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23 pages, 587 KiB  
Review
Immune Checkpoint Inhibitors and Allograft Rejection Risk: Emerging Evidence Regarding Their Use in Kidney Transplant Recipients
by Muhammad Ali Khan, Munir Mehmood, Hind EL Azzazi, Samiullah Shaikh, Bhavna Bhasin-Chhabra, Prakash Gudsoorkar, Sumi Sukumaran Nair, Lavanya Kodali, Girish Mour, Sundararaman Swaminathan and Bassam G. Abu Jawdeh
J. Clin. Med. 2025, 14(14), 5152; https://doi.org/10.3390/jcm14145152 - 20 Jul 2025
Viewed by 543
Abstract
The indications for immune checkpoint inhibitor (ICI) use in cancer treatment continue to expand. This is attributable to their proven anticancer activity in addition to their tolerability and favorable toxicity profile as compared to conventional chemotherapeutic agents. ICIs work by blocking the inhibitory [...] Read more.
The indications for immune checkpoint inhibitor (ICI) use in cancer treatment continue to expand. This is attributable to their proven anticancer activity in addition to their tolerability and favorable toxicity profile as compared to conventional chemotherapeutic agents. ICIs work by blocking the inhibitory signals between tumor cells and T-cells, thereby enhancing the T-cell cytotoxic activity to inhibit tumor growth. Because of their immune-stimulating effect, ICIs are linked to adverse renal outcomes in both native and transplanted kidneys. The risk of kidney allograft rejection in the setting of ICI use has been reported to be around 40%, leading to an increased risk of graft loss. In this report, we review the literature examining outcomes in kidney transplant recipients receiving ICIs for various oncologic indications. Full article
(This article belongs to the Special Issue Clinical Advancements in Kidney Transplantation)
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16 pages, 1099 KiB  
Article
Kidney Transplantation in Children Weighing Less than 15 kg: A 35-Year Single-Center Experience
by Elisa Benetti, Nicola Bertazza Partigiani, Marco Moi, Maria Sangermano, Francesco Fascetti Leon, Luisa Meneghini, Marco Daverio and Federica De Corti
J. Clin. Med. 2025, 14(14), 4905; https://doi.org/10.3390/jcm14144905 - 10 Jul 2025
Viewed by 335
Abstract
Background: Kidney transplantation is the treatment of choice for pediatric patients with end-stage kidney disease. However, transplantation in children weighing < 15 kg remains challenging due to limited donor availability and higher surgical and medical risks. We report our 35-year single-center experience [...] Read more.
Background: Kidney transplantation is the treatment of choice for pediatric patients with end-stage kidney disease. However, transplantation in children weighing < 15 kg remains challenging due to limited donor availability and higher surgical and medical risks. We report our 35-year single-center experience in this population, focusing on perioperative and long-term outcomes. Methods: We retrospectively analyzed kidney transplants performed from 1987 to 2023 in children weighing < 15 kg. Data on demographics, donor type, complications, immunosuppression, and outcomes at 2, 5, and 10 years (including survival, graft function, rejection, infections, and urological issues) were collected. Outcomes were compared between deceased and living donors and between recipients weighing < 10 kg and ≥10 kg. Results: Ninety-six transplants were included (mean age 3.3 years; mean weight 11.1 kg), 80 from deceased and 16 from living donors. Most patients (69.8%) had been treated with peritoneal dialysis. Median follow-up was 120 months. Patient survival was 95.8%; graft survival was 78.1%. Eight grafts (8.3%) were lost to renal vein thrombosis, all in deceased-donor recipients (p = 0.60). Preserved renal function (eGFR > 60 mL/min/1.73 m2) declined from 80.4% at 2 years to 66.0% at 5 years and 18.0% at 10 years. Graft survival at 10 years was significantly lower in children < 10 kg vs. ≥10 kg (49.6% vs. 80.3%, p = 0.003). CAKUT was associated with higher urological complication rates (p = 0.017). No significant differences emerged between living and deceased donor groups. Conclusions: Transplantation in children < 15 kg is feasible with good outcomes, but those <10 kg present lower graft survival at 10 years. Multidisciplinary assessment and center experience are key to optimizing results. Full article
(This article belongs to the Special Issue Updates on Renal Transplantation and Its Complications)
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16 pages, 638 KiB  
Article
De Novo Renal Cell Carcinoma in Kidney Transplant Recipients: Incidence, Outcomes, and Therapeutic Challenges
by Jacob Schmidt, Malte Lehnert, Isabel Lichy, Henning Plage, Jonathan Jeutner, Lukas Kurz, Bernhard Ralla, Markus H. Lerchbaumer, Thorsten Schlomm, Frank Friedersdorff, Andreas Maxeiner and Robert Peters
Cancers 2025, 17(13), 2200; https://doi.org/10.3390/cancers17132200 - 30 Jun 2025
Viewed by 416
Abstract
Background/Objectives: Kidney transplantation is associated with an increased risk of renal cell carcinoma (RCC). This study aimed to evaluate the outcomes of de novo RCC in kidney transplant recipients (KTRs). Methods: We retrospectively identified 50 de novo RCC cases among 4012 [...] Read more.
