Search Results (483)

Background/Objectives: Renal scintigraphy with 99mTc-MAG3 is a non-invasive tool for assessing early post-kidney-transplant function and detecting complications. While its utility in predicting delayed graft function (DGF) is established, evidence regarding its capacity to predict long-term graft survival remains limited. This study aimed to evaluate whether early post-transplant scintigraphy provides independent prognostic information for long-term graft survival. Methods: We conducted a retrospective cohort study of kidney transplantations performed at a single tertiary-care academic institution (2015–2019). Patients undergoing simultaneous multi-organ transplantation or experiencing complications precluding early scintigraphy were excluded. All included patients underwent 99mTc-MAG3 scintigraphy within 48 h post-transplantation. Renogram curves were categorized using the Heaf and Iversen classification (Grades 1–4). Univariate and multivariate Cox proportional hazards regression analyses were performed to assess death-censored graft survival. The study followed STROBE reporting guidelines. Results: Among the 317 included patients, renogram curves were distributed as follows: Grade 1 (n = 31, 9.8%), Grade 2 (n = 69, 21.8%), Grade 3 (n = 92, 29.0%), and Grade 4 (n = 125, 39.4%). The overall DGF incidence was 25.9%, with rates progressively increasing across the grades: 0% (Grade 1), 4.3% (Grade 2), 16.3% (Grade 3), and 51.2% (Grade 4) (p < 0.001). On multivariate analysis adjusting for recipient BMI, donation technique, Kidney Donor Risk Index (KDRI), and DGF, grafts with reduced uptake (Grade 4) demonstrated a significantly higher risk of graft loss compared to those with normal uptake (Grades 1–3 combined) (HR: 3.15; 95% CI: 1.34–7.40; p = 0.008). The mean follow-up was 45.6 months (IQR: 34.5–60). Conclusions: 99mTc-MAG3 scintigraphy performed within 48 h of kidney transplantation provides independent prognostic information for long-term graft survival. The Grade 4 renogram pattern identifies a high-risk subgroup with over threefold increased risk of subsequent graft loss. These findings support the integration of early scintigraphy into post-transplant risk stratification protocols, though prospective validation is warranted. Full article

Background/Objectives: Accurate kidney segmentation from magnetic resonance imaging (MRI) in kidney-transplant patients is essential for quantitative graft assessment, yet it remains challenging due to low tissue contrast, intensity inhomogeneity, and inter-patient anatomical variability introduced by surgical graft placement. Methods: We propose a 3D adversarial segmentation framework that incorporates probabilistic appearance and anatomical shape priors into a residual conditional generative adversarial network (GAN). The framework integrates image-driven and prior-guided information to improve boundary delineation under challenging imaging conditions and is evaluated on 100 kidney-transplant patients across T2-weighted imaging, BOLD-MRI, and DW-MRI using leave-one-out cross-validation. Results: The proposed method achieves mean Dice scores of 90.86% on T2-weighted imaging, 92.02% on BOLD-MRI, and 94.00% on DW-MRI. Consistent performance across all modalities demonstrates robustness under heterogeneous MRI acquisitions. The incorporation of prior guidance improves segmentation stability and anatomical consistency, particularly in low-contrast modalities. Conclusions: The proposed framework enables reliable kidney delineation across multiple MRI sequences, supporting consistent extraction of quantitative imaging biomarkers. This capability facilitates noninvasive assessment of renal graft function and supports longitudinal monitoring of transplant patients. Full article

