Search Results (1,336)

Background/Objectives: For kidney transplantation, it is very important to provide effective post-transplantation interventions to help patients achieve continuous and efficient self-management. Therefore, we review the self-management interventions applied to kidney transplant recipients and suggest the optimal approach to increase the effectiveness of future self-management interventions. Design: Systematic review. Methods: Search terms and strategies included kidney transplantation; self-management; intervention; systematic review. We searched MEDLINE via PubMed, Excerpta Media dataBASE, Cochrane Register Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and one domestic Korean database to identify studies of self-management interventions for kidney transplant recipients aged ≥ 18 years published in English or Korean until 14 May 2025. Two reviewers independently selected related studies and extracted relevant data. Identified studies were assessed for quality and bias. Results: Of 1340 studies identified, 27 with 1912 participants met the inclusion criteria. Educational interventions were the most common self-management interventions and were provided 3 months to 1 year after kidney transplantation; most interventions were administered by nurses. Outcome variables were divided into cognitive, behavioral, affective, and health outcomes. Educational interventions were effective in improving cognitive, behavioral, and affective aspects. Some differences were observed, depending on the study. Conclusions: We recommend that nurse-involved educational interventions be included when developing self-management interventions and guidelines for kidney transplant recipients in clinical and community nursing settings. Full article

Kidney transplantation is the treatment of choice for patients with end-stage kidney disease. Despite significant advances in graft survival, rejection continues to pose a major clinical challenge. Conventional monitoring tools, such as serum creatinine, donor-specific antibodies, and proteinuria, lack sensitivity and specificity for early detection of graft injury. Moreover, while biopsy remains the current gold standard for diagnosing rejection, it is prone to confounders, invasive, and associated with procedural risks. However, non-invasive novel biomarkers have emerged as promising alternatives for earlier rejection detection and improved immunosuppression management. This review focuses on the leading candidate biomarkers currently under clinical investigation, with an emphasis on their diagnostic performance, prognostic value, and potential to support personalised immunosuppressive strategies in kidney transplantation. Full article

IgA nephropathy is the most common primary glomerulonephritis, with pathohistological changes described by the Oxford classification, while the Banff classification is used in transplant pathology. This study included 253 patients with IgA nephropathy in native kidneys, divided into the pediatric (n = 105) and adult (n = 148) groups. It aimed to examine clinical, and Oxford and Banff morphological parameters in relation to age, correlations of clinical data with pathohistological parameters, and predictors of the disease outcome. Pediatric patients more frequently presented with macroscopic hematuria, while adults showed higher urea and creatinine levels, and lower eGFR. Examining Oxford classification parameters, chronic glomerular and tubulointerstitial lesions were more common in adults. Banff parameters revealed more frequent chronically active glomerular, inflammatory, chronic tubulointerstitial, and vascular lesions in adults. All inflammatory, chronic tubulointerstitial, and vascular parameters correlated with serum urea levels, eGFR and CKD stage in adults, while less frequent in pediatric patients. Tubulointerstitial Oxford and Banff parameters were strong predictors of CKD and proteinuria progression in children, while such predictors were fewer in adults; segmental glomerulosclerosis predicted hematuria progression in adults. Banff parameters (cg, t, ti, i, i-IFTA, ptc, cv), not in Oxford classification, significantly predict outcomes and are recommended for incorporation into IgA nephropathy reports. Full article

Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the “extreme” application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. Methods: A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. Results: Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney–pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. Conclusions: The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams. Full article