Background/Objectives: Kidney transplantation is associated with an increased risk of renal cell carcinoma (RCC). This study aimed to evaluate the outcomes of de novo RCC in kidney transplant recipients (KTRs). Methods: We retrospectively identified 50 de novo RCC cases among 4012 KTRs transplanted from 2005 to 2024. Data on patient characteristics and outcomes were collected. Propensity score matching (PSM) compared 34 localized RCC cases in KTRs with 34 non-transplant RCC cases. The statistical analyses used Kaplan–Meier estimates, the log-rank test, and the Cox regression. Results: The RCC incidence was 0.64 per 1000 person-years, with a standardized incidence ratio of 4.40 (95% CI: 3.33–5.80). In the KTR cohort, clear cell RCC was present in 42%, and papillary RCC was present in 42%. RCC developed predominantly in native kidneys (92%). UICC stage I was present in 74%. The treatment for the non-metastatic RCC was nephrectomy in the majority of cases (91%). For the metastatic RCC, 71% received a tyrosine kinase inhibitor (TKI). In the KTR cohort, the 3- and 5-year overall survival (OS) rates were 85% and 72%, respectively, with a median OS of 199 months; the synchronous metastasized (M1) patients had a median OS of 14 months. Rejection, age, advanced UICC stage, higher pT stage, clinical positive lymph nodes, M1, and higher grade were significantly associated with poor OS. The 5-year OS (96% vs. 84%, p = 0.72) and MFS (92% vs. 93%, p = 0.61) were comparable in the PSM cohort between the KTRs and the non-KTRs in the localized RCC. Conclusions: KTRs have a higher risk of RCC and present at a localized stage with comparable OS rates to non-transplant RCC patients. Adverse tumor characteristics, including synchronous metastases, significantly affect the prognosis, highlighting the need for surveillance and individualized treatment, particularly for metastatic RCC. Full article
(This article belongs to the Special Issue Cancer Risk Factors and Prognosis in Transplant Patients)
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15 pages, 1059 KiB  
Article
Kidney Transplant Recipients with Acute Antibody-Mediated Rejection Show Altered Levels of Matrix Metalloproteinases and Their Inhibitors: Evaluation of Circulating MMP and TIMP Profiles
by Miguel A. Vázquez-Toledo, Fausto Sánchez-Muñoz, Iván Zepeda-Quiroz, Carlos A. Guzmán-Martín, Horacio Osorio-Alonso, Juárez-Villa Daniel, Ma. Virgilia Soto-Abraham, Bernardo Moguel-González, Rommel Chacón-Salinas, César Flores-Gama and Rashidi Springall
Int. J. Mol. Sci. 2025, 26(13), 6011; https://doi.org/10.3390/ijms26136011 - 23 Jun 2025
Viewed by 714
Abstract
Antibody-mediated rejection (ABMR) remains a major cause of renal graft dysfunction and loss. The histological hallmark of antibody-mediated rejection is progressive tissue damage, in which extracellular matrix turnover plays an important role. This turnover is mainly regulated by matrix metalloproteinases (MMPs) and tissue [...] Read more.