Background: Renal allograft rejection remains a major challenge in transplantation. Current diagnostic approaches, including biopsies, are invasive and may fail to detect subclinical immune activation, potentially contributing to progressive graft dysfunction. Reliable, non-invasive biomarkers capable of monitoring immune activation and distinguishing rejection phenotypes are therefore needed. Methods: In this retrospective study, we evaluated serum neopterin as a biomarker of immune activation and graft status over 12 months following transplantation. Associations between neopterin levels and immune parameters, including natural killer (NK)-to-CD3⁺CD16/CD56⁺ T cell ratios, cytokines (IFN-γ and IL-10), and CD4⁺CD25⁺FoxP3⁺ T cell frequencies, were assessed. A total of 211 first renal allograft recipients were followed longitudinally, including patients with acute rejection (AR) and matched stable graft (SG) recipients. Serum neopterin was quantified by enzyme immunoassay, and immunophenotyping, mRNA expression, and cytokine profiling were performed on peripheral blood samples. Results: Serum neopterin levels were significantly elevated in AR compared to SG recipients, with a threshold of 57 nmol/L distinguishing AR with 81% sensitivity and 80% specificity. While IFN-γ demonstrated higher diagnostic performance in cross-sectional analysis, neopterin showed a more sustained elevation over time, remaining increased in AR recipients even at later post-transplant time points. Neopterin correlated positively with IFN-γ, but not IL-10, and inversely with CD4⁺CD25⁺FoxP3⁺ T cell frequency. NK cells were enriched during rejection, whereas CD3⁺CD16/CD56⁺ T cells were more prominent in graft stability. The NK-to-CD3⁺CD16/CD56⁺ T cell ratio was highest during acute cellular rejection. Conclusions: Neopterin reflects Th1-associated immune activation in renal allograft recipients and provides a temporally stable, non-invasive marker of immune status. Although it does not outperform IFN-γ levels at the time of rejection, its stability and sustained elevation suggest a complementary role in longitudinal monitoring. Integration of neopterin with immune parameters, including cytokine profiles and cellular subsets, may enhance the assessment of graft immunological status and support clinical decision-making. Full article

Background and Objectives: Renal transplantation is the optimal treatment for end-stage renal disease, yet long-term allograft survival remains threatened by immune-mediated injury and chronic nephropathy. Conventional monitoring using serum creatinine and protocol biopsy suffers from limited sensitivity for early, subclinical injury. Liquid biopsy-based biomarkers offer a non-invasive alternative. Materials and Methods: We conducted a systematic narrative review of studies published between January 2010 and December 2024, identified through PubMed, Scopus, and Web of Science. Results: Extracellular vesicles carry injury-specific molecular cargo reflecting the biological state of tubular, glomerular, and endothelial cells; urinary EV CXCL9 protein and exosomal CD3ε mRNA have demonstrated AUC values of 0.81–0.88 for the detection of T-cell-mediated rejection. Donor-derived cell-free DNA quantifies global graft cell death; the FDA-cleared AlloSure assay achieves an AUC of 0.74 and NPV of 84% at the validated ≥1.0% threshold established in the DART trial. Donor-specific antibodies—particularly complement-fixing C1q-positive DSAs—confer markedly inferior 5-year graft survival compared with DSA-negative recipients (54% versus 93%). Multi-biomarker panels integrating all three modalities yield AUCs of 0.88–0.94 and NPVs of 91–95%. Conclusions: The integration of EV, ddcfDNA, and DSA monitoring into a unified surveillance framework offers a clinically meaningful advance over creatinine-based monitoring. Prospective randomized trials confirming improvement in long-term allograft survival will be the critical next step. Full article

Background and Objectives: Rituximab, a monoclonal antibody targeting CD20+ B-cells, is used in autoimmune diseases and B-cell malignancies. Recently, rituximab has been used as an induction agent in kidney transplantation. Our study evaluates the efficacy of rituximab induction on biopsy-proven acute rejection (BPAR), patient survival, and graft survival in ABO-compatible patients. Materials and Methods: A systematic literature search was performed across five databases, following PRISMA guidelines, and the protocol was registered in PROSPERO (CRD42024603984). The inclusion criteria consisted of randomized controlled trials (RCTs), exploring the impact of rituximab induction on eligible kidney transplant recipients with BPAR, graft, and patient survival as the primary outcomes. Risk ratios (RR) with 95% confidence intervals (CI) were estimated by the random-effects model. The risk of bias was assessed via the Cochrane ROB-2 tool across five domains. Results: From an initial 859 potentially relevant studies, three RCTs, including 454 patients, met the inclusion criteria. At 6 months, rituximab was associated with a non-significant reduction in the risk of BPAR (RR 0.76; 95% CI, 0.50–1.15; I² = 0%). Similarly, patient survival remained unchanged at 6 months (RR 1.01; 95% CI, 0.98–1.04; I² = 0%). Due to significant heterogeneity, long-term outcomes were assessed using narrative synthesis, which revealed no additional benefit for rituximab in terms of graft or patient survival. Furthermore, potential safety concerns—especially in terms of infection risk—were noted. The certainty of this evidence was low, due to clinical heterogeneity in the included studies causing very serious indirectness. Conclusions: Induction with rituximab provides no significant benefit over standard regimens. Thus, its routine use in ABO-compatible renal transplants may not be justified. The available evidence is of low certainty. Further trials are needed before drawing a firm conclusion and to determine the best dosage, timing, and combinations. Full article

