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Search Results (2,026)

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29 pages, 1927 KiB  
Review
Aspects of Self-Management After Solid Organ Transplantation—A Scoping Review
by Stefan Jobst, Christiane Kugler and Anne Rebafka
Nurs. Rep. 2025, 15(8), 304; https://doi.org/10.3390/nursrep15080304 - 19 Aug 2025
Abstract
Background: Solid organ transplantation improves survival and quality of life but requires lifelong self-management. While models exist for kidney and liver recipients, a comprehensive framework for all solid organ transplant recipients is lacking. Addressing this gap is essential for optimizing post-transplant care. [...] Read more.
Background: Solid organ transplantation improves survival and quality of life but requires lifelong self-management. While models exist for kidney and liver recipients, a comprehensive framework for all solid organ transplant recipients is lacking. Addressing this gap is essential for optimizing post-transplant care. Objectives: This report aims to conceptualize self-management after solid organ transplantation by addressing questions related to (1) the contexts studied to date, (2) research methodologies and publication types used, and (3) core aspects associated with self-management post-transplantation. Methods: A scoping review was used to address the above objectives. A comprehensive search strategy identified relevant studies, followed by systematic screening, data extraction, and qualitative content analysis. Findings were categorized using a deductive–inductive coding approach to map core self-management aspects after solid organ transplantation. Results: The search yielded 34,417 records, with 742 ultimately included. Publications from 43 countries spanned 43 years, with many (48.9%) published after 2016. Research articles dominated (80.1%), covering kidney (61%), liver (22%), heart (21%), and lung (16%) transplants. A qualitative analysis identified four self-management domains containing various categories: (1) Managing the medical–therapeutic regimen, (2) managing biographical work, (3) managing (new) life roles, and (4) generic self-management skills. The conceptual model illustrates their interconnections, with aspects of the medical–therapeutic regimen management most frequently covered. Conclusions: Self-management after solid organ transplantation is complex, involving medical–therapeutic, emotional, social, and behavioral aspects. Aspects of managing the medical–therapeutic regimen dominate the research literature, while other aspects need further exploration. Future studies should address gaps to support holistic, patient-centered post-transplant care strategies. Full article
(This article belongs to the Special Issue Self-Management of Chronic Disease)
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16 pages, 821 KiB  
Article
Malignancies After Renal Transplantation: Frequency, Etiology, and Prognosis—A Single Center Experience
by Fatih Atalah, Aydın Acarbay, Akgün Karakök, Mehmet Beşiroğlu, Fatih Kuş, Huzeyfe Arıcı, Ahmet Burak Dirim, Vafa Suleymanova, Aydın Türkmen and Halil Yazıcı
J. Clin. Med. 2025, 14(16), 5858; https://doi.org/10.3390/jcm14165858 - 19 Aug 2025
Abstract
Introduction and Aim: Renal transplant recipients face significant long-term graft and patient loss due to post-transplant malignancies. This study aimed to characterize post-transplant malignancies, determine mortality risk factors, and evaluate patient outcomes. Materials and Methods: This retrospective study included 2052 kidney [...] Read more.