Antibody-mediated rejection (ABMR) remains a major cause of renal graft dysfunction and loss. The histological hallmark of antibody-mediated rejection is progressive tissue damage, in which extracellular matrix turnover plays an important role. This turnover is mainly regulated by matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). Recent studies suggest that MMP/TIMP imbalance may favor the progression of renal damage, inflammation, and fibrosis, but the utility of these molecules as a biomarker of antibody-mediated turnover has not been fully explored. We measured plasma MMP and TIMP levels by ELISA in 15 patients with antibody-mediated renal transplant rejection and 12 patients without rejection. There was a significant increase in MMP-1, MMP-2, and MMP-3 concentrations in the plasma of patients with rejection, directly correlating with the severity of different renal lesions. In contrast, TIMP-3 levels were elevated in patients without rejection, showing a negative correlation with the severity of histopathological lesions. The concentrations of these molecules demonstrated good diagnostic capacity for patients with rejection. Our results show that MMP-1, MMP-2, MMP-3, and TIMP-3 could be potential biomarkers of rejection. Full article
(This article belongs to the Special Issue Advances in Kidney Transplantation)
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15 pages, 577 KiB  
Article
Molecular Crosstalk Between SIRT1, Wnt/β-Catenin Signaling, and Inflammatory Pathways in Renal Transplant Rejection: Role of miRNAs, lncRNAs, IL-1, IL-6, and Tubulointerstitial Inflammation
by Nurhak Aksungur, Murat Kizilkaya, Necip Altundaş, Eda Balkan, Salih Kara, Elif Demirci and Abdullah Uyanik
Medicina 2025, 61(6), 1073; https://doi.org/10.3390/medicina61061073 - 11 Jun 2025
Viewed by 774
Abstract
Background/Objectives: This study aimed to evaluate the relationship between sirtuin family members (SIRT1, SIRT3, and SIRT6) and Wnt/β-catenin pathways with inflammation during the rejection process following kidney transplantation, as well as to explore their potential roles as candidate biomarkers. Materials and Methods [...] Read more.
Background/Objectives: This study aimed to evaluate the relationship between sirtuin family members (SIRT1, SIRT3, and SIRT6) and Wnt/β-catenin pathways with inflammation during the rejection process following kidney transplantation, as well as to explore their potential roles as candidate biomarkers. Materials and Methods: Blood samples were collected from 35 kidney transplant rejection patients and 30 healthy controls. The gene expression levels of SIRT1, SIRT3, SIRT6, and Wnt/β-catenin pathway components were measured using real-time PCR, and miRNA and lncRNA expression levels were analyzed. Statistical analyses were performed using SPSS version 23. Results: Significant alterations in SIRT1, SIRT3, and SIRT6 expression levels were observed in rejection patients, suggesting their potential role in disease pathogenesis and as therapeutic biomarkers. Key altered genes included hsa-miR-34c-1, hsa-miR-122b-5b, MALAT1, HOTAIR, LINC00473, TUG, PVT1, SIRT1, SIRT3, SIRT6, WNT1, TCF-LEF, LRP, AXIN1, IL1B, IL6, and IFNB1, all showing significant changes. However, no significant differences were found for miRNAs such as hsa-miR-21-2, hsa-miR-155-5p, and hsa-miR-200b-3p. SIRT1 expression was significantly decreased in the cellular rejection group, with a more pronounced reduction in these patients. Significant differences in SIRT1 expression were observed with interstitial inflammation and glomerulitis. Increased inflammation severity correlated with decreased SIRT1 and increased TCF-LEF, TUG, and miR-21 levels, while tubulitis severity was associated with elevated TCF-LEF and miR-155 expression. Conclusions: Along with the activation of Wnt/β-catenin pathways and increased levels of certain miRNAs and long non-coding RNAs (lncRNAs) associated with TCF-LEF transcription factors, the observed decrease in SIRT1 expression may be related to the severity of inflammation and tubulitis. These findings suggest that SIRT1, Wnt/β-catenin pathways, and non-coding RNAs play a role in the rejection process following kidney transplantation and could be considered as potential biomarkers or therapeutic target candidates for future research. Full article
(This article belongs to the Section Surgery)
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13 pages, 1147 KiB  
Article
Exploring Nanofiltration for Transport of Small Molecular Species for Application in Artificial Kidney Devices to Treat End-Stage Kidney Disease
by Haley Duncan, Christopher Newton, Jamie Hestekin, Christa Hestekin and Ira Kurtz
Membranes 2025, 15(6), 168; https://doi.org/10.3390/membranes15060168 - 2 Jun 2025
Viewed by 1669
Abstract
End-stage renal disease occurs when there is permanent loss of the kidney’s ability to filter toxins from the blood. Due to the limited number of transplants, dialysis is currently the most common treatment, but it significantly limits a patient’s lifestyle and has significant [...] Read more.
