Search Results (206)

Kidney transplant recipients (KTRs) remain vulnerable to infectious complications and malignancies due to chronic immunosuppression, both of which may contribute to allograft dysfunction and adverse clinical outcomes. This study aimed to evaluate the prevalence of viral infections and post-transplant malignancies among hospitalized KTRs and to identify factors associated with acute kidney injury (AKI) and chronic graft dysfunction. We conducted a prospective observational study including 215 adult KTRs admitted to a tertiary transplant center over a one-year period. Clinical data, malignancy history, and viral detection for BK polyomavirus (BKV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and parvovirus B19 were analyzed. AKI occurred in 65.6% of patients, while chronic graft dysfunction was present in 21.4%. Viral positivity was detected in 16.7% of the cohort, most frequently BKV and CMV. Infectious etiologies represented the most common cause of AKI. Viral positivity was significantly associated with infectious mechanisms of AKI and was independently associated with AKI in multivariable analysis (adjusted OR 3.01, p = 0.02). In a separate multivariable model, malignancy history (aOR 9.30), viral positivity (aOR 3.33), and concurrent AKI (aOR 3.42) were independently associated with chronic graft dysfunction. These findings suggest that viral reactivation and malignancy history cluster with clinical states of increased graft vulnerability in hospitalized KTRs. Integrated evaluation of infectious, immunologic, and clinical factors may improve risk stratification and management of transplant recipients presenting with acute illness. Full article

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

Design guidance for headed-bar development remains uncertain for large-diameter bars at cutoff points, where bar termination increases anchorage demand and confinement is often limited. This study quantified the anchorage behavior of 43 and 57 mm headed bars and established a regression-based strength model grounded in a splitting-controlled bond–bearing mechanism. Nineteen reinforced concrete beam specimens were tested under four-point loading configured to place the bending-moment inflection point at the head location. The primary variables were the development length (l_dt = 12–28d_b), concrete compressive strength (f_c′ = 42 and 70 MPa), clear side cover, clear spacing, and transverse reinforcement index (K_tr/d_b = 0–2.0). All the specimens failed by splitting prior to bar yielding, characterized by longitudinal cracking along the development region and cover spalling near the head. The anchorage strength increased with concrete compressive strength and development length and was most strongly enhanced by transverse reinforcement (up to ~60%). At failure, the bond contributed 70–86% of the developed stress, while the head-bearing contribution increased with confinement. Existing ACI 318-19 and KDS-2021 provisions were generally unconservative, particularly for unconfined specimens. The proposed bond–bearing model showed a close agreement with the test database (mean test/prediction = 0.99; COV = 4.72%) within stated parameter limits. Full article

Background/Objectives: Physical activity (PA) is a modifiable determinant of health and quality of life (QoL) in kidney transplant recipients (KTRs). However, associations between PA, health-related QoL (HRQoL), inflammation, and clinical factors in KTRs remain incompletely defined. The aim was to evaluate PA levels in KTRs and explore their associations with HRQoL, clinical characteristics, and biochemical and inflammatory markers. Methods: We conducted a cross-sectional study of 32 stable KTRs (56% male; mean age 54.5 ± 14.2 years). PA was assessed using the International Physical Activity Questionnaire and classified as low (<700 MET-min/week) or high (≥700 MET-min/week) according to IPAQ categorical scoring. HRQoL was evaluated using the SF-36. Associations with demographic, clinical, biochemical (including potassium), and inflammatory markers—including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, and ferritin—were analyzed using multivariable binary logistic regression models. Results: Sixty-three percent of participants achieved high PA, which was associated with better physical functioning (78.8 vs. 58.3; p = 0.016), fewer emotional role limitations, younger age at transplantation, and preemptive transplantation or peritoneal dialysis. Active patients had modestly higher potassium levels (4.61 vs. 4.25 mmol/L; p = 0.041), a hypothesis-generating finding that should be interpreted cautiously. Inflammatory indices showed no significant associations. Conclusions: Although most KTRs achieved adequate PA levels, physical inactivity persisted in over one-third. Targeted strategies addressing HRQoL and clinical factors may support PA engagement after transplantation. Full article