Background: Intraoperative high-volume diuresis is a common but under-recognized phenomenon during off-pump coronary artery bypass grafting (OPCABG). Its clinical correlates and implications for perioperative management remain incompletely characterized. Methods: This single-center retrospective cohort study included 1274 adults undergoing elective OPCABG between January and August 2025. High-volume diuresis was defined as urine output ≥ 5 mL·kg⁻¹·h⁻¹. Multivariable logistic regression was used to identify factors independently associated with intraoperative high-volume diuresis. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: High-volume diuresis occurred in 39.6% of patients. Older age, hypertension and greater intraoperative fluid infusion were independently associated with high-volume diuresis, whereas preoperative diuretic and greater cumulative exposure to systolic blood pressure < 100 mmHg were inversely associated with diuresis. The multivariable model demonstrated acceptable discrimination (AUC = 0.756). Postoperative outcomes, including acute kidney injury, duration of mechanical ventilation, intensive care unit stay, and hospital length of stay, did not differ between groups. Conclusions: Intraoperative high-volume diuresis during OPCABG reflects complex physiological and hemodynamic responses and can be anticipated based on preoperative and intraoperative factors. These findings support a more individualized interpretation of urine output and perioperative management strategies in OPCABG. Full article

Kidney transplantation (KTx) corrects many uremia-related metabolic disturbances; however, dyslipidemia remains common in kidney transplant recipients and contributes to persistent cardiovascular risk. Lipoprotein(a) [Lp(a)] is a largely genetically determined proatherogenic lipoprotein that increases in advanced chronic kidney disease (CKD) and may decrease after restoration of renal function. Autotaxin (ATX), an enzyme involved in proinflammatory lipid signaling through the ATX–lysophosphatidic acid axis, has also been implicated in cardiovascular pathology, but its early post-transplant dynamics remain poorly characterized. In addition to quantitative lipid abnormalities, CKD is associated with high-density lipoprotein (HDL) dysfunction and reduced paraoxonase-1 (PON-1) activity; however, data on early post-transplant changes in PON-1 activity are limited. In this prospective observational study, lipid profile parameters, Lp(a) concentration, ATX activity, and PON-1 activity were assessed in 55 Caucasian patients with CKD stage 5, most of whom were dialysis-dependent, before and 2–3 weeks after KTx. All recipients received tacrolimus-based maintenance immunosuppression with corticosteroids and mycophenolate mofetil. After KTx, Lp(a) levels decreased by a median of 21% and ATX activity by 28% (both p < 0.001). Lp(a) and ATX showed no cross-sectional or longitudinal association either before or after transplantation, and their percentage changes were not correlated. In contrast, conventional lipid fractions increased significantly, including total cholesterol (+22%), LDL cholesterol (+27%), HDL cholesterol (+24%), and triglycerides (+55%) (all p < 0.001). PON-1 activity increased by approximately 13% after KTx (p < 0.001), and its percentage change correlated positively with the increase in HDL cholesterol. In exploratory analyses, the magnitude of Lp(a) reduction was associated with early graft function: patients with eGFR <45 mL/min/1.73 m² exhibited a significantly smaller decline in Lp(a) than those with better graft function (−4.8% vs. −26.7%, p = 0.009). Multivariable analysis showed that demographic characteristics, body mass index, tacrolimus exposure, and post-transplant eGFR did not independently predict the magnitude of Lp(a) reduction. Tacrolimus trough concentrations and cumulative corticosteroid exposure were not associated with lipid parameters or their changes, except for a single subgroup difference in PON-1 activity of uncertain clinical significance. In summary, in the early period after KTx under tacrolimus-based immunosuppression, Lp(a) concentration and ATX activity decrease, whereas conventional lipid fractions increase and PON-1 activity improves. These changes were not associated with tacrolimus exposure or cumulative corticosteroid dose. The reduction in Lp(a) was associated with early graft function in exploratory analyses, suggesting that recovery of renal function may contribute to early post-transplant Lp(a) dynamics; however, no independent causal relationship was established, and the findings should be interpreted cautiously given the limited sample size and exploratory design. The clinical significance of these changes for long-term cardiovascular and graft outcomes requires further investigation. Full article