Cystinosis is a rare systemic disease characterized by the accumulation of cystine in tissues, leading to multi-organ damage. Infantile nephropathic cystinosis is the dominant and severe form of cystinosis with critical renal manifestations that require kidney transplantation at an early age if left untreated. Cysteamine, the lifelong cystine-depleting therapy, is the mainstay treatment of nephropathic cystinosis. Cysteamine prevents cystine crystal formation and delays disease progression. While the initially introduced cysteamine consists of an immediate-release (IR) formulation, a delayed-release (DR) formulation has been developed with a simplified dosing regimen (Q12H instead of Q6H) and an improved quality of life while maintaining comparable efficacy. Due to the rare incidence of the disease and lack of international guidelines, diagnosis and treatment initiation are oftentimes delayed, leading to a poor prognosis. Pediatric and adult nephrologists from Kuwait, Saudi Arabia, the United Arab Emirates (UAE), and Qatar, in addition to one international expert from Amsterdam, convened to share their clinical experience, reflecting on the challenges encountered and therapeutic approaches followed in the management of nephropathic cystinosis in the Gulf Cooperation Council (GCC) region. Experts completed a multiple-choice questionnaire and engaged in structured discussions, where they shed light on gaps and limitations with regard to diagnostic tests and criteria to ensure early diagnosis and timely treatment initiation. Based on available literature, experts suggested an algorithm to help guide nephropathic cystinosis management in the GCC. It is highly recommended for patients who do not tolerate IR-cysteamine and do not adhere to IR-cysteamine treatment to switch to DR-cysteamine. Given the systemic nature of the disease, a multi-disciplinary approach is required for optimal disease management. Full article

Background: BK polyomavirus (BKPyV) reactivation is a common complication after kidney transplantation and may result in nephropathy and graft loss. As there is no effective antiviral therapy, management focuses on early detection and reduction of immunosuppression, which increases the risk of rejection. Identifying patients at higher risk remains challenging. Monitoring BKPyV-specific T-cell responses could aid in predicting reactivation. This study evaluated the usefulness of ELISpot to monitor BKPyV-specific cellular immunity before and after kidney transplantation. Methods: A prospective multicenter study was conducted between October 2020 and March 2022. ELISpot assays were performed prior to transplantation and two months afterward. Results: Seventy-two patients were included, with a median age of 56 years; 61% were men, and 24% had undergone previous transplantation. Nine patients developed presumptive BKPyV-nephropathy. No significant differences were found in donor type, induction therapy, or rejection rates between patients with or without nephropathy (p = 0.38). Based on ELISpot results, patients were classified into three groups according to their risk of BKPyV-nephropathy. The high-risk group included those who changed from positive to negative at 2 months post-transplant, representing 40% of presumptive BKPyV-nephropathy cases. Patients who remained negative at 2 months were classified as moderate risk (14.5%), while those with a positive ELISpot at 2 months comprised the low-risk group (0%). In the logistic regression analysis, both the ELISpot risk category [OR 19 (CI 1.7–2.08)] and the use of mTOR inhibitors from the start of transplantation [OR 0.02 (CI 0.01–0.46)] were significantly associated with BKPyV-nephropathy. Conclusions: Monitoring BKPyV-specific T cells with ELISpot before and after kidney transplantation may help stratify patients by risk of reactivation. Loss of BKPyV immunity at two months is associated with nephropathy, while mTOR-based immunosuppression appears protective. This strategy could guide personalized immunosuppression and surveillance. Full article

Background: Several epidemiological studies have indicated that metabolic syndrome (MetS) after renal transplantation is caused by an accumulation of non-immunological risks of renal transplantation, and affects the prognosis of the kidney and the patient by increasing the risk of arteriosclerosis and cardiovascular complications. The incidence of MetS in Japanese renal transplant recipients is 14.9 to 23.8%, but its effects on cardiovascular events and kidney prognosis are not clear. Here, we report the results of a longitudinal study on MetS in renal transplant recipients. Methods: A retrospective cohort study was conducted in 104 stable renal transplant recipients who attended our outpatient department from January 2006 to June 2007 and were diagnosed with MetS at least 6 months after renal transplantation until 31 December 2020, or did not have MetS. The impact of MetS on composite vascular events was examined using multivariate Cox proportional hazards analysis. Results: The hazard ratios for the impact of MetS on composite vascular events diagnosed by NCEP Japan, NCEP Original, NCEP Asia, and IDF criteria on composite vascular events were 2.78 (95% CI: 1.15 to 6.75, p = 0.024), 2.65 (95% CI: 1.04 to 6.80, p = 0.042), 2.37 (95% CI: 0.93 to 6.01, p = 0.070), and 1.91 (95% CI: 0.77 to 4.75, p = 0.164), respectively. P for interaction was used to test the influence of each indicator, but was not statistically significant. Conclusions: MetS is a robust risk factor for graft loss and development of cardiovascular events in Japanese renal transplant recipients, even during long-term follow-up. This finding emphasizes the importance of monitoring and managing MetS in this population to improve long-term outcomes. Full article

