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Medicina
Special Issues
Kidney Transplantation Complications: Updates and Challenges
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Kidney Transplantation Complications: Updates and Challenges

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

Deadline for manuscript submissions: 30 April 2026 | Viewed by 8325

Special Issue Editors

Dr. Kumar Digvijay

E-Mail Website
Guest Editor
1. Department of Biomedicine, Aarhus University, Aarhus, Denmark
2. Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
Interests: nephrology; dialysis
Prof. Dr. Henrik Birn

E-Mail Website
Guest Editor
Department of Clinical Medicine, Health Faculty, Aarhus University, DK-8200 Aarhus N, Denmark
Interests: kidney transplantation; biomarkers in kidney injury; biomarkers in allograft rejection; stem cell

Special Issue Information

Dear Colleagues,

As a Guest Editor of this Special Issue titled "Kidney Transplantation Complications: Updates and Challenges," I am thrilled to extend an invitation for articles that delve into the dynamic field of post-transplantation issues. For patients with end-stage renal disease, kidney transplantation offers a potentially life-saving treatment, but its effectiveness depends on how well the related complications are managed.

The goal of this Special Issue is to provide medical professionals who work with transplant patients with a thorough and up-to-date resource. We encourage contributions that focus on diagnostic, prevention, and treatment approaches and cover both known and new issues.

With major improvements in immunosuppressive drugs and surgical methods, graft survival rates in kidney transplantation have increased significantly. Complications still pose a serious threat to overall transplant success and, in particular, to patient outcomes.

The purpose of this Special Issue is to offer a forum for innovative studies that clarify the ever-changing intricacies of post-transplantation issues. We welcome submissions that explore the following topics:

Threats from infections: Innovative methods to prevent infections in transplant recipients with impaired immune systems.

Novel perspectives on the processes and handling of instances of organ rejection.

Immunosuppressive drugs: The immunosuppressive impact over time and new approaches to reducing adverse effects.

Technological developments for the diagnosis and monitoring of early problems are known as diagnostic advances.

Methods of treatment: new treatments being developed to treat issues following transplantation.

We are especially interested in studies that provide new insights into transplant issues and stretch the limits of our present understanding. Research on precision medicines and customized medicine is greatly welcomed.

We think that all medical professionals involved in the treatment of kidney transplant recipients, including transplant nephrologists and infectious disease experts, will find great value in this Special Issue. We look forward to reading your submissions!

We invite original research papers, reviews, and case studies addressing the persistent issue of problems after kidney transplantation for this Special Issue. Submissions that introduce a new point of view and make a substantial contribution to the discipline are encouraged.

Dr. Kumar Digvijay
Prof. Dr. Henrik Birn
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 250 words) can be sent to the Editorial Office for assessment.

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. Medicina 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 2200 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
  • complications
  • infection
  • rejection
  • immunosuppression
  • diagnosis
  • prevention
  • treatment
  • long-term outcomes
  • patient care

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Published Papers (4 papers)