Introduction and Aim: Renal transplant recipients face significant long-term graft and patient loss due to post-transplant malignancies. This study aimed to characterize post-transplant malignancies, determine mortality risk factors, and evaluate patient outcomes. Materials and Methods: This retrospective study included 2052 kidney transplant recipients who underwent transplantation between 1976 and 2019 at our institution, other national centers, or international facilities, and who had at least six months of follow-up. Regardless of the transplant center, all patients were followed exclusively at our nephrology department for post-transplant care. A comprehensive review of patient files was conducted, encompassing demographic data, malignancy type and treatment, mortality rates, tissue compatibility assessments, viral serology results, immunosuppression protocols, acute rejection history, and pre-transplant malignancies. The relationships between these variables and mortality were examined. Results: A total of 167 malignant events were observed in 163 patients out of 2052 renal transplant patients (7.9%). The female patients comprised 34.4% (n = 56) of the participants. Ages at transplantation and malignancy diagnosis had medians of 40.0 (13–72) and 50.0 (23–78) years, respectively. The leading malignancy was skin cancer at 30.0%, with Kaposi sarcoma at 11.3% and post-transplant lymphoproliferative disease at 10.6% following. Of the patients followed up, 58.9% (93 patients) had mortality. In univariate analysis, older age at transplant, older age at malignancy diagnosis, and male sex were associated with mortality; however, no independent predictors were identified in the multivariate model (all p > 0.05), likely due to sample size limitations and inter-variable collinearity. Mortality showed statistically significant associations (p < 0.05) with increased age at transplantation, increased age at malignancy diagnosis, and male gender. Conclusions: Post-transplant malignancies significantly compromise both graft longevity and patient survival. Particularly aggressive skin cancers demand heightened clinical vigilance. Early detection through regular dermatological screening, patient education, and timely biopsies must become integral to long-term transplant care protocols. Full article
(This article belongs to the Section Nephrology & Urology)
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10 pages, 278 KiB  
Case Report
Paid Organ Donation: Case Report and Review of the Literature on Health Implications for Kidney Donors and Recipients
by Małgorzata Marchelek-Myśliwiec, Krzysztof Korzeniewski, Emilia Marchelek, Joanna Stępniewska and Danuta Kosik-Bogacka
Pathogens 2025, 14(8), 819; https://doi.org/10.3390/pathogens14080819 - 19 Aug 2025
Abstract
The shortage of organs for use in transplantation has contributed to the development of an international commercial market for organ transplantation. Unfortunately, transplant tourism (TT) is associated with risks for surgical complications, poor graft outcome, increased mortality, and infectious complications. TT increases the [...] Read more.
The shortage of organs for use in transplantation has contributed to the development of an international commercial market for organ transplantation. Unfortunately, transplant tourism (TT) is associated with risks for surgical complications, poor graft outcome, increased mortality, and infectious complications. TT increases the risk of several viral (HIV and hepatitis B and C viruses), bacterial (Mycobacterium tuberculosis, Pseudomonas sp., Enterococcus sp., Escherichia coli, and Acinetobacter sp.), fungal (Aspergillus sp., Zygomycetes, Ramichloridium sp., Scedosporium apiospermum, and Trichosporon sp.), and parasitic (Plasmodium sp., Trypanosoma cruzi and Strongyloides sp., and Microsporidia sp.) infections. This paper presents a case report of an anonymous patient who travelled to Pakistan and underwent a commercial kidney transplant. He developed infection from extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC). Moreover, we reviewed all published cases of bacterial, viral, and fungal infections in kidney transplant recipients who bought their organs abroad. Full article
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13 pages, 601 KiB  
Article
Post-Nephrectomy Orchialgia: A Cross-Sectional Assessment of an Underreported Complication in Living Kidney Donors
by Aviad Gravetz, Fahim Kanani, Karin Lifshitz, Vladimir Tennak, Dana Bielopolski and Eviatar Nesher
J. Clin. Med. 2025, 14(16), 5807; https://doi.org/10.3390/jcm14165807 - 16 Aug 2025
Viewed by 202
Abstract
Background/Objectives: Orchialgia following kidney donation is an underrecognized complication with reported incidence varying dramatically between retrospective (2–3%) and prospective (44–55%) studies, suggesting significant underreporting. This study aimed to determine the incidence, characteristics, and clinical relevance of orchialgia in male kidney donors within [...] Read more.