End-stage renal disease occurs when there is permanent loss of the kidney’s ability to filter toxins from the blood. Due to the limited number of transplants, dialysis is currently the most common treatment, but it significantly limits a patient’s lifestyle and has significant side effects. One solution is an artificial kidney, but significant challenges remain in its development. One challenge is the separation of glucose from urea. Nanofiltration is ideal for this separation; however, there is little understanding of the important parameters for this separation under physiological conditions. In this study, operating parameters (pressure and temperature) as well as feed conditions (increased glucose/salt) were explored for their effects on the separation of glucose from urea in six commercial membranes. The rejection of monovalent and divalent ions was also characterized. While increasing pressure increased flux, it had little effect on metabolite rejection, except for glucose, which increased above 20 psi. Increasing temperature led to a slight increase in flux and a slight decrease in the rejection of divalent ions. Glucose rejection was sensitive to feed conditions, while urea rejection was less affected. Divalent ions were rejected more strongly than monovalent ions and were also more affected by feed conditions. Full article
(This article belongs to the Section Membrane Applications for Other Areas)
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14 pages, 365 KiB  
Review
Renal Denervation After USA FDA Approval: An Update from an Interventional Cardiologist’s Perspective
by Jiandong Zhang, Peter M. Belford and George A. Stouffer
J. Clin. Med. 2025, 14(10), 3554; https://doi.org/10.3390/jcm14103554 - 19 May 2025
Viewed by 1596
Abstract
In late 2023, the U.S. Food and Drug Administration (FDA) approved two renal denervation (RDN) systems for the treatment of hypertension. Several professional societies, including the Society of Cardiovascular Angiography and Intervention (SCAI), the American Heart Association (AHA), and numerous European associations, have [...] Read more.
In late 2023, the U.S. Food and Drug Administration (FDA) approved two renal denervation (RDN) systems for the treatment of hypertension. Several professional societies, including the Society of Cardiovascular Angiography and Intervention (SCAI), the American Heart Association (AHA), and numerous European associations, have recognized the potential role of RDN in managing hypertension. Despite widespread enthusiasm from clinicians, patients, and the industry, the American Medical Association’s Current Procedural Terminology (CPT) panel rejected the introduction of new codes for renal denervation at its September 2024 meeting. This article analyzes the latest evidence from clinical trials and registries, reviews current challenges in clinical practice, and explores the role of contemporary hypertension treatment from the perspective of interventional cardiologists. Full article
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11 pages, 750 KiB  
Article
Risk Factors of Acute Rejection: Impact on Graft Outcomes in a Cohort of Kidney Transplant Recipients
by Valeria Corradetti, Elisa Gessaroli, Federico Bari, Claudia Bini, Valeria Grandinetti, Angelodaniele Napoletano, Vania Cuna, Valeria Pizzuti, Marcello Demetri, Matteo Ravaioli, Michele Provenzano, Gaetano La Manna and Giorgia Comai
J. Clin. Med. 2025, 14(10), 3373; https://doi.org/10.3390/jcm14103373 - 12 May 2025
Viewed by 618
Abstract
Background: Acute rejection (AR) in kidney transplant (KT) recipients remains a significant challenge for short- and long-term graft survival even in the most recent years characterized by extended criteria donors and older and more comorbid recipients. Methods: We analyzed risk factors [...] Read more.