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Research

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18 pages, 504 KB  
Article
CT-Derived Body Composition and Diet Quality in Kidney Transplant Recipients: A Single-Center Retrospective Cross-Sectional Study
by Oktay Bagdatoglu, Pinar Ulubasoglu, Emin Rencber, Murathan Koksal, Omer Iloglu and Mine Sebnem Karakan
Medicina 2026, 62(3), 550; https://doi.org/10.3390/medicina62030550 - 16 Mar 2026
Viewed by 406
Abstract
Introduction/Objectives: Body composition changes and diet quality may contribute to metabolic complications and graft outcomes after kidney transplantation. We evaluated the relationships between diet quality and CT-derived body composition components (skeletal muscle mass, muscle quality/myosteatosis, and visceral adiposity) and explored their associations with [...] Read more.
Introduction/Objectives: Body composition changes and diet quality may contribute to metabolic complications and graft outcomes after kidney transplantation. We evaluated the relationships between diet quality and CT-derived body composition components (skeletal muscle mass, muscle quality/myosteatosis, and visceral adiposity) and explored their associations with metabolic markers and graft function. Materials and Methods: In this single-center retrospective cross-sectional study, we included 161 adult first kidney transplant recipients (KTRs) with a functioning graft and ≥12 months of follow-up. Body composition was quantified on routine abdominal CT at the L3 level using skeletal muscle index (SMI), mean muscle attenuation (Hounsfield units) for myosteatosis, and visceral adipose tissue area (VAT). Diet quality was scored using the Revised Diet Quality Index (DQI-R). Graft function was followed with creatinine-based estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI equation. Results: Mean age was 45.7 ± 13.2 years and 58% were men. The prevalence of low muscle mass was 26.0%, myosteatosis 73.5%, and visceral obesity (VAT ≥ 100 cm2) 45.6%. No participant had “good” diet quality; 48.4% had poor diet quality. DQI-R showed a weak positive correlation with SMI (r = 0.157; p = 0.047) but was not significantly related to VAT, subcutaneous adipose tissue (SAT), Kidney transplant recipient (VSR) or myosteatosis. In multivariable models, age and VAT were associated with HbA1c, whereas body composition and diet quality variables were not independent predictors of eGFR. Myosteatosis was independently associated with older age. Conclusions: Visceral adiposity and impaired muscle quality frequently clustered and were linked to metabolic status. These findings support post-transplant follow-up strategies that go beyond BMI and integrate body composition and nutritional assessment within a multidisciplinary care model. Full article
(This article belongs to the Special Issue Kidney Transplantation Complications: Updates and Challenges)
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17 pages, 784 KB  
Article
Paired Remote Ischemic Preconditioning in Recipients and Living Donors Can Mitigate Cardiovascular Stress in Recipients After Living-Donor Kidney Transplantation: A Propensity-Score-Matching Analysis
by Jaewon Huh and Min Suk Chae
Medicina 2024, 60(11), 1826; https://doi.org/10.3390/medicina60111826 - 7 Nov 2024
Cited by 1 | Viewed by 1452
Abstract
Background and Objectives: This study explored the effect of paired remote ischemic preconditioning (RIPC), involving both recipients and living donors, on cardiovascular stress in recipients after living-donor kidney transplantation (LDKT). The analysis included an assessment of the impact on cardiovascular biomarkers and [...] Read more.
Background and Objectives: This study explored the effect of paired remote ischemic preconditioning (RIPC), involving both recipients and living donors, on cardiovascular stress in recipients after living-donor kidney transplantation (LDKT). The analysis included an assessment of the impact on cardiovascular biomarkers and post-transplant cardiovascular clinical events. Materials and Methods: A retrospective observational cohort study of 520 adult LDKT patients was conducted, employing propensity score matching (PSM) to analyze perioperative factors. The patients were allocated to no-RIPC (n = 260) and paired-RIPC (n = 260) groups. The two groups were compared with respect to high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, corrected QT (QTc) intervals, the occurrence of arrhythmia, and the requirement for cardiovascular interventions. Results: After PSM, there were no significant differences in perioperative parameters between the no-RIPC and paired-RIPC groups. However, on postoperative day (POD) 1, higher hsTnI levels and QTc interval prolongation, as well as higher incidences of arrhythmia and the need for percutaneous coronary intervention (PCI), were determined in the no-RIPC group than in the paired-RIPC group. The associations between paired RIPC and improved cardiovascular outcomes were significant, including reduced odds of elevated hsTnI levels, QTc prolongation, and arrhythmia. The no-RIPC group also had longer intensive care unit (ICU) stays, and higher rates of rescue dialysis. Conclusions: Paired-RIPC involving recipients and donors effectively reduces cardiovascular stress markers and improves postoperative cardiovascular outcomes in LDKT recipients, underscoring its potential as a protective strategy against perioperative cardiovascular risks. Full article
(This article belongs to the Special Issue Kidney Transplantation Complications: Updates and Challenges)
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Review

