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Novel Insights in Renal Transplantation—Volume 2
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Novel Insights in Renal Transplantation—Volume 2

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

Deadline for manuscript submissions: 10 May 2024 | Viewed by 5344

Special Issue Editors

Prof. Dr. Klemens Budde

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Guest Editor
Department of Nephrology and Intensive Medical Care, Charité – Universitätsmedizin Berlin, Corporate Member of Freie, Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
Interests: kidney transplantation; immunosuppression; antibody-mediated rejection; eHealth; rare kidney diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Fabian Halleck

E-Mail Website
Guest Editor
Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
Interests: kidney transplantation, immunosuppression, eHealth

Special Issue Information

Dear Colleagues,

Kidney transplantation is the best option with excellent short-term outcomes for patients with the need for renal replacement therapy. There are still several unmet medical needs for improving transplantation outcome. One of them is the scarcity of organs that lead, on one side, to prolonged waiting time and associated higher mortality rates and, on the other, to worse results when transplant candidates finally receive a transplant. Therefore, we need to find ways to enlarge the possible donor pool to increase utilization, which leads to higher transplantation rates. After transplantation, we still have the need for less toxic immunosuppressive regimens that have the potential to conserve renal transplant function over a long-term period. In addition to less toxic regimens, we should try to find ways to individualize therapies by analyzing immunological response to different therapies to prevent episodes of over- or under-immunosuppression, both jeopardizing transplant and patient survival. Finally, strategies in long-term follow-up that may detect non-adherence are desperately needed to especially prevent the development of donor-specific antibodies and resulting graft loss.

In this Special Issue, we invite investigators to submit studies that address novel approaches and unmet medical needs in kidney transplant medicine.

Prof. Dr. Klemens Budde
Dr. Fabian Halleck
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

  • renal transplantation
  • cardiovascular complications
  • viral complications
  • transplant rejection
  • immunosuppression
  • graft loss
  • optimizing donor organ pool
  • organ preconditioning
  • adherence
  • HLA antibodies

Published Papers (4 papers)

