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Medicina
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Kidney Transplantation—Clinical and Surgical Challenges II
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Kidney Transplantation—Clinical and Surgical Challenges II

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

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 7518

Special Issue Editors

Dr. Evaldo Favi

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Guest Editor
1. Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
2. Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
Interests: kidney transplantation; organ donation; immunosuppression; vascular access; polyomavirus
Special Issues, Collections and Topics in MDPI journals
Dr. Mariano Ferraresso

E-Mail Website
Guest Editor
1. Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Interests: kidney transplantation; organ donation; immunosuppression; vascular access
Special Issues, Collections and Topics in MDPI journals
Dr. Gionata Spagnoletti

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Guest Editor
Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Roma, Italy
Interests: pediatric transplantation; kidney and liver transplant; immunosuppression; organ perfusion and preservation

Special Issue Information

Dear Colleagues,

Kidney transplantation is universally considered the treatment of choice for end-stage renal disease. In the last two decades, tremendous advances in surgical care and immunosuppressive therapy have led to a significant reduction of peri-operative mortality and morbidity as well as cell-mediated rejection rates. However, long-term allograft survival has not improved as we would have expected. Currently, the main causes of premature transplant loss are death with function, antibody-mediated rejection, polyomavirus-associated nephropathy, and calcineurin-inhibitor nephrotoxicity. Albeit less frequently, late vascular and urological complications such as renal artery stenosis, post-biopsy arteriovenous fistulas, ureteric stricture, or allograft neoplasms do also play a role.

The present Special Issue intends to explore the impact of clinical and surgical complications on long-term renal allograft survival as well as to analyse possible prevention and treatment strategies. Both common and rare complications will be considered with the option of including narrative reviews and case reports of particular interest or exceptional didactical value.

“Kidney Transplantation—Clinical and Surgical Challenges” will give specialists involved in the care of renal transplant recipients the opportunity to share their experience or point of view on several relevant topics with the primary aims of improving global knowledge and patient outcomes.

Dr. Evaldo Favi
Dr. Mariano Ferraresso
Dr. Gionata Spagnoletti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • kidney transplantation
  • organ donation
  • organ allocation
  • immunosuppression
  • allograft survival
  • patient survival
  • rejection
  • malignancy
  • complications
  • polyomavirus
  • cytomegalovirus

Published Papers (5 papers)

