Recent Advances in Dialysis and Kidney Transplantation

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 7611

Special Issue Editors


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Guest Editor
Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
Interests: abdominal organ transplantation; transplant immunology; use of machine perfusion in kidney transplantation
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Guest Editor
Department of Urology, Division of Transplant Surgery, Miami Transplant Institute-Jackson Memorial Hospital, Miami, FL, USA
Interests: kidney and pancreas transplantation; living donor kidney transplantation; transplant immunology; xeno-transplantation; new surgical techniques in kidney transplantation
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Surgery, Division of HPB and Transplant Surgery, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
Interests: liver and kidney transplantation; living donor liver transplantation; hepato-pancreato-biliary surgery; ALPPS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Kidney transplantation is universally considered the treatment of choice for end-stage renal disease. In the last two decades, important advances in surgical care and immunosuppressive therapy have led to a significant reduction in peri-operative morbidity and mortality as well as cell-mediated rejection rates, with graft and patient survival of approximately 90% and 80% at 1 and 5 years, respectively.

Concurrently, considerable improvements in the therapeutic management of chronic kidney disease-associated conditions, such as anemia and secondary hyperparathyroidism together with optimized diabetes control and the enhanced physical conditioning of patients receiving dialysis, have led to promising results and noteworthy benefits in this class of patients.

Interesting and promising research areas such as wearable and bio-artificial kidneys, kidney organoid technologies, kidney-on-a-chip, xeno-transplantation, and immune-tolerance protocols for kidney transplants recipients will substantially advance the quality of life of patients on dialysis and improve long-term outcomes for those transplanted. 

Other approaches that have been successfully adopted for many years with demonstrated important benefits have recently undergone relevant improvements, i.e., optimizing perfusate through adding peculiar substances during hypothermic machine perfusion or applying regenerative therapies in normothermic machine perfusion.

The present Special Issue intends to explore the most recent progress regarding the areas of dialysis and kidney transplantation. Both clinical and technological evolutions will be considered with the option of including narrative reviews, meta-analysis, and case reports of particular interest or exceptional didactical value.

“Recent Advances in Dialysis and Kidney Transplantation” will give specialists involved in the care of end-stage renal patients and renal transplant recipients the opportunity to share their experience or point of view on several relevant topics with the primary aim of improving global knowledge and patient outcomes.

You may choose our Joint Special Issue in Transplantology.   

Dr. Paolo Vincenzi
Prof. Dr. Gaetano Ciancio
Prof. Dr. Marco Vivarelli
Guest Editors

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Keywords

  • kidney transplantation
  • dialysis
  • robotic surgery
  • machine perfusion
  • kidney-on-a-chip
  • kidney organoid
  • bioartificial kidney
  • xeno-transplantation
  • immune tolerance

Published Papers (5 papers)