Background/Objectives: Orchialgia following kidney donation is an underrecognized complication with reported incidence varying dramatically between retrospective (2–3%) and prospective (44–55%) studies, suggesting significant underreporting. This study aimed to determine the incidence, characteristics, and clinical relevance of orchialgia in male kidney donors within 2 years post-donation using direct patient assessment. Methods: This is a cross-sectional study of 100 male donors (64.5% response rate) from 155 eligible donors approached who underwent left laparoscopic donor nephrectomy between February 2021 and 2023. Donors completed a literature-based 15-item questionnaire at routine follow-up visits assessing testicular pain characteristics, timing, and impact. Results: Orchialgia occurred in 48% (48/100) of donors. Early onset (≤14 days) occurred in 47%, with median onset at day 2 (range 1–14). At 3-month follow-up, 37% reported persistent pain; by 1 year, only 0.8% experienced persistent pain based on our 10-year institutional database. No significant difference in incidence between altruistic (54%) and related donors (33%), though pain severity was lower in altruistic donors (mean 3.6 vs. 4.2, p = 0.04, independent t-test). Conservative management was effective in all cases; no invasive interventions were required. Conclusions: Orchialgia affects nearly half of male kidney donors when directly assessed, though it follows a benign, self-limiting course with minimal long-term clinical impact. These findings support enhanced preoperative counseling while reassuring donors about favorable outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in Kidney Transplantation)
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14 pages, 557 KiB  
Review
Advances in Kidney Transplant, Machine Perfusion, and Viability Markers
by Stephanie Y. Ohara, Mariana Chavez-Villa, Shennen Mao, Jacob Clendenon, Julie Heimbach, Randi Ryan, Lavanya Kodali, Michelle C. Nguyen, Rafael Nateras-Nunez and Caroline C. Jadlowiec
Kidney Dial. 2025, 5(3), 37; https://doi.org/10.3390/kidneydial5030037 - 14 Aug 2025
Viewed by 324
Abstract
Despite improvements in kidney transplantation rates, the shortage of donor kidneys remains a critical issue, exacerbated by non-utilization of recovered kidneys due to quality concerns, necessitating advancements in perfusion methods to enhance graft outcomes and usage. Although static cold storage remains the default [...] Read more.
Despite improvements in kidney transplantation rates, the shortage of donor kidneys remains a critical issue, exacerbated by non-utilization of recovered kidneys due to quality concerns, necessitating advancements in perfusion methods to enhance graft outcomes and usage. Although static cold storage remains the default standard for kidney preservation, newer methods like hypothermic machine perfusion have shown improved outcomes, including reduced delayed graft function and better survival rates. Hypothermic oxygenated machine perfusion and normothermic machine perfusion offer some potential clinical benefits but studies to date have demonstrated mixed results. In the United States, LifePort and the XVIVO’s Kidney Assist Transport are the most popular hypothermic perfusion devices, with NMP devices mostly in trials. Combining perfusion with biomarkers such as mitochondrial flavin mononucleotide, neutrophil gelatinase-associated lipocalin, and osteopontin shows promise in assessing kidney viability and predicting post-transplant outcomes, though further research is also needed. Emphasis on repair biomarkers, such as uromodulin and osteopontin, aims to better predict graft outcomes and develop new therapies. While notable advancements have been made in the use of machine perfusion and viability testing for liver transplantation, additional research with larger sample sizes is essential to substantiate these results and enhance kidney transplantation outcomes. Full article
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9 pages, 447 KiB  
Article
Impact of Tacrolimus Trough Levels at Discharge on Early Post-Kidney Transplantation Outcomes: A Nationwide Cohort Study
by Heungman Jun, Young Ju Oh, Hyo Kee Kim, Jun Young Lee, Yeong Hoon Kim, Joong Kyung Kim, Jaeseok Yang, Myoung Soo Kim, Cheol Woong Jung and Korean Organ Transplantation Registry Study Group
J. Clin. Med. 2025, 14(16), 5707; https://doi.org/10.3390/jcm14165707 - 12 Aug 2025
Viewed by 229
Abstract
Introduction: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation (KT), but its narrow therapeutic index necessitates precise monitoring. Early post-transplant tacrolimus trough concentrations (C0) are critical, as suboptimal levels can increase rejection and infection risks. This study evaluated the impact of C0 [...] Read more.