Background: Pancreas and pancreas–kidney transplantation are well-established therapeutic options for patients with type 1 diabetes mellitus (T1DM) and end-stage kidney disease (ESKD), offering the potential to restore endogenous insulin production and kidney function. It improves metabolic control, quality of life, and long-term survival. While surgical techniques and immunosuppressive strategies have advanced considerably, graft rejection and limited long-term graft survival remain significant clinical challenges. Method: To better understand these risks, the genetic and immunological factors that influence transplant outcomes are examined. Beyond traditional human leukocyte antigen (HLA) matching, non-HLA genetic variants such as gene deletions and single-nucleotide polymorphisms (SNPs) have emerged as contributors to alloimmune activation and graft failure. Result: Polymorphisms in cytokine genes, minor histocompatibility antigens, and immune-regulatory pathways have been implicated in transplant outcomes. However, the integration of such genomic data into clinical practice remains limited due to underexplored gene targets, variability in study results, and the lack of large, diverse, and well-characterized patient cohorts. Initiatives like the International Genetics & Translational Research in Transplantation Network (iGeneTRAiN) are addressing these limitations by aggregating genome-wide data from thousands of transplant donors and recipients across multiple centers. These large-scale collaborative efforts aim to identify clinically actionable genetic markers and support the development of personalized immunosuppressive strategies. Conclusions: Overall, genetic testing and genomics hold great promise in advancing precision medicine in pancreas and pancreas–kidney transplantation. Full article

Background: Kidney transplantation from a living donor is considered the most beneficial form of treatment for end-stage renal failure, which, in addition to providing patients with better treatment results, significantly improves their quality of life. Understanding factors that influence the willingness to donate kidneys to strangers is critical in promoting and expanding the living donor pool. When considering the decision to become an altruistic kidney donor, individuals must evaluate multiple factors, including the identity of the recipient and their own perceived level of safety. This study aimed to assess the willingness of dialysis center employees to act as living kidney donors for a stranger. Methods: We conducted a cross-sectional study from February 2023 to June 2024 among dialysis specialists across Poland. The study involved 1093 people (doctors and nurses). The study used our survey questionnaire and standardized tools. Results: Nurses (vs. physicians) and those who advocated the regulation of unspecified living kidney donation in Poland, did not believe in the risk of organ trafficking, and would donate a kidney to a husband/wife or friend and accept kidney transplantation from a husband/wife were more likely to donate a kidney to a stranger. Furthermore, respondents who accepted a loved one’s decision to donate a kidney to a stranger were significantly more willing to donate a kidney to such a person themselves. Perceived self-efficacy was positively associated with the willingness to donate a kidney to a stranger. Conclusions: Less than half of healthcare professionals supported unspecific living organ donation in Poland, and nurses were more willing to donate than physicians. The factors supporting the decision generally included knowledge about organ donation and transplantation, a lack of fear of organ trafficking, and attitudes towards donation. Full article

Background/Objectives: Perioperative hypotension during kidney transplantation poses a risk to graft function and survival. Angiotensin II (AngII) is an endogenous vasoconstrictor targeting the renin–angiotensin–aldosterone system (RAAS) to increase blood pressure. Black patients may have a different response to synthetic angiotensin II (AT2S) compared to non-Black patients, given differential expressions in renin profiles. The purpose of this study is to assess the difference between Black and non-Black patients in total vasopressor duration and usage when AT2S is first line for hypotension during kidney transplantation. Methods: A single-center, retrospective cohort study comparing Black and non-Black patients who required AT2S as a first-line vasopressor for hypotension during the perioperative period of kidney transplantation. Results: The primary outcome evaluating total usage of vasopressors found that Black patients required longer durations of vasopressors (36.9 ± 66.8 h vs. 23.7 ± 31.7 h; p = 0.022) but no difference in vasopressor amount (0.07 ± 0.1 NEE vs. 0.05 ± 0.1 NEE; p = 0.128) compared to non-Black patients. Regression analysis found that body weight was associated with the duration of vasopressors (p < 0.05), while baseline systolic blood pressure was inversely associated with it. Longer duration of vasopressors and duration of transplant surgery were associated with delayed graft function in regression analysis (p < 0.05). Conclusions: Black patients had a longer duration of vasopressors, but this was not driven by differences in usage of AT2S. As baseline weight was significantly higher in Black patients and associated with duration of usage, perhaps the metabolic differences in our Black patients led to the observed differences. Regardless, longer durations of vasopressors were associated with delayed graft function, making this an area of utmost importance for continued investigation. Full article