Background: Acute rejection (AR) in kidney transplant (KT) recipients remains a significant challenge for short- and long-term graft survival even in the most recent years characterized by extended criteria donors and older and more comorbid recipients. Methods: We analyzed risk factors and outcomes of AR in 339 KT recipients treated at St. Orsola-Malpighi Hospital, Bologna (Italy), between 1 January 2019 and 31 December 2021. Demographic, immunological, and transplant data (type, cold ischemia time, complications) were recorded with a follow-up period of up to 24 months. Key outcomes included estimated glomerular filtration rate (eGFR), 24 h proteinuria, delayed graft function (DGF), biopsy-proven AR, and graft loss. Results: During the first year after transplant, 57 AR episodes occurred: 19 antibody-mediated rejections (AMR), 18 borderline T cell-mediated rejections (TCMR), 18 TCMR, 2 mixed AMR/TCMR, and 11 graft losses. AR was linked to older donor age (59.9 ± 12.8 vs. 55.5 ± 15.1, p = 0.040), longer cold ischemia time (690 vs. 570 min, p = 0.044), higher DGF rates (61.40% vs. 39.57%, p = 0.002), and lower eGFR (39 vs. 52 mL/min, p = 0.003). AR was consistently prevalent in patients who underwent an AB0-incompatible (AB0-i) transplant (8.8% vs. 2.5%, p = 0.020). HLA matching was strongly associated with a reduced risk of AMR (HLA-DR: OR 0.35, HLA-A: OR 0.33, HLA-C: OR 0.35), while DGF was linked to a higher risk (OR 4.04). TCMR risk was associated with donor age (OR 1.05). The development of post-transplant donor-specific antibodies (DSAs) at 24 months showed no significant association with AR (AMR: p = 0.769; TCMR: p = 0.938). The decline in eGFR over time (24 months) did not differ between patients with and without AR (difference, −0.69 mL/min/year; Standard Error, 0.92; p = 0.452). Similarly, 24 h proteinuria change over time did not differ between patients with and without AR (difference, −0.12 g/24 h; Standard Error, 0.28; p = 0.657). Conclusions: Understanding the risk factors of AR is crucial to identifying KTs at more risk of rejection and to guiding targeted therapeutic decisions. In the most recent era of extended criteria donors and more vulnerable recipients, early diagnosis and prompt and tailored treatment of AR play a critical role in stabilizing renal function over time. Full article
(This article belongs to the Special Issue Clinical Practice and Personalized Medicine in Kidney Transplantation)
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9 pages, 850 KiB  
Case Report
Management of Diffuse Large B-Cell Lymphoma as Post-Transplant Lymphoproliferative Disorder in a Kidney Transplant Recipient: A Case Report
by Salem Alshemmari, Abdulaziz Hamadah, Samar Ousia, Rasha Abdel Tawab Hamed and Hany Zaky
Hematol. Rep. 2025, 17(3), 22; https://doi.org/10.3390/hematolrep17030022 - 23 Apr 2025
Cited by 2 | Viewed by 734
Abstract
Background and Clinical Significance: Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation, often associated with prolonged immunosuppression. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype. Managing PTLD requires a balance between reducing immunosuppression and preventing graft rejection. [...] Read more.
Background and Clinical Significance: Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation, often associated with prolonged immunosuppression. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype. Managing PTLD requires a balance between reducing immunosuppression and preventing graft rejection. Case Presentation: A 41-year-old female kidney transplant recipient developed PTLD eight years post-transplant, presenting with a right submandibular mass. Biopsy confirmed CD20-positive DLBCL. Initial treatment involved reducing immunosuppression and rituximab monotherapy, which failed to prevent disease progression. The patient underwent six cycles of R-CHOP chemotherapy, achieving complete metabolic remission. Relapse occurred twice, with disease progression in the cervical nodes and tonsils. Salvage therapies, including polatuzumab vedotin and rituximab, achieved remission. During a subsequent relapse, loncastuximab tesirine induced metabolic resolution. Compromised renal function limited treatment options and a second renal transplant was delayed, reducing the risk of PTLD recurrence. Conclusions: This case underscores the challenges of managing PTLD in transplant recipients, especially in relapsed/refractory cases. Single-agent rituximab was insufficient, but combination chemotherapy and novel agents like loncastuximab tesirine were effective. Balancing oncologic control and graft preservation remains critical. This case highlights the need for individualized approaches and novel therapies in managing PTLD while addressing the complexities of immunosuppression and organ preservation. Full article
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9 pages, 736 KiB  
Article
Comparative Analysis Between Insulated Gel Bags and Direct Cooling for Temperature Management During Kidney Transplant Vascular Anastomosis
by Yuichi Machida, Tomoaki Iwai, Kazuya Kabei and Junji Uchida
J. Clin. Med. 2025, 14(7), 2368; https://doi.org/10.3390/jcm14072368 - 29 Mar 2025
Viewed by 509
Abstract
Background/Objectives: Ischemic time plays a crucial role in graft function and survival during kidney transplantation. Cooling methods, including cold perfusion and ice slush, are predominantly applied to preserve the kidney, but they may cause uneven cooling and complications. The Organ Pocket®, [...] Read more.