Introduction: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation (KT), but its narrow therapeutic index necessitates precise monitoring. Early post-transplant tacrolimus trough concentrations (C0) are critical, as suboptimal levels can increase rejection and infection risks. This study evaluated the impact of C0 levels at discharge on early post-transplant outcomes in a large Korean cohort. Materials and Methods: This retrospective analysis included 5293 KT recipients from the Korean Organ Transplant Registry (KOTRY) who received a kidney transplant between 2014 and 2019. Recipients were categorized into three groups based on C0 levels at discharge: <5.9 ng/mL, 5.9–9.5 ng/mL, and >9.5 ng/mL. Clinical outcomes, including serum creatinine (sCr), biopsy-proven acute rejection (BPAR), and infections requiring hospitalization, were analyzed using the Kruskal–Wallis test and chi-squared test. Results: The BPAR rates were 22.5%, 20.9%, and 21.5% for the low, middle, and high C0 groups, respectively (p = 0.221). However, the incidence of infections requiring hospitalization was significantly higher in the high C0 group (28.1%) compared to the middle (23.9%) and low (21.7%) groups at 1-year follow-up (p < 0.001). In high-risk recipients, lower C0 levels correlated with increased BPAR rates (33.9% vs. 29.1% and 26.4%, p = 0.030). Higher intrapatient variability (IPV) between discharge and 6 months was linked to higher infection risk in all recipients and increased BPAR and infection risk in high-risk patients. Conclusions: Optimal C0 levels at discharge are essential to balance rejection and infection risks in KT. Lower C0 levels and higher IPV increase the risk of adverse outcomes, especially in high-risk sensitized recipients, underscoring the need for careful monitoring and personalized management. Full article
(This article belongs to the Section Nephrology & Urology)
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11 pages, 2377 KiB  
Case Report
Biopsy-Proven Solid Organ Transplant Graft-Versus-Host Disease (SOT-GVHD) Involving the Skin, Liver, and Bone Marrow in a Simultaneous Kidney-Pancreas Transplant Recipient
by Reza Rahimi Shahmirzadi, Danielle Ouellette, Martin Igbokwe, Alp Sener, Manal Y. Gabril, Subrata Chakrabarti, Uday Deotare and Lili Ataie
Transplantology 2025, 6(3), 24; https://doi.org/10.3390/transplantology6030024 - 12 Aug 2025
Viewed by 236
Abstract
Background: Graft-versus-host disease (GVHD) is a rare but serious complication following solid organ transplantation (SOT), particularly in transplants involving organs with a high volume of passenger donor T-lymphocytes. This case highlights the clinical course and diagnostic challenges of GVHD following simultaneous pancreas and [...] Read more.
Background: Graft-versus-host disease (GVHD) is a rare but serious complication following solid organ transplantation (SOT), particularly in transplants involving organs with a high volume of passenger donor T-lymphocytes. This case highlights the clinical course and diagnostic challenges of GVHD following simultaneous pancreas and pre-emptive kidney transplantation. Methods: A 51-year-old male with long-standing type 1 diabetes mellitus underwent simultaneous pancreas and kidney transplantation with induction therapy using rabbit anti-thymocyte globulin and methylprednisolone. Three months post-transplant, he presented with a diffuse lichenoid cutaneous eruption. Diagnostic evaluation included an extensive infectious workup, skin punch biopsy, liver and bone marrow biopsies, and microchimerism assay. Results: Skin biopsy revealed interface vacuolar dermatitis consistent with cutaneous GVHD. Subsequent liver and bone marrow biopsies confirmed GVHD involvement, with microchimerism assay showing 43% donor-origin T-cells in the bone marrow. Initial treatment with systemic and topical corticosteroids led to temporary improvement. However, the patient developed bone marrow suppression, recurrent bacteremia, and invasive fungal infection, resulting in a prolonged ICU stay and ultimately death. Conclusions: This case underscores the importance of considering SOT-GVHD in patients receiving organs rich in donor lymphocytes, such as pancreas transplants. Early recognition and multidisciplinary management are critical to improving outcomes in this rare but life-threatening condition. Full article
(This article belongs to the Section Transplant Immunology and Immunosuppressive Drugs)
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12 pages, 822 KiB  
Article
Evaluation of Different Initial Doses of Envarsus in De Novo Kidney Transplant Recipients
by Patricio Más-Serrano, Antonio Franco, Iván Beltrá-Picó, Marcos Díaz-González, Claudia Colomer, Isabel Gascón, Elena de la Cruz, Javier Pérez-Contreras, Ricardo Nalda-Molina and Amelia Ramón-López
J. Clin. Med. 2025, 14(16), 5687; https://doi.org/10.3390/jcm14165687 - 11 Aug 2025
Viewed by 295
Abstract
Background/Objectives: Envarsus is a novel prolonged-release formulation of tacrolimus with enhanced bioavailability. The summary of product characteristics recommends an initial dose of 0.17 mg/kg/day for the prophylaxis of rejection in kidney transplant recipients, which may be excessive. This study aimed to compare [...] Read more.