Kidney transplant recipients face a substantial burden of premature mortality and morbidity, primarily due to persistent inflammation, cardiovascular risk, and nutritional deficiencies. Traditional nutritional interventions in this population have either focused on supplementing individual nutrients—often with limited efficacy—or required comprehensive dietary overhauls that compromise patient adherence. In this narrative review, we explore the rationale for dietary nut enrichment as a feasible, multi-nutrient strategy tailored to the needs of kidney transplant recipients. Nuts, including peanuts and tree nuts with no added salt, sugar, or oil, are rich in beneficial fats, proteins, vitamins, minerals, and bioactive compounds. We summarize the multiple post-transplant challenges—including obesity, sarcopenia, dyslipidemia, hypertension, immunological dysfunction, and chronic inflammation—and discuss how nut consumption may mitigate these issues through mechanisms involving improved micro-nutrient intake (e.g., magnesium, potassium, selenium), lipid profile modulation, endothelial function, immune support, and gut microbiota health. Additionally, we highlight the scarcity of randomized controlled trials in high-risk populations such as kidney transplant recipients and make the case for studying this group as a model for investigating the clinical efficacy of nuts as a nutritional intervention. We also consider practical aspects for future clinical trials, including the choice of study population, intervention design, duration, nut type, dosage, and primary outcome measures such as systemic inflammation. Finally, potential risks such as nut allergies and oxalate or mycotoxin exposure are addressed. Altogether, this review proposes dietary nut enrichment as a promising, simple, and sustainable multi-nutrient approach to support cardiometabolic and immune health in kidney transplant recipients, warranting formal investigation in clinical trials. Full article

Background and Objectives: Glucose instability has been established to be related to postoperative morbidity and mortality in liver transplantation. To date, the impact of maintaining optimal blood glucose (BG) levels on the incidence of acute kidney injury (AKI) following liver transplantation (LT) remains unclear. This study aimed to determine the impact of optimal BG level after reperfusion (REP BG) on the incidence of AKI after living donor LT (LDLT). Materials and Methods: This study retrospectively reviewed 3331 patients who underwent LDLT between January 2008 and December 2019. Patients were divided into optimal (110 mg/dL < BG < 180 mg/dL) and non-optimal (BG < 110 mg/dL or >180 mg/dL) REP BG groups. Multivariable logistic regression analysis was performed to assess factors associated with AKI. Propensity score matching (PSM) was used to compare the incidence of AKI, AKI severity, and progression to chronic kidney disease (CKD) between the groups. Results: The incidence of AKI was 66.7%. After PSM, patients in the optimal REP BG group showed a lower incidence of AKI (66.5% vs. 70.6%, p = 0.032). Multivariable logistic regression analysis showed that the non-optimal REP BG group was independently associated with a higher risk of AKI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02–1.45; p = 0.037) compared to the optimal group. Similarly, the risks of severe AKI (OR, 1.32; 95% CI, 1.11–1.58; p = 0.002) and progression to CKD (OR, 1.19; 95% CI, 1.01–1.41; p = 0.039) were significantly higher in the non-optimal group after PSM. Conclusions: Maintenance of an optimal REP BG was associated with a significantly lower incidence of AKI and a reduced risk of progression to CKD within 1 year after LDLT. Full article