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Research

14 pages, 883 KiB  
Article
Effects of Anti-COVID-19 Vaccination and Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab in Kidney and Liver Transplant Recipients
by Roberta Angelico, Francesca Romano, Luigi Coppola, Marco Materazzo, Domiziana Pedini, Maria Sara Santicchia, Roberto Cacciola, Luca Toti, Loredana Sarmati and Giuseppe Tisone
Medicina 2023, 59(12), 2101; https://doi.org/10.3390/medicina59122101 - 30 Nov 2023
Cited by 2 | Viewed by 1254
Abstract
Background and Objectives: Underpowered immune response to vaccines against SARS-CoV-2 was observed in solid organ transplant (SOT) recipients. A novel combination of monoclonal antibodies tixagevimab-cilgavimab (TGM/CGM) received authorization as pre-exposure prophylaxis (PrEP) in those with reduced response to vaccine. We aimed to [...] Read more.
Background and Objectives: Underpowered immune response to vaccines against SARS-CoV-2 was observed in solid organ transplant (SOT) recipients. A novel combination of monoclonal antibodies tixagevimab-cilgavimab (TGM/CGM) received authorization as pre-exposure prophylaxis (PrEP) in those with reduced response to vaccine. We aimed to evaluate the response rate to COVID-19 vaccination in kidney transplant (KT), compared to liver transplant (LT) recipients, and the efficacy and safety of PrEP with TGM/CGM. Material and Methods: Between March and November 2022, adult KT and LT recipients who had completed the vaccination schedule (3 doses) were tested for anti-SARS-CoV-2 antibodies titer. SOT recipients with anti-SARS-CoV-2 titer ≥ 100 IU/mL were considered protected against infection, while those with titer < 100 UI/mL were defined non-protected. Patients with inadequate response were invited to PrEP. Results: In total, 306 patients were enrolled [KT:197 (64.4%), LT:109 (35.6%)]. After the complete scheme of vaccination, 246 (80.3%) patients developed a protective titer, while 60 (19.6%) did not have a protective titer. KT recipients had a lower rate of protective anti-COVID-19 titer compared to LT patients [149 (75.6%) vs. 97 (89.0%), p = 0.004]. Recipients with non-protective anti-COVID-19 titer received mainly tacrolimus-based regimen associated with mycophenolate mofetil (MMF) (70%) e steroids (46.7%) as maintenance immunosuppression, while those treated with everolimus were associated with higher protective titer. Of 35 (58.3%) patients who received PrEP, within 12 months, 6 (17.1%) (all KT) developed pauci-symptomatic COVID-19 disease, while 15/25 (60%) of non-responders, who did not receive the prophylaxis, developed COVID-19 disease. After PrEP, hospitalization rate was lower (2.8% vs. 16%), and no adverse events, neither graft loss nor rejection, were observed. Conclusions: Despite complete COVID-19 vaccination, SOT recipients might be not protected from the SARS-CoV-2 infection, especially after KT. In non-protected SOT patients, the subsequent pre-exposure prophylaxis with combination of monoclonal antibodies (TGM/CGM) might be an efficacy and safe strategy to prevent COVID-19 severe disease and hospitalization. Full article
(This article belongs to the Special Issue Recent Advances in Dialysis and Kidney Transplantation)
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11 pages, 820 KiB  
Article
The Role of Pre- and Post-Transplant Hydration Status in Kidney Graft Recovery and One-Year Function
by Andrejus Bura, Vaiva Kaupe, Justina Karpaviciute, Asta Stankuviene, Kestutis Vaiciunas, Inga Arune Bumblyte and Ruta Vaiciuniene
Medicina 2023, 59(11), 1931; https://doi.org/10.3390/medicina59111931 - 1 Nov 2023
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Abstract
Background and Objectives: Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) [...] Read more.
Background and Objectives: Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) and lung ultrasonography (LUS) and to investigate the hydration status’ relationship with the function of the transplanted kidney during the first year after transplantation. Materials and Methods: This observational prospective cohort study included deceased kidney recipients transplanted in the Hospital of the Lithuanian University of Health Sciences between September 2016 and January 2023. BIA and LUS were performed before transplantation, on days 3 and 7, and at discharge. Data on recipient and donor clinical characteristics were collected. Graft function was evaluated according to the serum creatinine reduction ratio and the need for dialysis. Hydration status was evaluated by calculating B-lines (BL) on LUS and the ratio of extracellular/total body water on BIA. Results: Ninety-eight kTx recipients were included in the study. Patients