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Research

15 pages, 1584 KiB  
Article
Association of Different Risk Scores and 30-Day Mortality in Kidney Transplant Recipients with COVID-19
by Josipa Domjanović, Tea Domjanović Škopinić and Andrija Matetic
Medicina 2023, 59(4), 657; https://doi.org/10.3390/medicina59040657 - 26 Mar 2023
Viewed by 1131
Abstract
Background and Objectives: Clinical risk scores were poorly examined in kidney transplant recipients (KTR) with COVID-19. Materials and Methods: This observational study compared the association and discrimination of clinical risk scores (MEWS, qCSI, VACO, PSI/PORT, CCI, MuLBSTA, ISTH-DIC, COVID-GRAM and 4C) [...] Read more.
Background and Objectives: Clinical risk scores were poorly examined in kidney transplant recipients (KTR) with COVID-19. Materials and Methods: This observational study compared the association and discrimination of clinical risk scores (MEWS, qCSI, VACO, PSI/PORT, CCI, MuLBSTA, ISTH-DIC, COVID-GRAM and 4C) with 30-day mortality in 65 hospitalized KTRs with COVID-19. Cox regression was used to derive hazard ratios (HR) and 95% confidence intervals (95% CI), and discrimination was assessed by Harrell’s C. Results: A significant association with 30-day mortality was demonstrated for MEWS (HR 1.65 95% CI 1.21–2.25, p = 0.002); qCSI (HR 1.32 95% CI 1.15–1.52, p < 0.001); PSI/PORT (HR 1.04 95% CI 1.02–1.07, p = 0.001); CCI (HR 1.79 95% CI 1.13–2.83, p = 0.013); MuLBSTA (HR 1.31 95% CI 1.05–1.64, p = 0.017); COVID-GRAM (HR 1.03 95% CI 1.01–1.06, p = 0.004); and 4C (HR 1.79 95% CI 1.40–2.31, p < 0.001). After multivariable adjustment, significant association persisted for qCSI (HR 1.33 95% CI 1.11–1.59, p = 0.002); PSI/PORT (HR 1.04 95% CI 1.01–1.07, p = 0.012); MuLBSTA (HR 1.36 95% CI 1.01–1.85, p = 0.046); and 4C Mortality Score (HR 1.93 95% CI 1.45–2.57, p < 0.001) risk scores. The best discrimination was observed with the 4C score (Harrell’s C = 0.914). Conclusions: Risk scores such as qCSI, PSI/PORT and 4C showed the best association with 30-day mortality amongst KTRs with COVID-19. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges II)
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13 pages, 346 KiB  
Article
Prevalence and Risk Factors of Abnormal Glucose Metabolism and New-Onset Diabetes Mellitus after Kidney Transplantation: A Single-Center Retrospective Observational Cohort Study
by Carlo Alfieri, Evaldo Favi, Edoardo Campioli, Elisa Cicero, Paolo Molinari, Mariarosaria Campise, Maria Teresa Gandolfo, Anna Regalia, Donata Cresseri, Piergiorgio Messa and Giuseppe Castellano
Medicina 2022, 58(11), 1608; https://doi.org/10.3390/medicina58111608 - 7 Nov 2022
Cited by 1 | Viewed by 1495
Abstract
Background and objectives: New-onset diabetes after transplantation (NODAT) represents a primary cause of morbidity and allograft loss. We assessed prevalence and risk factors for NODAT in a population of Italian kidney transplant (KT) recipients. Methods: Data from 522 KT performed between January 2004 [...] Read more.
Background and objectives: New-onset diabetes after transplantation (NODAT) represents a primary cause of morbidity and allograft loss. We assessed prevalence and risk factors for NODAT in a population of Italian kidney transplant (KT) recipients. Methods: Data from 522 KT performed between January 2004 and December 2014 were analyzed. Participants underwent clinical examination; blood and urine laboratory tests were obtained at baseline, one, six, and 12-month of follow-up to detect glucose homeostasis abnormalities and associated metabolic disorders. An oral glucose tolerance test (OGTT) was performed at six months in 303 subjects. Results: Most patients were Caucasian (82.4%) with a mean age of 48 ± 12 years. The prevalence of abnormal glucose metabolism (AGM) and NODAT was 12.6% and 10.7%, respectively. Comparing characteristics of patients with normal glucose metabolism (NGM) to those with NODAT, we found a significant difference in living donation (16.6% vs. 6.1%; p = 0.03) and age at transplant (46 ± 12 vs. 56 ± 9 years; p = 0.0001). Also, we observed that patients developing NODAT had received higher cumulative steroid doses (1-month: 1165 ± 593 mg vs. 904 ± 427 mg; p = 0.002; 6-month:2194 ± 1159 mg vs. 1940 ± 744 mg; p = 0.002). The NODAT group showed inferior allograft function compared to patients with NGM (1-year eGFR: 50.1 ± 16.5 vs. 57 ± 20 mL/min/1.73 m2; p = 0.02). NODAT patients were more likely to exhibit elevated systolic blood pressure and higher total cholesterol and triglyceride levels than controls. Conclusions: The prevalence of NODAT in our cohort was relatively high. Patient age and early post-transplant events such as steroid abuse are associated with NODAT development. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges II)
8 pages, 309 KiB  
Article
Clinical Outcomes of Transplanted Kidneys from Deceased Donors Using Different Generic Preservation Solutions
by Aureliusz Kolonko, Natalia Słabiak-Błaż, Robert Król and Andrzej Więcek
Medicina 2022, 58(11), 1579; https://doi.org/10.3390/medicina58111579 - 2 Nov 2022
Viewed by 1122
Abstract
Background and Objectives: StoreProtect Plus® is a preserving solution for cold organ storage, with a composition identical to Institute Georges Lopez (IGL-1) solution. The aim of this single center study was to compare the clinical performance of StoreProtect Plus with the [...] Read more.