Background/Objectives: Static cold storage (SCS) remains the standard method of kidney preservation. As a referral transplant center, we frequently receive kidneys initially preserved with SCS and subsequently initiate prolonged hypothermic machine perfusion (HMP) to extend allocation time and optimize recipient matching. The clinical impact of this sequential preservation strategy remains incompletely defined. To compare outcomes between kidneys preserved with SCS followed by prolonged HMP (SCS+HMP) and SCS alone. Methods: This single-center retrospective study included 200 adult recipients of kidney transplants from brain-dead donors (67 SCS+HMP; 133 SCS). Outcomes were primary graft non-function (PNF), delayed graft function (DGF), patient and death-censored graft survival, and renal function over 24 months. Univariable and multivariable analyses identified predictors of DGF. Propensity score matching was performed to adjust for baseline imbalances. Results: In the SCS+HMP group, grafts underwent a median of 244 min of SCS followed by 1300 min of HMP, resulting in longer total cold ischemia time than SCS alone (1545 vs. 1104 min; p < 0.001). After matching, 51 pairs (n = 102) were analyzed. In the matched cohort, PNF occurred in 2 patients (3.9%) in the SCS+HMP group and 3 patients (5.9%) in the SCS group (p = 1.0). DGF occurred less frequently in the SCS+HMP group than in the SCS group (17.6% vs. 39.2%; p = 0.027). In multivariable Firth penalized logistic regression, HMP was independently associated with lower odds of DGF (OR 0.34; 95% CI 0.13–0.82). During the 24-month follow-up, patient survival, death-censored graft survival, and creatinine trajectories were comparable between groups. Conclusions: Sequential HMP after initial SCS enables extended preservation and was associated with a lower incidence of delayed graft function. This strategy does not compromise patient survival, death-censored graft survival, or renal function at 24 months. Full article

Background/Objectives: Chronic lower limb ulcers represent a significant clinical challenge, with conventional therapies achieving healing in only 30–40% of complex cases. This study evaluated the comparative effectiveness of autologous blood clot therapy (ActiGraft, delivering platelet- and leukocyte-derived growth factors) and autologous micrograft therapy (Rigenera, containing viable progenitor cells) versus advanced wound dressings for refractory chronic wounds. Methods: This retrospective analysis of a prospectively collected, non-randomized clinical cohort included 132 patients with chronic lower limb ulcers refractory to prior therapy, who were treated between 2019 and 2024 at a single wound care center. The patients received ActiGraft (n = 32), Rigenera (n = 33), or advanced wound dressings (n = 67) based on their choice after informed discussion. The primary outcome was complete wound closure at 52 weeks. Multivariable Poisson regression with robust variance was performed, adjusting for baseline wound area (log-transformed), chronic renal failure, age, and peripheral vascular disease. Cox proportional hazards was used to model time to closure. Bonferroni correction (threshold p < 0.0167) was applied for three pairwise comparisons. This study was not pre-registered, and the results should be considered hypothesis-generating. Results: Unadjusted wound closure rates were 68.8% (ActiGraft; RR = 1.71, 95% CI: 1.17–2.48, p = 0.015), 60.6% (Rigenera; RR = 1.50, 95% CI: 1.01–2.25, p = 0.089), and 40.3% (advanced dressings). After multivariable adjustment, ActiGraft showed attenuated benefit (adjusted RR = 1.38, 95% CI: 0.86–2.21, p = 0.179), while the beneficial effect of Rigenera became non-significant (adjusted RR = 1.19, 95% CI: 0.73–1.94, p = 0.488). However, the adjusted Cox regression revealed significantly faster healing for ActiGraft (HR = 10.67, 95% CI: 4.17–27.30, p < 0.001) and Rigenera (HR = 4.12, 95% CI: 1.75–9.73, p = 0.001). Sensitivity analyses restricted to comparable wound sizes (≤10 cm²) showed a consistent direction of effect (ActiGraft 71.4% vs. Advanced 37.5%). Infection rates were lower in the autologous therapy groups (0–3.0% vs. 11.9%; Fisher’s exact p = 0.006). Conclusions: ActiGraft autologous blood clot therapy showed trends toward superior wound closure and demonstrated significantly faster healing compared to advanced dressings in patients with refractory chronic lower limb ulcers, with autologous micrograft therapy (Rigenera) showing intermediate results. Significant baseline imbalances in wound size limit causal inference from the closure rate comparisons. These hypothesis-generating findings from a non-randomized cohort warrant confirmation in adequately powered randomized controlled trials with stratification by wound characteristics. Full article

