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Kidney Transplantation: Current Challenges and Future Perspectives
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Kidney Transplantation: Current Challenges and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 2814

Special Issue Editors

Dr. Alberto Piana

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Guest Editor
Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
Interests: kidney transplantation; urologic oncology; endourology; urolithiasis; laparoscopic urology; prostate; prostate cancer
Dr. Angelo Territo

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Guest Editor
Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
Interests: kidney transplantation; minimally invasive surgery; laparoscopic surgery; renal

Special Issue Information

Dear Colleagues,

This Special Issue aims to investigate new scenarios and challenges in the field of kidney transplantation.

This Special Issue invites original research articles, review papers, and clinical studies that contribute to enrich our knowledge about kidney transplantation. We encourage submissions focusing on topics such as urologic cancers in transplanted patients, surgical challenges in kidney transplantation, and the use of technology for patient-tailored clinical management.

To ensure the highest-quality publications, we kindly request that authors refrain from submitting mini-reviews and case reports for this Special Issue. Instead, we seek in-depth research articles and comprehensive reviews that present novel findings and insights into kidney transplantation.

By bringing together leading experts and researchers in the field, this Special Issue aims to foster interdisciplinary discussions and promote collaborations to address the pressing issues faced in kidney transplantation. We believe that this collection of articles will serve as a valuable resource for clinicians and researchers involved in improving patient outcomes and advancing the field of kidney transplantation.

Dr. Alberto Piana
Dr. Angelo Territo
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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
  • urologic cancers
  • organ preservation
  • surgical challenges
  • donor selection
  • long-term out-comes
  • complications
  • post-transplant care
  • technology

Published Papers (5 papers)