Background and Objectives: Kidney transplant recipients (KTRs) face increased susceptibility to persistent viral infections due to prolonged immunosuppression. While high-risk human papillomavirus (HR-HPV) infection is known to be more prevalent in this population, little is known about the co-occurrence of HPV with human herpesviruses (HHVs) infection in the female genital tract. This study aimed to investigate the presence, dynamics, and potential interactions between HR-HPV and HHVs infections—including HSV-1, HSV-2, EBV, CMV, HHV-6, and HHV-7—in female KTRs during the first year after transplantation. Materials and Methods: A total of 39 female KTRs and 79 age-matched healthy controls were enrolled in the study. Cervicovaginal swabs from recipients were obtained at three time points: two weeks, six months, and one year post-transplantation. HPV DNA was screened using PCR, followed by high-risk HPV genotyping and quantitative viral load assessment using two commercial PCR kits. HHVs were detected using a multiplex PCR assay. Results: HPV DNA was detected in 98% of the KTRs at least once during follow-up, which was significantly greater than in the controls (38%). HR-HPV was identified in 46% of the recipients over the study period, with the highest viral load at one year post-transplantation. HHVs were detected in 72% of the KTRs but not in 43% of the controls (p < 0.01), with EBV and CMV being the most common. Coinfection with HR-HPV and HHVs occurred in 46% of the recipients but not in the controls. Samples containing both EBV and CMV had significantly higher HR-HPV viral loads than samples with no HHVs or with single/other HHV combinations (p < 0.01). All cervical intraepithelial neoplasia patients were found to have combined HPV and HHV infection. Conclusions: Female KTRs present a high burden of both HR-HPV and herpesviruses infections, with increased HPV viral loads. These findings suggest a potential synergistic interaction between HR-HPV and herpesviruses in the immunosuppressed setting. Full article

Background: Despite the lack of formal indication for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter-2 inhibitors (SGLT2i) in post-transplant diabetes mellitus (PTDM), their use in clinical practice is growing. While robust evidence supporting their use in kidney transplant recipients (KTRs) remains limited, PTDM remains a major driver of adverse outcomes, including cardiovascular morbidity, accelerated graft dysfunction, graft loss, and reduced survival. Methods: This retrospective cohort study analyzed adult KTRs with PTDM treated with SGLT2is and/or GLP-1 RAs between 2013 and 2024. Metabolic, kidney, and safety parameters were assessed from baseline to follow-up. Results: After a median treatment duration of 1.8 years, glycated hemoglobin (HbA1c) changed from 7.22% to 7.01% (p = 0.558), whereas fasting plasma glucose increased from 112.62 mg/dL to 125.01 mg/dL (p = 0.03). Body mass index decreased from 27.27 kg/m² to 25.95 kg/m² (p < 0.001). The lipid profile improved, with reductions in total cholesterol (p < 0.01) and low-density lipoprotein cholesterol (LDL-c, p = 0.02). Kidney function remained stable throughout the observation period, and adverse events were infrequent. Conclusions: In KTRs with PTDM, GLP-1 RAs and SGLT2is were associated with significant improvements in weight and lipid metabolism, alongside stable kidney function and a favorable safety profile. These findings support the consideration of these agents in the management of PTDM. Prospective studies are warranted to confirm these results. Full article

Background: Sarcopenia and sarcopenic obesity are increasingly recognized in kidney transplant recipients (KTRs), yet their molecular underpinnings remain poorly defined. We sought to synthesize current evidence on biomarker associations with muscle loss and function in the post renal transplant setting. Methods: A comprehensive search of PubMed/MEDLINE and Cochrane databases was conducted according to PRISMA guidelines. Studies evaluating biomarkers related to sarcopenia or sarcopenic obesity in adult and pediatric KTRs were included. Quality assessment was performed with the NHLBI tool. Results: Seven studies were included, encompassing 548 KTRs. Myostatin levels predicted sarcopenia in KTRs (cut-off: 390 pg/mL) and inversely correlated with Metabolic equivalent of Tasks (METs), handgrip strength (HGS), and graft performance. Although adiponectin was negatively correlated with body fat, its high-molecular-weight isoform was linked to lower muscle mass and long-term graft decline. Leptin was associated with sarcopenic obesity and lower estimated Glomerular Filtration Rate (eGFR). Insulin like Growth Factor-1 (IGF-1) independently predicted HGS but not muscle mass. Brain-derived neurotrophic factor (BDNF) levels predicted sarcopenia (cut off: 17.8 ng/mL) and reflected physical activity levels. Visfatin showed no association with sarcopenia but it was positively correlated with eGFR. Lastly, certain polymorphisms of Alpha-actinin-3 (ACTN3) were shown to genetically predispose to post-transplant sarcopenia. Conclusions: These emerging candidate biomarkers provide promising mechanistic insight into post-transplant muscle decline and may ultimately support more personalized risk assessment. Further validation is needed, and functional measures remain the most reliable clinical tools at present. Full article