Background: Metalloproteinases (MMPs), together with their tissue inhibitors (TIMPs), regulate the extracellular matrix (ECM) in various tissues. MMP-2 and TIMP-2 maintain this process in renal tissue. An imbalance in the MMP-2/TIMP-2 ratio alters the abundance and proportions of specific extracellular matrix components, leading to kidney fibrosis. We aimed to assess differences in the morphometric parameters of the kidney and the immunohistochemical (IHC) expression of MMP-2 and TIMP-2 in kidney biopsies according to their fibrotic state. Methods: The histological slides were scanned using the 3DHISTECH Pannoramic MIDI II Scanner, and the resulting digital images of the sections were analyzed using Pattern Quant software; the morphometric analyses were performed with the Slide Viewer application. Results: In the current manuscript, we have investigated the significant enlargement of the diameter of the urinary space and renal corpuscle, as well as the reduced height of the epithelial lining of the proximal and distal convoluted tubules, of grafted kidneys with fibrosis when compared to the non-fibrotic kidneys. Moreover, we have noticed a rising MMP-2/TIMP-2 ratio in the immunohistochemical reaction in the renal tissue of fibrotic grafted kidneys in comparison to healthy kidneys. Conclusions: These results suggest that the MMP-2/TIMP-2 ratio, together with the lower inhibition of MMP-2, may promote an increased extracellular matrix remodeling, which accompanies the development of fibrosis. Full article

Background and Objectives: Hypocalcemia due to hypoparathyroidism (HypoPTH) is the most common complication following thyroid surgery, typically resulting from iatrogenic removal, tissue damage, or compromised vascularization of the parathyroid glands. Patients with persistent HypoPTH are at risk for long-term complications such as osteoporosis, cardiac dysfunction, and renal impairment. Lifelong regulation of calcium levels is therefore essential to prevent morbidity and mortality associated with these complications. In this study, we aimed to evaluate the functional engraftment efficacy of 3D bioprinted human parathyroid tissue constructs in a xenograft model in vivo. Materials and Methods: Primary cells obtained from freshly excised human parathyroid tissue specimens were isolated and 3D bioprinted using alginate-based bioink. The bioprinted tissue constructs were implanted into CD1 athymic mice. Histopathological evaluation of the grafted constructs was performed at different time points. In addition, surface calcium-sensing receptor (CaSR) expression was assessed by immunofluorescence as an indicator of functional parathyroid tissue engraftment. Results: The presence of CaSR on parathyroid cells within the 3D-printed scaffolds confirmed the persistence of functional parathyroid cells following implantation. In tissue samples obtained during the first, second, and third weeks after implantation, CaSR positivity was consistently observed in the parathyroid cells. However, at the three-month follow-up, the pores within the scaffolds were found to be filled with calcified material and replaced by fibrotic tissue. At this stage, the absence of parathyroid hormone (PTH) expression indicated a loss of functional activity in the grafted biomaterial. Conclusions: Human primary parathyroid cells were successfully isolated, and a functional, hormone-active parathyroid tissue substitute was developed ex vivo using 3D-bioprinted hydrogel scaffolds combined with autologous cells. Although short-term functional engraftment was achieved, long-term graft viability and hormonal activity were limited due to scaffold degradation and fibrosis. These findings indicate the necessity for further improvement in scaffold biocompatibility to enhance the therapeutic potential of 3D-bioprinted parathyroid tissue constructs for in vivo applications. Full article