with immediate graft function (IGF) were compared to those with slow or delayed graft function (SGF + DGF). Recipients in the SGF + DGF group had a higher sum of BL on LUS before transplantation. After transplantation in early postoperative follow-up, both groups showed hyperhydration as determined by BIA and LUS. After one year, recipients with no BL before transplantation had better graft function than those with BL. Logistic regression analysis showed that having more than one BL in LUS was associated with a 2.5 times higher risk of SGF or DGF after transplantation. Conclusions: This study found that lung congestion detected by LUS before kTx was associated with slower graft recovery and worse kidney function after 1 year. Meanwhile, the hyperhydration status detected by BIA analysis did not correlate with the function of the transplanted kidney. Full article
(This article belongs to the Special Issue Recent Advances in Dialysis and Kidney Transplantation)
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14 pages, 1551 KiB  
Article
Association of Different Total Bilirubin Levels with Prognosis of Peritoneal Dialysis-Associated Peritonitis
by Yujian He, Jingjing Zhu, Fei Xiao, Qingyun Luo, Pengpeng Wang, Xu Wang, Yan He and Zibo Xiong
Medicina 2023, 59(10), 1837; https://doi.org/10.3390/medicina59101837 - 16 Oct 2023
Viewed by 1115
Abstract
Background and Objectives: Peritoneal dialysis-associated peritonitis (PDAP) poses significant challenges in peritoneal dialysis (PD) patient management and outcomes. Total bilirubin has gained attention due to its antioxidant and immunomodulatory properties. However, its relationship with PDAP prognosis remains underexplored. Materials and Methods: We conducted [...] Read more.
Background and Objectives: Peritoneal dialysis-associated peritonitis (PDAP) poses significant challenges in peritoneal dialysis (PD) patient management and outcomes. Total bilirubin has gained attention due to its antioxidant and immunomodulatory properties. However, its relationship with PDAP prognosis remains underexplored. Materials and Methods: We conducted a retrospective single-center study involving 243 PDAP patients stratified into tertile-based groups according to total bilirubin levels. The association between total bilirubin levels and treatment failure risk was investigated through statistical analyses and restricted cubic spline curve analysis. Results: Our analysis revealed a non-linear correlation between total bilirubin levels and PDAP treatment failure risk. At total bilirubin levels below 8.24 µmol/L, a protective effect was observed, while levels exceeding this threshold heightened the risk of treatment failure. Conclusions: This study unveils a dual role of total bilirubin in PDAP prognosis. Below a certain threshold, it confers protection, while higher levels exacerbate the risk of treatment failure. These findings emphasize the need for further investigation in larger, multicenter prospective studies to validate and elucidate the mechanisms behind bilirubin’s impact on PDAP, potentially guiding the development of targeted therapeutic strategies. Full article
(This article belongs to the Special Issue Recent Advances in Dialysis and Kidney Transplantation)
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13 pages, 1092 KiB  
Article
Lower Circulating Cytotoxic T-Cell Frequency and Higher Intragraft Granzyme-B Expression Are Associated with Inflammatory Interstitial Fibrosis and Tubular Atrophy in Renal Allograft Recipients
by Brijesh Yadav, Narayan Prasad, Vinita Agrawal, Vikas Agarwal and Manoj Jain
Medicina 2023, 59(6), 1175; https://doi.org/10.3390/medicina59061175 - 20 Jun 2023
Cited by 1 | Viewed by 1475
Abstract
Background and Objectives: Inflammatory interstitial fibrosis and tubular atrophy (i-IFTA) is an inflammation in the area of tubular atrophy and fibrosis. i-IFTA is poorly associated with graft outcome and associated with infiltration of inflammatory mononuclear cells. A cytotoxic T cell is a granzyme [...] Read more.