Objective: The aim was to characterize the real-world use of GLP-1 receptor agonists (GLP-1 RAs) and/or SGLT2 inhibitors in kidney transplant recipients (KTRs) with diabetes and to compare the clinical management, safety, and effectiveness between patients with type 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM). Methods: This retrospective longitudinal cohort study included 141 adult KTRs (T2DM: 52; PTDM: 89) who initiated GLP-1 RA and/or SGLT2 inhibitor (SGLT2i) therapy between August 2013 and April 2024. Metabolic control, medication use, and safety outcomes were assessed from baseline to end follow-up, with a mean treatment exposure of 2.4 years. Results: Overall, 69% were treated with an SGLT2i and 59% with a GLP-1 RA; because the groups were not mutually exclusive, 28% received both agents. Treatment was associated with significant reductions in body weight (−3.38 kg; p < 0.001) and BMI (−1.28 kg/m²; p < 0.001) in both subgroups. HbA1c showed a non-significant overall decline (−0.31%; p = 0.21), with a greater reduction in the T2DM subgroup (−0.50%; p < 0.01). Significant improvements were also observed in lipid profile and blood pressure. Renal allograft function remained stable in both groups. The overall safety profile of the therapies was favorable, with mild urinary tract infections (18%) and manageable nausea (6%) reported in the entire cohort. No episodes of acute rejection or severe hypoglycemia occurred during the study period. Conclusions: In real-world practice, GLP-1 RAs and SGLT2is were associated with improved cardiometabolic parameters and stable renal function in KTRs, with a manageable safety profile. Similar effectiveness and safety across T2DM and PTDM support the use of these agents throughout the spectrum of diabetes in transplant recipients. Full article

In semiconductor manufacturing, fluorinated gases such as CHF₃ and CH₂F₂ are widely used as process gases for plasma etching and cleaning. However, their decomposition within the plasma environment leads to the formation of secondary fluorinated by-products with high global warming potential (GWP). Understanding how plasma intensity affects the generation characteristics of these by-products under realistic process conditions is essential for developing country-specific emission factors and improving inventory accuracy. This study analyzes the by-product formation behavior of CHF₃ and CH₂F₂ under three plasma power conditions (500 W, 600 W, and 700 W), based on process data representative of domestic semiconductor facilities. The quantitative analysis revealed distinct reaction trends between the two gas systems. In the CHF₃ process, a reaction-pathway bifurcation was observed at 700 W, where the formation of high-GWP perfluorocarbons (PFCs, e.g., CF₄, C₂F₆) decreased, while the production of low-GWP fluorinated compounds such as C₄F₆ increased, resulting in an overall 18% reduction in CO₂eq. emissions. Conversely, CH₂F₂ showed a continuous increase in fluoromethane (CH₃F) generation with higher plasma power due to the higher hydrogen content in its molecular structure, leading to an 18.4% net reduction in total GWP emissions. These results provide scientific evidence for understanding the relationship between plasma intensity and by-product formation in fluorinated gas systems under conditions relevant to the Korean semiconductor industry, and offer a foundation for improving national F-gas emission factor development. Full article

Background: Gut microbiota plays a critical role in host metabolism, immunity, and intestinal barrier integrity. Both chronic kidney disease (CKD) and kidney transplantation (KTR) are associated with gut dysbiosis, driven by uremic toxins, comorbidities, and immunosuppressive therapy. However, direct comparisons between hemodialysis (HD), KTR, and healthy controls (HC), while accounting for dietary factors, remain limited. Methods: We conducted a cross-sectional study including 48 HD patients, 75 KTR patients, and 13 HC. Stool patient samples were analyzed using 16S rRNA amplicon sequencing targeting the V4-V4 region to assess microbial composition and diversity. Data on clinical status, laboratory parameters, and dietary intake were collected and integrated with microbiome profiling. Results: Firmicutes and Bacteroidota dominated all groups, with Akkermansia enriched in HD and SCFA-producing genera (Faecalibacterium, Roseburia) more abundant in KTR. LEfSe and sPLS-DA analyses identified Akkermansia and Clostridia-related taxa as discriminants of HD, while Acidaminococcus and Megasphaera characterized KTR. HD patients exhibited higher alpha diversity (Faith’s PD and Chao1) than KTR (p < 0.05). Dietary intake differed across groups, but explained only a small proportion of microbial variance. Conclusions: Both HD and KTR patients display persistent gut dysbiosis with distinct microbial signatures. While transplantation partially restores SCFA producers, immunosuppression and diet shape new ecological shifts. These findings underscore the potential of microbiota as a biomarker and therapeutic target in renal replacement therapies. Full article