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Research

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21 pages, 1399 KiB  
Article
Does Timepoint of Surgical Procedure Affect the Outcome in Simultaneous Pancreas–Kidney Transplantation? A Retrospective Single-Center Analysis over 20 Years
by Hans Michael Hau, Nora Jahn, Christos Vlachos, Tim Eichler, Andri Lederer, Antonia Geisler, Uwe Scheuermann, Daniel Seehofer, Sylvia Köppen, Sven Laudi, Robert Sucher and Sebastian Rademacher
J. Clin. Med. 2024, 13(13), 3688; https://doi.org/10.3390/jcm13133688 - 25 Jun 2024
Viewed by 278
Abstract
Background: Sleep deprivation and disturbances in circadian rhythms may hinder surgical performance and decision-making capabilities. Solid organ transplantations, which are technically demanding and often begin at uncertain times, frequently during nighttime hours, are particularly susceptible to these effects. This study aimed to [...] Read more.
Background: Sleep deprivation and disturbances in circadian rhythms may hinder surgical performance and decision-making capabilities. Solid organ transplantations, which are technically demanding and often begin at uncertain times, frequently during nighttime hours, are particularly susceptible to these effects. This study aimed to assess how transplant operations conducted during daytime versus nighttime influence both patient and graft outcomes and function. Methods: simultaneous pancreas–kidney transplants (SPKTs) conducted at the University Hospital of Leipzig from 1998 to 2018 were reviewed retrospectively. The transplants were categorized based on whether they began during daytime hours (8 a.m. to 6 p.m.) or nighttime hours (6 p.m. to 8 a.m.). We analyzed the demographics of both donors and recipients, as well as primary outcomes, which included surgical complications, patient survival, and graft longevity. Results: In this research involving 105 patients, 43 SPKTs, accounting for 41%, took place in the daytime, while 62 transplants (59%) occurred at night. The characteristics of both donors and recipients were similar across the two groups. Further, the rate of (surgical) pancreas graft-related complications and reoperations (daytime 39.5% versus nighttime 33.9%; p = 0.552) were also not statistically significant between both groups. In this study, the five-year survival rate for patients was comparable for both daytime and nighttime surgeries, with 85.2% for daytime and 86% for nighttime procedures (p = 0.816). Similarly, the survival rates for pancreas grafts were 75% for daytime and 77% for nighttime operations (p = 0.912), and for kidney grafts, 76% during the day compared to 80% at night (p = 0.740), indicating no significant statistical difference between the two time periods. In a multivariable model, recipient BMI > 30 kg/m2, donor age, donor BMI, and cold ischemia time > 15 h were independent predictors for increased risk of (surgical) pancreas graft-related complications, whereas the timepoint of SPKT (daytime versus nighttime) did not have an impact. Conclusions: The findings from our retrospective analysis at a big single German transplant center indicate that SPKT is a reliable procedure, regardless of the start time. Additionally, our data revealed that patients undergoing nighttime transplants have no greater risk of surgical complications or inferior results concerning long-term survival of the patient and graft. However, due to the small number of cases evaluated, further studies are required to confirm these results. Full article
(This article belongs to the Special Issue Kidney Transplantation: Current Challenges and Future Perspectives)
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11 pages, 2434 KiB  
Article
Exploring Thyroid Function after Kidney Transplantation: The Complex Interplay Unacknowledged in Post-Transplant Care
by Ita Jelić Pranjić, Lidija Orlić, Ana Carević, Tea Vrdoljak Margeta, Jelena Šimić and Ivan Bubić
J. Clin. Med. 2024, 13(12), 3559; https://doi.org/10.3390/jcm13123559 - 18 Jun 2024
Viewed by 435
Abstract
Background/Objectives: The interplay between thyroid function and kidney graft function following kidney transplantation remains incompletely understood. Thyroid disorders are more prevalent in kidney transplant recipients than in the general population and are associated with poorer outcomes. Methods: This prospective, single-center study was designed [...] Read more.
Background/Objectives: The interplay between thyroid function and kidney graft function following kidney transplantation remains incompletely understood. Thyroid disorders are more prevalent in kidney transplant recipients than in the general population and are associated with poorer outcomes. Methods: This prospective, single-center study was designed to estimate thyroid function (thyroid-stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (FT3), thyroxine (T4), free thyroxine (FT4), as well as anti-thyroid peroxidase antibody (anti-TPO), anti-thyroglobulin antibody (anti-Tg), and thyroid-stimulating immunoglobulin (TSI)) and its influence on kidney graft function among a cohort of 23 kidney transplant recipients during a follow-up period of 12 months. Results: Significantly increased levels of T4 and T3 were observed 12 months post-transplantation, with FT3 levels increasing significantly after 6 months. The prevalence of immeasurably low anti-Tg antibodies rose during follow-up. Initially, 8% of patients showed positive TSI, which turned negative for all after 6 months. A statistically significant correlation was found between the initial TSH and the estimated glomerular filtration rate (eGFR) value 6 months after transplantation (p = 0.023). The graft function was stable. Proteinuria was statistically significantly lower 12 months after transplantation. Conclusions: Identifying additional risk factors, understanding their impact on kidney graft function, and recognizing cardiovascular comorbidities could enhance patient care. Notably, this study marks the first prospective investigation into thyroid function after kidney transplantation in Croatia, contributing valuable insights to the global understanding of this complex interplay. Full article
(This article belongs to the Special Issue Kidney Transplantation: Current Challenges and Future Perspectives)
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14 pages, 261 KiB  
Article
Effect of Different Induction Immunosuppression on the Incidence of Infectious Complications after Kidney Transplantation—Single Center Study
by Matej Vnučák, Karol Graňák, Monika Beliančinová, Patrícia Kleinová, Tímea Blichová, Vladimír Doboš and Ivana Dedinská
J. Clin. Med. 2024, 13(8), 2162; https://doi.org/10.3390/jcm13082162 - 9 Apr 2024
Viewed by 660
Abstract
Background/Objectives: Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim [...] Read more.
Background/Objectives: Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim of our analysis was to find whether there were higher incidences of infectious complications after kidney transplantation (KT) in groups with different induction immunosuppressive treatment and also to find independent risk factors for recurrent infections. Materials: We retrospectively evaluated all patients with induction treatment with basiliximab after kidney transplantation from 2014 to 2019 at our center relative to age- and sex-matched controls of patients with thymoglobulin induction immunosuppression. Results: Our study consisted of two groups: basiliximab (39) and thymoglobulin (39). In the thymoglobulin group we observed an increased incidence of recurrent infection in every observed interval; however, acute rejection was seen more often in the basiliximab group. A history of respiratory diseases and thrombocytopenia were identified as independent risk factors for recurrent bacterial infections from the first to sixth month after KT. Decreased eGFR from the first month, infections caused by multi-drug-resistant bacteria, and severe infections (reflected by the need for hospitalization) were identified as independent risk factors for recurrent bacterial infections from the first to the twelfth month after KT. Conclusions: We found that in the group of patients with thymoglobulin induction immunosuppressive treatment, infectious complications occurred significantly more often during the entire monitored period with decreased incidence of acute humoral and cellular rejection occurred more often. Full article
(This article belongs to the Special Issue Kidney Transplantation: Current Challenges and Future Perspectives)
11 pages, 401 KiB  
Article
The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates
by Michael Corr, Amber Orr and Aisling E. Courtney
J. Clin. Med. 2024, 13(4), 953; https://doi.org/10.3390/jcm13040953 - 7 Feb 2024
Cited by 1 | Viewed by 866
Abstract
Background: There is increasing evidence that cardiac screening prior to kidney transplantation does not improve its outcomes. However, risk aversion to perioperative events means that, in practice, testing remains common, limiting the availability of ‘real-world’ data to support any change. Our objective [...] Read more.
Background: There is increasing evidence that cardiac screening prior to kidney transplantation does not improve its outcomes. However, risk aversion to perioperative events means that, in practice, testing remains common, limiting the availability of ‘real-world’ data to support any change. Our objective was to assess perioperative and 1-year post-transplant cardiovascular events in a kidney transplant candidate cohort who received minimal cardiovascular screening. Methods: The retrospective cohort study included all adult kidney-only transplant recipients in a single UK region between January 2015 and December 2021. Kidney transplant recipients asymptomatic of cardiac disease, even those with established risk factors, did not receive cardiac stress testing. The perioperative and 1-year post-transplant cardiovascular event incidences were examined. Logistic regression was used to identify variables of statistical significance that predicted cardiovascular or cerebrovascular events. Results: A total of 895 recipients fulfilled the inclusion criteria. Prior to transplantation, 209 (23%) recipients had an established cardiac diagnosis, and 193 (22%) individuals had a diagnosis of diabetes. A total of 18 (2%) patients had a perioperative event, and there was a 5.7% incidence of cardiovascular events 1 year post-transplantation. The cardiovascular mortality rate was 0.0% perioperatively, 0.2% at 3 months post-transplant, and 0.2% at 1 year post-transplant. Conclusions: This study demonstrates comparable rates of cardiovascular events despite reduced screening in asymptomatic recipients. It included higher risk individuals who may, on the basis of screening results, have been excluded from transplantation in other programmes. It provides further evidence that extensive cardiac screening prior to kidney transplantation is unlikely to be offset by reduced rates of cardiovascular events. Full article
(This article belongs to the Special Issue Kidney Transplantation: Current Challenges and Future Perspectives)
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Review

