitization was conducted. [...] Read more.
(1) Background: We aimed to investigate the outcomes of human leukocyte antigen (HLA)-incompatible transplantation for patients who received desensitization with intravenous immunoglobulins (IVIg), plasmapheresis, and rituximab. (2) Methods: A comprehensive search of multiple electronic databases to identify studies that utilized desensitization was conducted. The random-effects model was used to calculate the pooled rates and the 95% confidence interval (CI). (3) Results: A total of 1517 studies were initially identified. From these, 16 studies met the inclusion criteria, encompassing 459 patients, with a mean age of 45 years, of whom 40.8% were male. CDC crossmatch was positive in 68.3% (95% CI: 43.5–85.8; I2 87%), and 89.4% (95% CI: 53.4–98.4%; I2 89.8%) underwent living-donor transplantation. The 1-year graft survival pooled rate was 88.9% (95% CI: 84.8–92; I2 0%) and the 5-year graft survival rate was 86.1% (95% CI: 81.2–89.9; I2 0%). The 1-year patient survival rate was 94.2% (95% CI: 91–96.3; I2 0%), and the 5-year patient survival rate was 88.9% (95% CI: 83.5–92.7%; I2 7.7%). The rate of antibody-mediated rejection was 37.7% (95% CI: 25–52.3; I2 80.3%), and the rate of acute cell-mediated rejection was 15.1% (95% CI: 9.1–24; I2 55%). (4) Conclusions: Graft and patient survival are favorable in highly sensitized patients who undergo desensitization using IVIg, plasmapheresis, and rituximab for HLA-incompatible transplantation. Full article
(This article belongs to the Special Issue Kidney Transplantation: What’s Hot and What’s New)
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