Background: Arterial stiffness assessed by measuring pulse wave velocity (PWV) is a well-established predictor of cardiovascular mortality. To our knowledge, no studies on arterial stiffness in kidney transplant recipients (KTRs) from Tunisia have been conducted. The present study aimed to assess arterial stiffness in Tunisian KTRs and to identify the key predictors associated with its increase. Methods: We conducted a cross-sectional, single-center study enrolling Tunisian KTRs aged 18 years or older with a minimum post-transplant follow-up of six months. Arterial stiffness was measured as pulse carotid–femoral PWV (CF-PWV) by a Complior device. A CF-PWV ≥ 10 m/s was defined as elevated. Results: Fifty-four KTRs were included (mean age: 42.55 ± 10.61 years). Among them, 19 (35.2%) had a CF-PWV ≥ 10 m/s. The univariate analysis showed a significant association between elevated CF-PWV and the following parameters: age, hypertension prior to transplantation, dyslipidemia, donor age, parameters obtained through office blood pressure measurement (systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP)), central SBP recorded by the Complior device, nocturnal SBP obtained through 24 h ambulatory blood pressure monitoring (ABPM), and fasting blood glucose. A multivariable analysis with CF-PWV ≥ 10 m/s as a dependent variable retained the following independent factors: dyslipidemia (p = 0.015; OR = 60.32), donor age (p = 0.014; OR = 1.16), SBP obtained through office blood pressure measurement (p = 0.015; OR = 1.25), and fasting blood glucose (p = 0.034; OR = 22.35). Conclusions: Given the major impact of cardiovascular disease on post-transplant outcomes, understanding the determinants of arterial stiffness is crucial for improving patient care. Routine PWV assessment may not be feasible in all centers due to cost or limited equipment availability. Therefore, identifying the clinical and biological markers associated with arterial stiffness offers a low-cost and widely accessible alternative for evaluating cardiovascular risk. These findings may support the development of a simple risk score to help nephrologists detect and manage high-risk KTRs more effectively. Full article

Background: Kidney transplant recipients (KTRs) experience improved survival and quality of life compared to dialysis treatment, but chronic immunosuppression may increase the risk of de novo post-transplant cancer. Colorectal cancer (CRC) is increasingly recognized in this population. This systematic review aims to synthetize contemporary evidence on CRC epidemiology, outcomes, and risk determinants among KTRs. Methods: A comprehensive search for observational and registry-based studies reporting CRC in adult KTRs was conducted on PubMed, Scopus, Web of Science, and ProQuest. The studies found were subsequently subjected to screening, data extraction, and the risk-of-bias appraisal process. Due to heterogeneity, findings were synthesized narratively. Results: Twenty-six studies encompassing 863,005 KTRs met inclusion criteria: 22 retrospective cohorts, 1 prospective cohort, 2 cross-sectional, and 1 case-control. Absolute CRC occurrence varies by geography, population, and follow-up. Reported risks ranged from no excess to modestly elevated standardized incidence ratios (SIRs): ~0.76–3.60 overall, with a right-sided colon predominance. Overall, higher mortality and worse prognosis were reported in kidney transplant recipients with colorectal cancer compared to the general population, as a result of later-stage diagnosis and more aggressive histologies. Consistent risk factors included older age, time since transplantation, diabetes and metabolic comorbidities, prior dialysis duration/graft failure, and smoking; the female sex showed higher relative CRC risk in some cohorts. The remarkable role of immunosuppression profiles was consistently highlighted: cyclosporine—azathioprine maintenance and alemtuzumab induction were associated with higher CRC risk in large registries, whereas tacrolimus—mycophenolate regimens showed lower risk signals and mTOR inhibitors suggested possible protective effects. Conclusions: Contemporary evidence suggests a modest, heterogenous increase in CRC risk among KTRs, a proximal (right-sided) predominance, and a tendency toward advanced-stage presentation with reduced survival. These findings justify the need to consider risk-tailored, lifelong surveillance strategies anchored in a full colonoscopy, with earlier initiation in younger or otherwise high-risk recipients, alongside careful optimization and periodic re-evaluation of immunosuppression. Prospective multicenter studies and cost-effectiveness analyses should refine screening thresholds and therapeutic strategies. PROSPERO ID: CRD420251071658. Full article