Background/Objectives: Envarsus is a novel prolonged-release formulation of tacrolimus with enhanced bioavailability. The summary of product characteristics recommends an initial dose of 0.17 mg/kg/day for the prophylaxis of rejection in kidney transplant recipients, which may be excessive. This study aimed to compare the pharmacokinetics of four different initial doses of Envarsus: 0.15 mg/kg/day (group 1), 0.12 mg/kg/day (group 2), 0.10 mg/kg/day (group 3), and 0.08 mg/kg/day (group 4). Induction therapy included thymoglobulin, sirolimus, and prednisone, with Envarsus initiated once serum creatinine levels fell below 3 mg/dL. Methods: A comprehensive pharmacokinetic sampling strategy was implemented between 48 and 72 h post-transplant, allowing for the calculation of AUC using the trapezoidal method. Additionally, trough levels at 72 h were assessed, with the therapeutic range defined as 5–8 ng/mL. Patients with trough concentrations above 8 ng/mL either had their tacrolimus dose reduced or their treatment temporarily discontinued for 24 h. Kidney function was evaluated three months post-transplant. Results: A total of 167 patients completed the study (39 in group 1, 43 in group 2, 42 in group 3, and 43 in group 4). The groups were balanced in baseline characteristics. Compared with groups 1 and 2, groups 3 and 4 had significantly lower mean trough concentrations (7.9 ng/mL and 6.5 ng/mL vs. 11.3 ng/mL and 10.8 ng/mL, respectively) and lower AUC values (310 ng·h/mL and 271 ng·h/mL vs. 458 ng·h/mL and 390 ng·h/mL, respectively). Additionally, the proportion of patients with supratherapeutic drug levels was lower in groups 3 and 4 (47.6% and 37.2% vs. 76.9% and 67.4%, respectively), as was the proportion of patients requiring a skipped dose (14.3% and 14.0% vs. 30.8% and 27.9%, respectively). Importantly, the percentage of patients within the therapeutic range was higher in the 0.08 mg/kg/day group (41.9%), demonstrating improved drug level stability at this dose. Despite these differences, kidney function remained similar in all groups at three months, and no significant differences in the incidence of adverse events were observed among the four dosing groups. Conclusions: An initial dose of 0.08 mg/kg/day resulted in adequate tacrolimus exposure, improved the proportion of patients within the therapeutic range, and minimized unnecessary drug accumulation. These findings suggest that a lower initial dose of Envarsus may be preferable to optimize drug exposure while improving therapeutic precision. Full article
(This article belongs to the Section Pharmacology)
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19 pages, 2133 KiB  
Systematic Review
Clinical Impact of Blood Pressure Variability in Kidney Transplant Patients: A Systematic Review and Meta-Analysis
by Mehmet Kanbay, Alexandru Dan Costache, Crischentian Brinza, Ozgur Aktas, Busra Z. Bayici, Sevde Odemis, Candan Genc, Alexandru Burlacu, Irina Iuliana Costache Enache, Andreea Simona Covic, Pantelis Sarafidis, Masanari Kuwabara and Adrian Covic
Life 2025, 15(8), 1271; https://doi.org/10.3390/life15081271 - 11 Aug 2025
Viewed by 604
Abstract
Background: The association between blood pressure (BP) dipping profiles and kidney function among chronic kidney disease (CKD) patients has been well established within the literature, but studies conducted on kidney transplant (KT) patients remain limited. Individual KT studies have small sample sizes and [...] Read more.