Background: Kidney transplantation is the optimal treatment for end-stage renal disease; however, acute rejection remains a major determinant of long-term graft dysfunction and failure. Donor-derived cell-free DNA (dd-cfDNA) has emerged as a minimally invasive biomarker reflecting allograft injury, with growing evidence supporting diagnostic and prognostic utility. Objectives: This structured narrative review aimed to synthesize contemporary evidence (2020–2025) on the diagnostic and prognostic utility of plasma dd-cfDNA and its integration into kidney transplant rejection surveillance. Methods: A narrative literature review was conducted using PubMed to identify studies published or available online ahead of print, between January 2020 and September 2025, evaluating plasma dd-cfDNA in adult kidney transplant recipients. Manual screening of reference lists supplemented the search. Original clinical studies reporting diagnostic or prognostic outcomes were included, and the results were synthesized narratively due to methodological heterogeneity. Results: Across prospective and retrospective cohorts, elevated dd-cfDNA discriminated rejection from non-rejection biopsies, with strongest performance in antibody-mediated and microvascular rejection phenotypes. Longitudinal studies demonstrated that dd-cfDNA elevations often preceded histologically confirmed rejection and predicted adverse graft outcomes, while low levels were associated with immunologic quiescence. Assay variability limited cross-study comparability, whereas integration with donor-specific antibodies, gene expression profiling, or algorithm-based approaches improved diagnostic and prognostic discrimination. Conclusions: Dd-cfDNA is a clinically meaningful biomarker for kidney transplant rejection monitoring, providing diagnostic and prognostic information beyond conventional functional markers. When interpreted longitudinally and in clinical context, dd-cfDNA supports risk stratification and surveillance, with evidence supporting its expanding role in risk-adapted transplant care. Full article

Background and Objectives: Recurrence of lupus nephritis (LN) after kidney transplantation is a major clinical concern in patients with systemic lupus erythematosus (SLE) who progress to end-stage renal disease (ESRD). Reported rates of post-transplant LN recurrence vary widely and are influenced by patient characteristics, immunosuppressive regimens, and indications for allograft biopsy. Patients and Methods: Medical records of adult LN patients treated at the University Hospital in Kraków, Poland, during the years 2012–2022 were retrospectively reviewed to identify individuals who progressed to ESRD and received a kidney transplant. Data collected included patient demographics as well as clinical, laboratory, transplant-related, and dialysis-related information. Results: Among 1039 patients with SLE, LN was diagnosed in 351 (33.8%), and 28 (8.0%) progressed to ESRD, of whom n = 9 (32.1%) underwent kidney transplantation. All patients received deceased-donor grafts, with a median time from ESRD to transplantation of 3 years (range 1–8) and a median post-transplant follow-up of 6 years (3–20). Maintenance immunosuppression consisted predominantly of glucocorticosteroids, mycophenolate mofetil, and tacrolimus in 77.8% of patients, with basiliximab induction was used in 2 of 2 patients with available data. Biopsy-proven LN recurrence occurred in 22.2% (2/9) of recipients. Graft loss was observed in 22.2% (2/9), while overall mortality reached 33.3% (3/9), including one peri-transplant death and one death due to infectious complications. Hematological manifestations were present in 100% of patients, hypercholesterolemia in 100%, and arterial hypertension in 88.9%, while anti-dsDNA antibodies were detected in 77.8%. LN relapse occurred despite standard immunosuppressive therapy and in the absence of consistent clinical or immunological predictors. Conclusions: LN recurrence occurred in 2 of 9 patients (22.2%). Patients with LN after kidney transplantation require careful long-term monitoring and individualized immunosuppressive management, considering baseline risk profile and relevant clinical with immunological factors. Full article