Background: The management of end-stage renal disease (ESRD) is undergoing a paradigm shift, with increasing emphasis on kidney transplantation as a preferred treatment modality for elderly patients (≥65 years), who constitute a substantial portion of new ESRD cases. Transplantation offers markedly superior survival and quality of life (QoL) advantages compared to dialysis for this demographic. Nevertheless, key determinants such as frailty, physical functionality, and cognitive function have emerged as critical predictors of post-transplant success. Despite their relevance, standardized methodologies for evaluating these parameters in transplantation candidacy remain absent. This systematic review examines the influence of frailty, physical functionality, and cognitive function on outcomes in elderly kidney transplant recipients. Methods: Adhering to PRISMA guidelines, a rigorous literature search was conducted across PubMed, CINAHL, Embase, PsycINFO, and the Web of Science for studies published up to October 31, 2024. Relevant studies focused on elderly transplant candidates and examined correlations between frailty, physical functionality, or cognitive function and post-transplant outcomes. The Newcastle–Ottawa Scale was employed to evaluate studies quality. Results: Seven studies met the inclusion criteria. Five explored physical functionality, demonstrating that better pre-transplant physical performance predicts enhanced survival. Two studies addressed frailty, utilizing the Fried frailty phenotype, and linked frailty to elevated mortality and diminished QoL recovery. Notably, no studies explored cognitive function in elderly kidney transplant candidates or recipients and its association with post-transplant outcomes, exposing a salient gap in the literature. The included studies’ varied methodologies, reliance on single time-point assessments, and exclusive focus on kidney transplant recipients restrict both comparability among studies and the generalizability of findings to the broader end-stage renal disease (ESRD) population. Conclusions: These findings underscore the profound impact of physical functionality and frailty on transplant outcomes in the growing elderly kidney transplant population, illuminating the necessity for standardized assessment protocols and targeted pre-transplant interventions. The critical gap in cognitive function research underscores a vital direction for future investigation. This research received no external funding. This review is registered with PROSPERO under registration ID CRD42025645838. Full article

Polycystic liver disease (PLD) is a rare genetic disorder characterized by the development of >10 fluid-filled cysts in the liver. While PLD can occur in isolation, it is most commonly associated with autosomal dominant polycystic kidney disease, adding complexity to its management. PLD is often asymptomatic but can lead to hepatomegaly, causing symptoms such as abdominal distension, pain and discomfort, early satiety, gastroesophageal reflux, and malnutrition, ultimately affecting patients’ quality of life. Current treatment strategies, including pharmacological and interventional approaches, focus on reducing liver volume and alleviating symptoms. However, management remains largely symptomatic, as no definitive therapies exist to halt cyst progression. Liver transplantation is the only curative option for patients with severe, progressive disease and refractory complications. The EASL guidelines recognize that PLD-related symptoms, primarily due to hepatomegaly, can contribute to involuntary weight loss and recommend assessing symptomatic patients for malnutrition and sarcopenia. Although evidence suggests that patients with PLD may be at risk of malnutrition, original data on the quality and extent of nutritional alterations remain scarce. The potential influence of nutrition on disease progression, symptom burden, and overall well-being is also largely unexplored. Given these knowledge gaps, addressing nutritional challenges, such as early satiety, is essential for optimizing symptom management and maintaining overall nutritional status. This review outlines a possible pathophysiology of malnutrition, specific dietary considerations and recommendations, and weight management in patients with PLD. Additionally, dietary complexities in patients with concurrent renal involvement are discussed, offering a practical framework for clinicians and dietitians in managing this challenging condition. Full article

The increasing prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) has led to a growing demand for kidney transplantation (KTx). Identifying risk factors that enable improved allograft survival through novel therapeutic agents, advanced biomarkers, and artificial intelligence (AI)-driven data integration are critical to addressing this challenge. Drugs, such as SGLT2 inhibitors and finerenone, have demonstrated improved outcomes in patients but lack comprehensive long-term evidence in KTx patients. The use of biomarkers, including circulating cytokines and transcriptomics, coupled with AI, could enhance early detection and personalized treatment strategies. Addressing patient self-management and addressing health access disparities may be more achievable using technologies used at home rather than traditional models of healthcare and thus lead to increased transplant success, both in terms of transplantation rates and allograft longevity. Full article