Background and Objectives: Inflammatory interstitial fibrosis and tubular atrophy (i-IFTA) is an inflammation in the area of tubular atrophy and fibrosis. i-IFTA is poorly associated with graft outcome and associated with infiltration of inflammatory mononuclear cells. A cytotoxic T cell is a granzyme B+CD8+CD3+ T cell, mainly secret granzyme B. Granzyme B is a serine protease that may mediate allograft injury and inflammatory interstitial fibrosis and tubular atrophy (i-IFTA). However, there is no report identifying the association of granzyme B with i-IFTA after a long post-transplant interval. Material and Methods: In this study, we have measured the cytotoxic T-cell frequency with flow cytometry, serum and PBMCs culture supernatants granzyme-B levels with ELISA and intragraft granzyme-B mRNA transcript expression with the RT-PCR in RTRs in 30 patients with biopsy-proven i-IFTA and 10 patients with stable graft function. Result: The frequency of cytotoxic T cells (CD3+CD8+ granzyme B+) in SGF vs. i-IFTA was (27.96 ± 4.86 vs. 23.19 ± 3.85%, p = 0.011), the serum granzyme-B level was (100.82 ± 22.41 vs. 130.32 ± 46.60, p = 0.038 pg/mL) and the intragraft granzyme-B mRNA transcript expression was (1.01 ± 0.048 vs. 2.10 ± 1.02, p < 0.001 fold). The frequency of CD3+ T cells in SGF vs. i-IFTA was (66.08 ± 6.8 vs. 65.18 ± 9.35%; p = 0.68) and that of CD3+CD8+ T cells was (37.29 ± 4.11 vs. 34.68 ± 5.43%; p = 0.28), which were similar between the 2 groups. CTLc frequency was negatively correlated with urine proteinuria (r = −0.51, p < 0.001), serum creatinine (r = −0.28, p = 0.007) and eGFR (r = −0.28, p = 0.037). Similarly, the PBMC culture supernatants granzyme-B level was negatively correlated with urine proteinuria (r = −0.37, p < 0.001) and serum creatinine (r = −0.31, p = 0.002), while the serum granzyme-B level (r = 0.343, p = 0.001) and intragraft granzyme-B mRNA transcript expression (r = 0.38, p < 0.001) were positively correlated with proteinuria. Conclusions: A decrease in the CTLc frequency in circulation and an increased serum granzyme-B level and intragraft granzyme-B mRNA expression shows that cytotoxic T cells may mediate the allograft injury in RTRs with i-IFTA by releasing granzyme B in serum and intragraft tissue. Full article
(This article belongs to the Special Issue Recent Advances in Dialysis and Kidney Transplantation)
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14 pages, 902 KiB  
Article
The Association of Beta-Blocker Use and Bone Mineral Density Level in Hemodialysis Patients: A Cross-Sectional Study
by Suthiya Anumas, Saranya Thitisuriyarax, Pichaya Tantiyavarong, Waroot Pholsawatchai and Pattharawin Pattharanitima
Medicina 2023, 59(1), 129; https://doi.org/10.3390/medicina59010129 - 9 Jan 2023
Viewed by 2062
Abstract
Background and Objectives: Osteoporosis results in increasing morbidity and mortality in hemodialysis patients. The medication for treatment has been limited. There is evidence that beta-blockers could increase bone mineral density (BMD) and reduce the risk of fracture in non-dialysis patients, however, a [...] Read more.
Background and Objectives: Osteoporosis results in increasing morbidity and mortality in hemodialysis patients. The medication for treatment has been limited. There is evidence that beta-blockers could increase bone mineral density (BMD) and reduce the risk of fracture in non-dialysis patients, however, a study in hemodialysis patients has not been conducted. This study aims to determine the association between beta-blocker use and bone mineral density level in hemodialysis patients. Materials and Methods: We conducted a cross-sectional study in hemodialysis patients at Thammasat University Hospital from January 2018 to December 2020. A patient receiving a beta-blocker ≥ 20 weeks was defined as a beta-blocker user. The association between beta-blocker use and BMD levels was determined by univariate and multivariate linear regression analysis. Results: Of the 128 patients receiving hemodialysis, 71 were beta-blocker users and 57 were non-beta-blocker users (control group). The incidence of osteoporosis in hemodialysis patients was 50%. There was no significant difference in the median BMD between the control and the beta-blocker groups of the lumbar spine (0.93 vs. 0.91, p = 0.88), femoral neck (0.59 vs. 0.57, p = 0.21), total hip (0.73 vs. 0.70, p = 0.38), and 1/3 radius (0.68 vs. 0.64, p = 0.40). The univariate and multivariate linear regression analyses showed that the beta-blocker used was not associated with BMD. In the subgroup analysis, the beta-1 selective blocker used was associated with lower BMD of the femoral neck but not within the total spine, total hip, and 1/3 radius. The multivariate logistic regression showed that the factors of age ≥ 65 years (aOR 3.31 (1.25–8.80), p = 0.02), female sex (aOR 4.13 (1.68–10.14), p = 0.002), lower BMI (aOR 0.89 (0.81–0.98), p = 0.02), and ALP > 120 U/L (aOR 3.88 (1.33–11.32), p = 0.01) were independently associated with osteoporosis in hemodialysis patients. Conclusions: In hemodialysis patients, beta-blocker use was not associated with BMD levels, however a beta-1 selective blocker used was associated with lower BMD in the femoral neck. Full article
(This article belongs to the Special Issue Recent Advances in Dialysis and Kidney Transplantation)
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