Background and Objectives: StoreProtect Plus® is a preserving solution for cold organ storage, with a composition identical to Institute Georges Lopez (IGL-1) solution. The aim of this single center study was to compare the clinical performance of StoreProtect Plus with the generic counterpart of University of Wisconsin preservation fluid, named SPS-1®. Materials and Methods: The clinical outcomes of 168 consecutive organs preserved with StoreProtect Plus solution and 167 organs preserved with SPS-1 solution were compared. During an 18-month post-transplant follow-up period, kidney graft function, the frequency of acute rejection, post-transplant diabetes, and infectious complications, as well as patient and graft survival were analyzed. Results: There was significantly more immediate graft function (IGF) (39.3 vs. 24.0%; p < 0.01) and less slow graft function (SGF) (38.7 vs. 51.5%; p < 0.05) in the StoreProtect Plus group in comparison with the SPS-1 group, whereas the occurrence of DGF was similar in both groups. Long-term kidney graft function was comparable. Multivariate regression analysis showed that the use of StoreProtect Plus vs. SPS-1 solution (rpartial = 0.217; p < 0.001) and the amount of residual diuresis (rpartial = 0.147; p < 0.001) independently increased the occurrence of IGF, whereas Scr > 1.5 mg/dL prior to organ procurement (rpartial = −0.198; p < 0.001), longer CIT (rpartial = −0.170; p < 0.01), and CVD donor death (rpartial = −0.214; p < 0.001) were associated with SGF. Conclusions: The higher occurrence of IGF was found in kidney transplant recipients whose organs were preserved using StoreProtect Plus solution as compared with SPS-1 solution. The two groups did not differ in kidney graft function, the frequency of post-transplant complications, as well as patient and graft survival. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges II)
7 pages, 488 KiB  
Article
Diabetes Mellitus as a Predictive Factor for Urinary Tract Infection for Patients Treated with Kidney Transplantation
by Kaori Ozawa, Manabu Takai, Tomoki Taniguchi, Makoto Kawase, Shinichi Takeuchi, Kota Kawase, Daiki Kato, Koji Iinuma, Keita Nakane and Takuya Koie
Medicina 2022, 58(10), 1488; https://doi.org/10.3390/medicina58101488 - 19 Oct 2022
Cited by 2 | Viewed by 1828
Abstract
Background and Objectives: We aimed to investigate the rate of incidence and risk factors of post-transplant urinary tract infection (UTI) in patients receiving kidney transplantation (KT) at our institution. Materials and Methods: A retrospective cohort study was carried out on patients [...] Read more.
Background and Objectives: We aimed to investigate the rate of incidence and risk factors of post-transplant urinary tract infection (UTI) in patients receiving kidney transplantation (KT) at our institution. Materials and Methods: A retrospective cohort study was carried out on patients who underwent KT for end-stage kidney disease (ESKD) from January 2008 to December 2021 at Gifu University Hospital. UTI was defined as the existence of bacterial and/or fungal infection in urine with ≥105 colony-forming units/mL, with or without urinary and/or systemic symptoms of UTI. Patients were divided into two groups: those with UTI after KT (UTI group) and those without UTI (non-UTI group). The primary endpoint of this study was the relationship between covariates and UTI after KT. Results: Two hundred and forty patients with ESKD received KT at Gifu University Hospital. Thirty-four participants developed UTI after surgery, and the most common pathogen was Escherichia coli. At the end of the follow-up, graft loss was observed in six patients (2.5%), independent of UTI episodes. In the multivariate analysis, diabetes mellitus (DM) was statistically associated with post-transplant UTI in kidney transplant recipients. Conclusions: Preoperative serum glucose control in patients with DM may have a crucial role in preventing UTI and preserving renal function after KT. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges II)
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11 pages, 310 KiB  
Article
Influence of Self-Determination and Social Support on Post-Traumatic Growth among Living Kidney Donors: A Cross-Sectional Study
by Younghui Hwang, Kyoungok Min and Jihyun Oh
Medicina 2022, 58(9), 1155; https://doi.org/10.3390/medicina58091155 - 25 Aug 2022
Cited by 1 | Viewed by 1465
Abstract
Background and Objectives: Although many studies have reported that kidney donation is not physically harmful to living kidney donors, there are few studies on the psychological changes that they experience, especially post-traumatic growth. This study aimed to investigate the influence of self-determination [...] Read more.
Background and Objectives: Although many studies have reported that kidney donation is not physically harmful to living kidney donors, there are few studies on the psychological changes that they experience, especially post-traumatic growth. This study aimed to investigate the influence of self-determination and social support on post-traumatic growth among living kidney donors. Materials and Methods: This study used a descriptive, cross-sectional design. Data were collected from 114 living kidney donors who visited the outpatient solid organ transplant center at Seoul National University Hospital. The data were analyzed using the t-test, one-way analysis of variance, and stepwise multiple regression. Results: The results showed that the mean for post-traumatic growth of living kidney donors was 4.24 (0.81), a level higher than the midpoint. The factors affecting total post-traumatic growth were the relatedness of self-determination, the social support of their significant other, and donor type. In particular, the relatedness of self-determination was a significant factor affecting changed perceptions of self, relating to others, and spiritual change, subscales of post-traumatic growth. Additionally, the social support of donors’ significant others was a significant factor affecting relating to others and new possibilities, subscales of post-traumatic growth. Conclusions: Healthcare providers should endeavor to help living kidney donors experience post-traumatic growth, which can be facilitated by improving their self-determination and social support. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges II)
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