Background/Objectives: To evaluate the outcome of developing BKPyV-DNAemia and presumptive BKPyV-nephropathy (BKPyV-DNAemia ≥ 10⁴ copies/mL for more than 2 weeks) within the first 2 years post-transplant in a Belgian population of renal transplanted children. Methods: All children transplanted between 1 January 2010 and 31 December 2022 at Queen Fabiola Children’s University Hospital, Brussels (HUDERF) and at University Hospitals Leuven (UHL) were included in this retrospective study and 86 were followed for at least 2 years post-transplantation. Results: Within the first 2 years, 11/86 (13%) patients developed BKPyV-DNAemia ≥ 10⁴ copies/mL (82% within the first 6 months). Among the 11 patients, 7 underwent a biopsy, of whom 4 were confirmed to have biopsy-proven BKPyV-nephropathy. Of those 11 patients, 4 (36%) developed an acute cellular rejection following immunosuppression reduction. The median eGFR at 2 years post-transplantation was 69 mL/min/1.73 m² (IQR: 59–79) in the seven patients with presumptive BKPyV-nephropathy and 40 mL/min/1.73 m² (IQR: 39–41) in the four with biopsy-proven BKPyV-nephropathy. At last follow-up visit, the median eGFR was 65 mL/min/1.73 m² (IQR: 59–71) in the children with presumptive BKPyV-nephropathy, and 28 mL/min/1.73 m² (IQR: 20–34) in the patients with biopsy-proven BKPyV-nephropathy. No risk factors for developing BKPyV-DNAemia were identified. Conclusions: Our study confirms that while BKPyV-DNAemia monitoring is essential in pediatric kidney transplant recipients, decisions based solely on viral load risk overtreatment and immunological complications. A personalized approach integrating viral, clinical, and immunological markers is urgently needed to balance infection control with graft preservation. Full article

Background and Objectives: Early saphenous vein graft (SVG) failure remains a clinically significant limitation of contemporary coronary artery bypass grafting (CABG). Platelet function testing has been proposed to identify patients with an attenuated aspirin effect who may be at higher thrombotic risk. Therefore, this study aimed to determine whether preoperative aspirin non-responsiveness, assessed by the platelet function assay, is associated with early graft failure after CABG, as evaluated by CT coronary angiography. Materials and Methods: In this prospective observational study, consecutive patients undergoing elective, first-time isolated on-pump CABG with ≥1 SVG and preoperative aspirin therapy were enrolled. Platelet function was measured preoperatively using a point-of-care assay (ASPI, aspirin reaction units [ARU]), and patients were stratified as responders (<550 ARU) or non-responders (≥550 ARU). The primary endpoint was early SVG occlusion, detected by CT angiography performed before discharge after CABG. Secondary endpoints included postoperative cardiac and renal biomarkers, myocardial infarction, stroke, rehospitalization, and 30-day mortality. Results: Early CT-confirmed SVG occlusion occurred in 22/170 patients (12.9%) and did not differ between responders and non-responders (20/136 [14.7%] vs. 2/34 [5.9%]; p = 0.21). Cardiac biomarkers were similar between the groups for 4–24 h. Thirty-day mortality (1.5%), myocardial infarction (5.9% in each group), and stroke (2.2% vs. 5.9%) were infrequent and similar between groups. Rehospitalization was more common among non-responders, driven by deep wound infection (5.9% vs. 0%; p = 0.040). In exploratory analysis, females had a significantly higher early graft occlusion rate than males (27.3% vs. 8.6%; p = 0.004). Conclusions: Aspirin non-responsiveness, as assessed by ASPI testing, was not associated with early CT-confirmed SVG occlusion, and these data do not support intensifying antiplatelet therapy based solely on a single preoperative platelet-function measurement. Given the absence of serial postoperative platelet function measurements, future studies should prioritize postoperative platelet reactivity and different treatment strategies during the early window of graft vulnerability. Full article