Background/Objectives: Ischemic time plays a crucial role in graft function and survival during kidney transplantation. Cooling methods, including cold perfusion and ice slush, are predominantly applied to preserve the kidney, but they may cause uneven cooling and complications. The Organ Pocket®, an insulated gel bag, has been introduced as an alternative cooling method. However, no studies have compared renal temperature changes between the Organ Pocket® and conventional cooling methods. Methods: We retrospectively analyzed 49 cases of living-donor kidney transplantation. Among these, 33 received kidney grafts preserved with the Organ Pocket® (OP group), and 16 underwent conventional cooling (control group). Renal surface temperatures were recorded at 5 min intervals during vascular anastomosis using thermography. Postoperative renal function was assessed with estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and liver-type fatty acid-binding protein (L-FABP) levels. Results: The OP group demonstrated significantly higher renal surface temperatures than the control group during vascular anastomosis (p < 0.05). Renal surface temperature before reperfusion was 20.4 °C ± 2.5 °C and 17.2 °C ± 2.5 °C in the OP and control groups, respectively. No significant differences in postoperative eGFR, sCr, and L-FABP levels; delayed graft function (DGF); or acute rejection rates were observed between the groups. Conclusions: The Organ Pocket® effectively stabilized renal temperatures during vascular anastomosis without direct cooling, thereby reducing continuous manual cooling requirements. Short-term renal function outcomes were comparable between groups; however, the Organ Pocket® may improve surgical efficiency and be particularly beneficial in robot-assisted kidney transplantation. Further studies are warranted to investigate its long-term benefits. Full article
(This article belongs to the Special Issue Sustaining Success Through Innovation in Kidney Transplantation)
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10 pages, 895 KiB  
Article
Evaluating ATG Induction Therapy Outcomes After Commercial Kidney Transplantation: Insights from a Tertiary Hospital Experience
by Sarah A. Albilal, Mohammed A. Gafar, Wesam S. Abdel-Razaq, Sarah Almugbil, Mohammed Alotaibi, Aiman A. Obaidat, Mohammad S. Shawaqfeh and Abdulkareem M. Albekairy
J. Clin. Med. 2025, 14(6), 1896; https://doi.org/10.3390/jcm14061896 - 11 Mar 2025
Viewed by 1070
Abstract
Background: Kidney transplantation improves life expectancy in patients with end-stage renal disease but encounters ethical concerns, particularly in commercial transplantation, which yields worse outcomes. Anti-thymocyte globulin (ATG) is an immunosuppressant used as an induction therapy in transplantation. This study evaluates ATG induction therapeutic [...] Read more.
Background: Kidney transplantation improves life expectancy in patients with end-stage renal disease but encounters ethical concerns, particularly in commercial transplantation, which yields worse outcomes. Anti-thymocyte globulin (ATG) is an immunosuppressant used as an induction therapy in transplantation. This study evaluates ATG induction therapeutic outcomes in commercial kidney transplants. Methods: A retrospective cohort analysis was conducted on adults who underwent commercial kidney transplantation and were subsequently admitted to King Abdulaziz Medical City spanning 2018 to 2023, with a follow-up period of one year. Results: A total of 70 commercial kidney transplant patients were evaluated by comparing patients who received ATG (n = 24) and those who did not (n = 46). ATG patients had elevated serum creatinine levels at admission (mean 457.5 vs. 172.6 µmol/L, p < 0.001). Over time, creatinine levels in the ATG group improved but remained higher than the non-ATG group (p < 0.001). Despite the higher early rejection rate in the ATG group, this difference was not statistically significant (p-value = 0.256). Elevated admission creatinine strongly predicted rejection (OR = 10.08, p < 0.001). Conclusions: Elevated admission creatinine is a significant predictor of rejection. Although the ATG group showed a higher early rejection rate, this difference was not statistically significant. Early rejection remains a concern, particularly within the first month after transplantation. Full article
(This article belongs to the Section Nephrology & Urology)
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24 pages, 702 KiB  
Systematic Review
Predictors of Treatment Adherence in Kidney Transplant Patients: A Systematic Review of the Literature
by Edoardo Melilli, María Isabel Díaz, Mar Gomis-Pastor, Esther González, Alex Gutierrez-Dalmau, Enriqueta Isabel Nuño, Ana María Pérez, Inmaculada Plasencia, Ana Sangrador, Esther Lázaro, Nuria Montero and Cristina Soria
J. Clin. Med. 2025, 14(5), 1622; https://doi.org/10.3390/jcm14051622 - 27 Feb 2025
Cited by 1 | Viewed by 1257
Abstract
Background: Kidney transplantation (KTx) is a safe procedure that improves the life expectancy and quality of life of patients requiring it. However, despite the known benefits for patients who receive a kidney transplant, non-adherence to immunosuppressive medication is an unsolved problem, reflected mainly [...] Read more.