Background: The association between blood pressure (BP) dipping profiles and kidney function among chronic kidney disease (CKD) patients has been well established within the literature, but studies conducted on kidney transplant (KT) patients remain limited. Individual KT studies have small sample sizes and conflicting results. Meta-analysis overcomes these limitations by pooling data to increase statistical power and provide robust clinical guidance. This meta-analysis systematically assesses the impact of BP patterns on KT and CKD populations, aiming to highlight improved BP management strategies in these populations. Materials and methods: A comprehensive search was conducted up to September 9th, 2024, using multiple electronic databases. Results: The current study included 7 studies with a total of 788 patients. KT recipients showed a higher prevalence of non-dipper blood pressure profile than CKD patients. Also, those with a dipper profile had a significantly higher estimated glomerular filtration rate (eGFR) compared to non-dippers and reverse dippers, implying better graft function. No significant differences were observed in acute rejection risk, proteinuria, renal resistive index, cholesterol, or triglycerides across blood pressure profiles. Conclusions: These findings reveal a high prevalence of non-dipping blood pressure profiles in KT and CKD patients, linked to worse renal and cardiovascular outcomes, while also highlighting the need for ambulatory blood pressure monitoring and tailored BP management strategies in these high-risk populations to potentially improve outcomes. However, the observational nature of available studies limits causal inference, and further prospective research is required to establish definitive therapeutic recommendations. Full article
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26 pages, 444 KiB  
Systematic Review
Self-Management Interventions for Kidney Transplant Recipients: A Systematic Review
by Hyejin Lee and Chan Mi Kang
Healthcare 2025, 13(15), 1918; https://doi.org/10.3390/healthcare13151918 - 5 Aug 2025
Viewed by 463
Abstract
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 [...] Read more.
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
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12 pages, 1107 KiB  
Article
DHA–Triacylglycerol Accumulation in Tacrolimus-Induced Nephrotoxicity Identified by Lipidomic Profiling
by Sho Nishida, Tamaki Ishima, Daiki Iwami, Ryozo Nagai and Kenichi Aizawa
Int. J. Mol. Sci. 2025, 26(15), 7549; https://doi.org/10.3390/ijms26157549 - 5 Aug 2025
Viewed by 250
Abstract
Tacrolimus (TAC)-induced chronic nephrotoxicity (TAC nephrotoxicity) remains a major contributor to late allograft dysfunction in kidney transplant recipients. Although detailed mechanisms remain incompletely understood, our previous metabolomic studies revealed disruptions in carnitine-related and redox pathways, suggesting impaired mitochondrial β-oxidation of fatty acids. To [...] Read more.
Tacrolimus (TAC)-induced chronic nephrotoxicity (TAC nephrotoxicity) remains a major contributor to late allograft dysfunction in kidney transplant recipients. Although detailed mechanisms remain incompletely understood, our previous metabolomic studies revealed disruptions in carnitine-related and redox pathways, suggesting impaired mitochondrial β-oxidation of fatty acids. To further characterize metabolic alterations associated with this condition, we conducted an untargeted lipidomic analysis of renal tissues using a murine model of TAC nephrotoxicity. TAC (1 mg/kg/day) or saline was subcutaneously administered to male ICR mice for 28 days, and kidney tissues were harvested for comprehensive lipidomic profiling. Lipidomic analysis was performed with liquid chromatography–tandem mass spectrometry (p < 0.05, n = 5/group). Triacylglycerols (TGs) were the predominant lipid class identified. TAC-treated mice exhibited reduced levels of unsaturated TG species with low carbon numbers, whereas TGs with higher carbon numbers and various degrees of unsaturation were increased. All detected TGs containing docosahexaenoic acid (DHA) showed an increasing trend in TAC-treated kidneys. Although accumulation of polyunsaturated TGs has been previously observed in chronic kidney disease, the preferential increase in DHA-containing TGs appears to be a unique feature of TAC-induced nephrotoxicity. These results suggest that DHA-enriched TGs may serve as a metabolic signature of TAC nephrotoxicity and offer new insights into its pathophysiology. Full article
(This article belongs to the Special Issue Recent Molecular Trends and Prospects in Kidney Diseases)
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14 pages, 278 KiB  
Review
Novel Biomarkers for Rejection in Kidney Transplantation: A Comprehensive Review
by Michael Strader and Sam Kant
J. Clin. Med. 2025, 14(15), 5489; https://doi.org/10.3390/jcm14155489 - 4 Aug 2025
Viewed by 535
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Clinical Advancements in Kidney Transplantation)
26 pages, 6880 KiB  
Article
IgA Nephropathy in Native Kidneys: Oxford and Banff Classifications Reveal Distinct Profiles and Predict Outcomes in Pediatric and Adult Patients
by Danijel Milivojević, Gorana Nikolić, Björn Tampe, Maja Pecić, Snežana Babac, Dušan Paripović, Gordana Miloševski Lomić, Voin Brković, Marko Baralić, Aleksandar Janković, Petar Đurić, Nataša Stajić, Jovana Putnik, Sanja Radojević Škodrić and Maja Životić
Life 2025, 15(8), 1231; https://doi.org/10.3390/life15081231 - 3 Aug 2025
Viewed by 403
Abstract
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 = [...] Read more.