In the Alberta Oil Sands Region (AOSR), environmental stressors linked to oil sands industrial activity may have significant and species-specific impacts on local wildlife. This study evaluated the kynurenine–tryptophan ratio (KTR) as a potential biomarker for environmental exposure in longnose suckers (Catostomus catostomus) and white suckers (Catostomus commersonii) collected from various locations within the AOSR. The relationship between KTR and CYP1 enzyme activity (ethoxyresorufin-O-deethylase; EROD) was assessed alongside biometric indices, including gonadosomatic index (GSI), hepatic somatic index (HSI), and fat content. Both species exhibited increased EROD activity when exposed to oil sands natural deposits and potential industrial activity, indicating significant polycyclic aromatic compound (PAC) exposure. However, KTR changes were species-dependent: longnose suckers showed an inversely proportional relationship between KTR and EROD, while white suckers displayed a directly proportional correlation. Longnose suckers downstream of both municipal waste and industrial activity exhibited significant increases in GSI and fat content, with KTR varying more consistently by location rather than sex, suggesting that KTR may be a more reliable marker for location-based exposure. Species-specific differences in KTR and EROD relationships may be influenced by the distinct environmental requirements of each species, and their differing sensitivities to environmental conditions, including temperature, turbidity and flow conditions, during sampling periods. These findings illustrate the complexity of interpreting environmental biomarkers in wildlife and emphasize the need to consider ecological requirements and environmental conditions. Further research is necessary to validate this biomarker across different years and conditions and enhance its application in environmental monitoring and conservation efforts. Full article

Background: Post-transplant diabetes mellitus (PTDM) is a complication of kidney transplantation, but the impact of early hyperglycemia (EH) remains unclear. This study aimed to assess the incidence of PTDM in kidney transplant recipients (KTRs) who experienced EH compared to those who do not at 6 months post-transplant. Methods: A single-center, retrospective cohort study was conducted in adults who underwent kidney transplantation from 1 January 2019 to 25 May 2022. KTRs who developed EH were compared against those who did not. Results: The primary outcome was the difference in incidence of PTDM at 6 months. Secondary outcomes included rehospitalizations and infections within 6 months and PTDM, renal function, cardiovascular events, and graft and patient survival within 12 months. Two hundred and seventy-nine KTRs (EH, n = 204 vs. comparator, n = 75) were included. There were higher incidences of PTDM in the EH group compared to the comparator group at 6 months (11% vs. 1.4%, p = 0.012) and 12 months post-transplant (18.5% vs. 5.5%, p = 0.007). KTRs with EH had 8.9 times greater odds of developing PTDM (OR 8.9; 95% 1.2–67.3, p = 0.03) at 6 months. There was no significant difference found in other secondary outcomes. Conclusions: KTRs with EH had an increased incidence of developing PTDM. Full article

Background: Kidney transplant recipients (KTRs) exhibit a significantly diminished immune response to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccines compared with the general population, primarily due to ongoing immunosuppressive therapy. This study evaluated the immunogenicity of a third SARS-CoV-2 mRNA vaccine dose in KTRs and assessed the association between antibody response and protection against SARS-CoV-2 breakthrough infection. Additionally, the clinical and immunological correlates of post-vaccination SARS-CoV-2 infection were examined. Methods: A prospective cohort of 135 KTRs received a third vaccine dose approximately six months following the second dose. Plasma samples were collected at baseline (pre-vaccination), six months after the second dose, and six weeks following the third dose. Humoral responses were assessed using SARS-CoV-2-specific Immunoglobulin G (IgG) titers and virus neutralization assays against wild-type (WT) and viral strains, including multiple Omicron sub-lineages. Results: After the third vaccine dose, 74% of the KTRs had detectable SARS-CoV-2-specific IgG antibodies, compared with 48% following the second dose. The mean IgG titers increased approximately ten-fold post-booster. Despite this increase, neutralizing activity against the Omicron variants remained significantly lower than that against the WT strain. KTRs who subsequently experienced a SARS-CoV-2 breakthrough infection demonstrated reduced neutralizing antibody activity across all variants tested. Additionally, individuals receiving triple immunosuppressive therapy had a significantly higher risk of SARS-CoV-2 breakthrough infection compared with those on dual or monotherapy. A multivariate machine learning analysis identified age and neutralizing activity against WT, Delta, and Omicron BA.2 as the most robust correlates of SARS-CoV-2 breakthrough infection. Conclusions: A third SARS-CoV-2 mRNA vaccine dose significantly improves SARS-CoV-2-specific IgG levels in KTRs; however, the neutralizing response against Omicron variants remains suboptimal. Diminished neutralizing capacity and intensified immunosuppression are key determinants of SARS-CoV-2 breakthrough infection in this immunocompromised population. Full article