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10 pages, 969 KiB  
Review
Robotic-Assisted Nephrectomy for Living Kidney Donation—Single Center Initial Experience (Case Series) and Review of the Literature
by Karolina Kędzierska-Kapuza, Inga Łopuszyńska, Agnieszka Mizerska, Marta Matejak-Górska, Krzysztof Safranow and Marek Durlik
J. Clin. Med. 2024, 13(13), 3754; https://doi.org/10.3390/jcm13133754 - 27 Jun 2024
Viewed by 221
Abstract
Background: Robotic-assisted nephrectomy for living kidney-donation (RANLD) has the potential of becoming the leading technique of harvesting kidney, if expertise is available. The aim of this work is to present our initial experience with robotic technique with additional hand-assistance. Materials and Methods [...] Read more.
Background: Robotic-assisted nephrectomy for living kidney-donation (RANLD) has the potential of becoming the leading technique of harvesting kidney, if expertise is available. The aim of this work is to present our initial experience with robotic technique with additional hand-assistance. Materials and Methods: We initiated RANLD at our clinic using the DaVinci System in September 2022, since then harvesting six kidneys, four left and two right; in two cases, multiple arteries existed. The renal vessels were ligated using vascular staplers. All the operations included a hand-assist with the use of Gelport. The mean operation time was 119.2 min (SD 12 min). Results: There were no conversions or donors’ post-operative complications. Time of discharge from the hospital was 4.5 days post-operatively. Total hospital length of stay was 7.8 days. All the harvested kidneys were transplanted, five of them with adequate function, three with initially delayed function, and one needed to be removed due to thrombotic complications. Post-operative was pain assessed on the VAS scale and overall pain was assessed according to the NRS scale. At the discharge day, donors’ performance status was about 87.5% according to the Karnofsky scale. The donors resumed their normal life activity within 15.7 days and returned to work within 45.2 days. The serum mean creatinine level before the donation was 0.85 mg/dL (SD 0.1 mg/dL), and mean eGFR (MDRD) = 91.8 mL/min/1.73 m2 (SD 16.1 mL/min/1.73 m2). Conclusions: Further development of RANLD could lead to an increase in the number of living kidney donors, particularly in Poland where the number is currently lower than that of deceased donors. Prolonged operation time, longer warm ischemic time, and high equipment costs are significant drawbacks of RANLD. Full article
(This article belongs to the Special Issue Kidney Transplantation: Current Challenges and Future Perspectives)
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