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
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15 pages, 2024 KiB  
Article
Oxy210 Inhibits Hepatic Expression of Senescence-Associated, Pro-Fibrotic, and Pro-Inflammatory Genes in Mice During Development of MASH and in Hepatocytes In Vitro
by Feng Wang, Simon T. Hui, Frank Stappenbeck, Dorota Kaminska, Aldons J. Lusis and Farhad Parhami
Cells 2025, 14(15), 1191; https://doi.org/10.3390/cells14151191 - 2 Aug 2025
Viewed by 515
Abstract
Background: Senescence, a state of permanent cell cycle arrest, is a complex cellular phenomenon closely affiliated with age-related diseases and pathological fibrosis. Cellular senescence is now recognized as a significant contributor to organ fibrosis, largely driven by transforming growth factor beta (TGF-β) signaling, [...] Read more.
Background: Senescence, a state of permanent cell cycle arrest, is a complex cellular phenomenon closely affiliated with age-related diseases and pathological fibrosis. Cellular senescence is now recognized as a significant contributor to organ fibrosis, largely driven by transforming growth factor beta (TGF-β) signaling, such as in metabolic dysfunction-associated steatohepatitis (MASH), idiopathic pulmonary fibrosis (IPF), chronic kidney disease (CKD), and myocardial fibrosis, which can lead to heart failure, cystic fibrosis, and fibrosis in pancreatic tumors, to name a few. MASH is a progressive inflammatory and fibrotic liver condition that has reached pandemic proportions, now considered the largest non-viral contributor to the need for liver transplantation. Methods: We previously studied Oxy210, an anti-fibrotic and anti-inflammatory, orally bioavailable, oxysterol-based drug candidate for MASH, using APOE*3-Leiden.CETP mice, a humanized hyperlipidemic mouse model that closely recapitulates the hallmarks of human MASH. In this model, treatment of mice with Oxy210 for 16 weeks caused significant amelioration of the disease, evidenced by reduced hepatic inflammation, lipid deposition, and fibrosis, atherosclerosis and adipose tissue inflammation. Results: Here we demonstrate increased hepatic expression of senescence-associated genes and senescence-associated secretory phenotype (SASP), correlated with the expression of pro-fibrotic and pro-inflammatorygenes in these mice during the development of MASH that are significantly inhibited by Oxy210. Using the HepG2 human hepatocyte cell line, we demonstrate the induced expression of senescent-associated genes and SASP by TGF-β and inhibition by Oxy210. Conclusions: These findings further support the potential therapeutic effects of Oxy210 mediated in part through inhibition of senescence-driven hepatic fibrosis and inflammation in MASH and perhaps in other senescence-associated fibrotic diseases. Full article
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Review
The Clinical and Medico-Legal Aspects in the Challenge of Transfusion-Free Organ Transplants: A Scoping Review
by Matteo Bolcato, Ludovico Fava, Aryeh Shander, Christoph Zenger, Kevin M. Trentino, Mario Chisari, Vanessa Agostini, Ivo Beverina, Giandomenico Luigi Biancofiore and Vincenzo De Angelis
J. Clin. Med. 2025, 14(15), 5444; https://doi.org/10.3390/jcm14155444 - 1 Aug 2025
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Abstract
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” [...] Read more.
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
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