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17 pages, 822 KB  
Review
Combined Biomarker Approach Using Extracellular Vesicles, Donor-Derived Cell-Free DNA, and Donor-Specific Antibodies for Monitoring Renal Allograft Function: A Narrative Review
by Kumar Digvijay and Henrik Birn
Medicina 2026, 62(4), 664; https://doi.org/10.3390/medicina62040664 - 31 Mar 2026
Viewed by 498
Abstract
Background and Objectives: Renal transplantation is the optimal treatment for end-stage renal disease, yet long-term allograft survival remains threatened by immune-mediated injury and chronic nephropathy. Conventional monitoring using serum creatinine and protocol biopsy suffers from limited sensitivity for early, subclinical injury. Liquid biopsy-based [...] Read more.
Background and Objectives: Renal transplantation is the optimal treatment for end-stage renal disease, yet long-term allograft survival remains threatened by immune-mediated injury and chronic nephropathy. Conventional monitoring using serum creatinine and protocol biopsy suffers from limited sensitivity for early, subclinical injury. Liquid biopsy-based biomarkers offer a non-invasive alternative. Materials and Methods: We conducted a systematic narrative review of studies published between January 2010 and December 2024, identified through PubMed, Scopus, and Web of Science. Results: Extracellular vesicles carry injury-specific molecular cargo reflecting the biological state of tubular, glomerular, and endothelial cells; urinary EV CXCL9 protein and exosomal CD3ε mRNA have demonstrated AUC values of 0.81–0.88 for the detection of T-cell-mediated rejection. Donor-derived cell-free DNA quantifies global graft cell death; the FDA-cleared AlloSure assay achieves an AUC of 0.74 and NPV of 84% at the validated ≥1.0% threshold established in the DART trial. Donor-specific antibodies—particularly complement-fixing C1q-positive DSAs—confer markedly inferior 5-year graft survival compared with DSA-negative recipients (54% versus 93%). Multi-biomarker panels integrating all three modalities yield AUCs of 0.88–0.94 and NPVs of 91–95%. Conclusions: The integration of EV, ddcfDNA, and DSA monitoring into a unified surveillance framework offers a clinically meaningful advance over creatinine-based monitoring. Prospective randomized trials confirming improvement in long-term allograft survival will be the critical next step. Full article
(This article belongs to the Special Issue Kidney Transplantation Complications: Updates and Challenges)
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26 pages, 2107 KB  
Review
Kidney and Bladder Transplantation: Advances, Barriers, and Emerging Solutions
by Gani Kuttymuratov, Timur Saliev, Ardak Ainakulov, Askar Ayaganov, Kuat Oshakbayev, Daulet Zharassov, Abdurakhman Tuleuzhan and Nurlybek Uderbayev
Medicina 2025, 61(6), 1045; https://doi.org/10.3390/medicina61061045 - 5 Jun 2025
Cited by 2 | Viewed by 4655
Abstract
Urogenital transplantation has emerged as a ground-breaking field with the potential to revolutionize the treatment of end-stage organ failure and congenital or acquired defects of the kidney and urinary bladder. This review provides a comprehensive analysis of the current state, clinical experiences, and [...] Read more.
Urogenital transplantation has emerged as a ground-breaking field with the potential to revolutionize the treatment of end-stage organ failure and congenital or acquired defects of the kidney and urinary bladder. This review provides a comprehensive analysis of the current state, clinical experiences, and experimental progress in kidney and bladder transplantation, with a particular focus on immunological, surgical, and ethical challenges. While kidney transplantation is now a well-established procedure offering improved survival and quality of life for patients with chronic renal failure, bladder transplantation remains in the experimental phase, facing hurdles in vascularization, tissue integration, and functional restoration. Recent advancements in tissue engineering, regenerative medicine, and immunosuppressive strategies are critically discussed, highlighting their role in shaping the future of urogenital grafts. This review also explores xenotransplantation and bio-artificial organ development as promising frontiers. Continued interdisciplinary research is essential to overcome the current limitations and enable routine clinical application of bladder transplantation while optimizing outcomes in kidney grafts. Full article
(This article belongs to the Special Issue Kidney Transplantation Complications: Updates and Challenges)
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