Background: Kidney transplantation (KTx) is a safe procedure that improves the life expectancy and quality of life of patients requiring it. However, despite the known benefits for patients who receive a kidney transplant, non-adherence to immunosuppressive medication is an unsolved problem, reflected mainly by graft rejection. Objective: The aim of this study is to systematically review the existing literature on adherence factors to medication after renal transplantation. Methods: A systematic literature review of studies published since 2010 was conducted in three databases. Records for the search were limited to publications from 2010 to 2024, available in full-text. The search was carried out in July 2024. In total, 2632 abstracts were downloaded from the different databases. Inclusion criteria were papers of any type (quantitative or qualitative) whose objective was the identification of predictors of adherence for patients who were prescribed immunosuppressive medication after kidney transplantation. Results: The predictors of adherence to treatment found in the systematic review were grouped into the following categories of the World Health Organization classification: socio-economic factors, factors related to the treatment/therapy, patient-related factors, disease-related factors, and health care system factors. Most of the studies were excluded, and in the end, 30 were included in the final analysis. According to these studies, a set of strong predictors was identified, but discrepancies among the variables of gender in young patients, pre-emptive transplantation, and the time of the transplantation were detected. Conclusions: In this study, we identified specific predictors and directions for the association of those predictors with adherence to immunosuppressive medication for patients after KTx. Further research should consider conducting reviews for different patient sub-groups on medication adherence and the development and validation of a screening instrument for adherence/non-adherence factors that clinicians could use as a detection tool for subjects at risk of low adherence. Full article
(This article belongs to the Special Issue New Insights into Kidney Transplantation)
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5 pages, 574 KiB  
Case Report
Cutaneous Anguillulosis During Immunotherapy for Metastatic Renal Cell Carcinoma
by Pierre Cornillon, Marie Beguinot, Denis Maillet, Wafa Bouleftour, Yanis Bouqallaba, Pierre Flori, Pauline Corbaux and Guorong Li
Medicina 2025, 61(2), 339; https://doi.org/10.3390/medicina61020339 - 14 Feb 2025
Viewed by 784
Abstract
Immunotherapy has been widely applied to treat metastatic renal cell cancer patients. Managing the side effects of immunotherapy can be a challenge. Here, we describe a rare presentation of cutaneous anguillulosis during immunotherapy. The patient experienced a rash eruption after receiving immunotherapy for [...] Read more.
Immunotherapy has been widely applied to treat metastatic renal cell cancer patients. Managing the side effects of immunotherapy can be a challenge. Here, we describe a rare presentation of cutaneous anguillulosis during immunotherapy. The patient experienced a rash eruption after receiving immunotherapy for metastatic renal cell cancer. The diagnosis of skin toxicity caused by immunotherapy was rejected after the failure of treatment by cortisone. The travelling history and a laboratory test confirmed the presence of anguillulosis infection. A diagnosis of cutaneous anguillulosis was established. Satisfactory treatment with ivermectin was achieved for cutaneous lesions. Immunotherapy was restored without any skin symptoms. We suggested the possible mechanism of cutaneous demonstration of immune inflammatory syndrome during the immunotherapy of a cancer patient with parasitic infection. It was concluded that a comprehensive search for previous infectious pathogens should be performed to ensure a correct diagnosis and timely treatment. Full article
(This article belongs to the Section Oncology)
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11 pages, 487 KiB  
Article
Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support
by Michele D’Alonzo, Amedeo Terzi, Massimo Baudo, Mauro Ronzoni, Nicola Uricchio, Claudio Muneretto and Lorenzo Di Bacco
J. Clin. Med. 2025, 14(1), 275; https://doi.org/10.3390/jcm14010275 - 6 Jan 2025
Viewed by 1133
Abstract
Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new [...] Read more.
Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new perspectives for increasingly complex clinical scenarios. This study aimed to compare long-term clinical outcomes in patients in heart failure with reduced ejection fraction (HFrEF) receiving an LVAD as BTT to those undergoing direct-to-transplant (DTT) without mechanical support, focusing on survival and post-transplant complications. Methods: A retrospective, single-center study included 105 patients who underwent HT from 2010. Patients were divided into two groups: BTT (n = 28) and DTT (n = 77). Primary endpoints included overall survival at 1 and 7 years post-HT. Secondary outcomes involved late complications, including organ rejection, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular events. Results: At HT, the use of LVADs results in longer cardiopulmonary bypass and cross-clamping times in the BTT group; nevertheless, surgical complexity does not affect 30-day mortality. Survival at 1 year was 89.3% for BTT and 85.7% for DTT (p = 0.745), while at 7 years, it was 80.8% and 77.1%, respectively (p = 0.840). No significant differences were observed in the incidence of major complications, including permanent dialysis, organ rejection, and CAV. However, a higher incidence of cerebrovascular events was noted in the BTT group (10.7% vs. 2.6%). Conclusions: LVAD use as BTT does not negatively impact early post-transplant survival compared to DTT. At long-term follow-up, clinical outcomes remained similar across groups, supporting LVADs as a viable option for bridging patients to transplant. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)
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13 pages, 592 KiB  
Study Protocol
Everolimus Through Plasmatic Concentrations in Cancer Patients: Prospective Longitudinal Observational Multicentric Study (DIANA-1 Project)
by Eduard Fort-Casamartina, Sonia Pernas, Sara Otero, Paula Mate, Núria Gonzalo, Sonia Narváez, Raúl Rigo-Bonnin, Ariadna Padró-Miquel, Àlex Teulé, Xavier Garcia del Muro, Inma Peiró, Lorena Arribas, Anna Esteve, Andrea Gonzalez, Montse Rey, Ana Clopés, Sandra Fontanals and Carme Muñoz
J. Clin. Med. 2025, 14(1), 145; https://doi.org/10.3390/jcm14010145 - 30 Dec 2024
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Abstract
Background: Everolimus, an oral inhibitor of the mammalian target of rapamycin (mTOR), is actually used to prevent organ transplant rejection and treat metastatic breast, renal, and neuroendocrine cancers. Despite significant pharmacokinetic variability among patients, routine therapeutic drug monitoring (TDM) is not commonly used [...] Read more.
Background: Everolimus, an oral inhibitor of the mammalian target of rapamycin (mTOR), is actually used to prevent organ transplant rejection and treat metastatic breast, renal, and neuroendocrine cancers. Despite significant pharmacokinetic variability among patients, routine therapeutic drug monitoring (TDM) is not commonly used in oncology. Methods: The aim of this multicenter, prospective observational cohort study is to assess the prevalence of everolimus minimum concentration at a steady state (Cminss) falling outside the therapeutic range (10–26.3 ng/mL) during a routine TDM programme. Sixty patients with metastatic breast, neuroendocrine, or renal cancers, either starting or continuing everolimus treatment according to hospital protocols, are to be included between 1st of January 2024 and 31st of December 2025 (patients undergoing clinical trials are excluded). We hypothesize that 30–50% of our patients and their blood samples will not achieve the target optimal plasma concentrations. Blood samples are collected every 4–6 weeks to monitor drug levels. The secondary goal is to explore correlation between out-of-range everolimus levels and factors such as demographic and anthropometric data, treatment specifics, lab results, genetic polymorphisms, and the presence of toxicity. Conclusions: This study could offer valuable insights into optimizing dosing strategies and may contribute to future research on personalizing everolimus and other anticancer treatments. This personalized approach seeks to tailor therapy not only to the tumour’s molecular profile but also to the individual characteristics of each patient, improving both drug selection and dosing precision. Full article
(This article belongs to the Section Oncology)
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