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Research

11 pages, 1128 KiB  
Article
The Seattle Heart Failure Model in Kidney Transplant Recipients
by Angelica Perez-Gutierrez, Rita L. McGill, Braden Juengel, Piotr J. Bachul, David N. Danz, Michelle Josephson, Ben B. Chung, Ann Nguyen, John J. Fung, Rolf N. Barth and Yolanda T. Becker
J. Clin. Med. 2023, 12(24), 7614; https://doi.org/10.3390/jcm12247614 - 11 Dec 2023
Viewed by 752
Abstract
Cardiovascular disease is the leading cause of mortality following kidney transplantation. Heart failure affects 17–21% of patients with chronic kidney disease and increases along with time receiving dialysis. The Seattle Heart Failure Model (SHFM) is a validated mortality risk model for heart failure [...] Read more.
Cardiovascular disease is the leading cause of mortality following kidney transplantation. Heart failure affects 17–21% of patients with chronic kidney disease and increases along with time receiving dialysis. The Seattle Heart Failure Model (SHFM) is a validated mortality risk model for heart failure patients that incorporates clinical, therapeutic, and laboratory parameters but does not include measures of kidney function. We applied the SHFM to patients with end-stage renal disease (ESRD) who were being evaluated for kidney transplantation to determine if the model was associated with post-transplant mortality. This retrospective single-center study analyzed survival among 360 adult deceased-donor kidney transplant recipients. Cox regression was used to model post-transplant patient survival. Our findings indicated that a 1.0-point increase in the adapted SHFM score was significantly associated with post-transplant mortality (HR 1.76, 95% CI = 1.10–2.83, p = 0.02), independently of the Kidney Donor Profile Index and Estimated Post-Transplant Survival. Individual covariates of the SHFM were evaluated in univariate analyses, and age, sodium, cholesterol, and lymphocyte count were significantly related to mortality. This study provides preliminary evidence that an adapted SHFM score could be a useful tool in evaluating mortality risk post-transplant in patients with ESRD. Full article
(This article belongs to the Special Issue Novel Insights in Renal Transplantation—Volume 2)
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11 pages, 1429 KiB  
Article
Risk Factor Analysis for Long-Term Graft Survival Following Pediatric Kidney Transplantation: The Importance of Pretransplantation Time on Dialysis and Donor/Recipient Age Difference
by Marios Marcou, Matthias Galiano, Anja Tzschoppe, Katja Sauerstein, Sven Wach, Helge Taubert, Bernd Wullich, Karin Hirsch-Koch and Hendrik Apel
J. Clin. Med. 2023, 12(22), 7014; https://doi.org/10.3390/jcm12227014 - 09 Nov 2023
Cited by 2 | Viewed by 688
Abstract
Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation. We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years [...] Read more.
Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation. We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years with the aim of determining baseline characteristics that could be identified as prognostic risk factors for long-term graft survival. Between 2001 and 2020, a total of 91 kidney transplantations in children under the age of 18 years were undertaken in our center. Early graft failure was observed in six of the 91 patients (7%). The median follow-up of the remaining 85 children was 100 months, and the overall kidney graft survival rates at 5, 10, 15 and 20 years were 85.2%, 71.4%, 46.0% and 30.6%, respectively. Small children with a body surface area of <1 m2 were significantly associated with better long-term graft survival outcomes, while adolescents aged more than twelve years showed poorer graft survival rates than younger children. Body surface area of the recipient of ≥1 m2, pretransplantation duration of the recipient on dialysis ≥18 months, hemodialysis prior to transplantation and donor/recipient age difference of ≥25 years were significantly associated with poorer long-term graft survival. Full article
(This article belongs to the Special Issue Novel Insights in Renal Transplantation—Volume 2)
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17 pages, 944 KiB  
Article
Difficult-to-Treat Rejections in Kidney Transplant Recipients: Our Experience with Everolimus-Based Quadruple Maintenance Therapy
by Pierre Larsson, Bodil Englund, Jana Ekberg, Marie Felldin, Verena Broecker, Lars Mjörnstedt and Seema Baid-Agrawal
J. Clin. Med. 2023, 12(20), 6667; https://doi.org/10.3390/jcm12206667 - 21 Oct 2023
Viewed by 2203
Abstract
All chronic and treatment-resistant acute rejections are “difficult-to-treat” and lead to progressive loss of graft function in kidney transplant recipients (KTR), as no effective treatment exists for such rejections to date. We review our experience with a novel strategy to treat such rejections [...] Read more.
All chronic and treatment-resistant acute rejections are “difficult-to-treat” and lead to progressive loss of graft function in kidney transplant recipients (KTR), as no effective treatment exists for such rejections to date. We review our experience with a novel strategy to treat such rejections by adding everolimus as a “rescue” to conventional triple maintenance therapy with prednisolone, mycophenolate mofetil and calcineurin inhibitor. We retrospectively analysed data in 28 KTR who received everolimus-based quadruple therapy at our institution for biopsy-proven chronic active T cell-mediated or antibody-mediated rejection (n = 19) or treatment-resistant acute rejections (n = 9) between 2011–2017. The primary outcome was 5-year death-censored graft survival. Main secondary outcomes were response to treatment defined by stable or improved graft function, 5-year patient survival and discontinuation rate of treatment. The Kaplan–Meier estimate for 5-year death-censored graft survival was 79% in all patients, 90% for patients with chronic active T cell-mediated rejections, 78% for chronic active antibody-mediated rejection and 67% for acute rejections. Response to treatment was achieved in 43% and 5-year patient survival was 94%. Treatment was stopped in 12 (43%) patients due to adverse events. Everolimus-based maintenance quadruple therapy, despite high rate of everolimus discontinuation due to adverse events, may be a valid approach in a subset of kidney transplant recipients with such difficult-to-treat rejections, which otherwise would lead to a high rate of graft loss. Full article
(This article belongs to the Special Issue Novel Insights in Renal Transplantation—Volume 2)
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9 pages, 1028 KiB  
Article
Donor-Derived Cell-Free DNA for Kidney Allograft Surveillance after Conversion to Belatacept: Prospective Pilot Study
by Bilgin Osmanodja, Aylin Akifova, Michael Oellerich, Julia Beck, Kirsten Bornemann-Kolatzki, Ekkehard Schütz and Klemens Budde
J. Clin. Med. 2023, 12(6), 2437; https://doi.org/10.3390/jcm12062437 - 22 Mar 2023
Cited by 4 | Viewed by 1167
Abstract
Donor-derived cell-free DNA (dd-cfDNA) is used as a biomarker for detection of antibody-mediated rejection (ABMR) and other forms of graft injury. Another potential indication is guidance of immunosuppressive therapy when no therapeutic drug monitoring is available. In such situations, detection of patients with [...] Read more.
Donor-derived cell-free DNA (dd-cfDNA) is used as a biomarker for detection of antibody-mediated rejection (ABMR) and other forms of graft injury. Another potential indication is guidance of immunosuppressive therapy when no therapeutic drug monitoring is available. In such situations, detection of patients with overt or subclinical graft injury is important to personalize immunosuppression. We prospectively measured dd-cfDNA in 22 kidney transplant recipients (KTR) over a period of 6 months after conversion to belatacept for clinical indication and assessed routine clinical parameters. Patient and graft survival was 100% after 6 months, and eGFR remained stable (28.7 vs. 31.1 mL/min/1.73 m2, p = 0.60). Out of 22 patients, 2 (9%) developed biopsy-proven rejection—one episode of low-grade TCMR IA and one episode of caABMR. While both episodes were detected by increase in creatinine, the caABMR episode led to increase in absolute dd-cfDNA (168 copies/mL) above the cut-off of 50 copies/mL, while the TCMR episode did show slightly increased relative dd-cfDNA (0.85%) despite normal absolute dd-cfDNA (22 copies/mL). Dd-cfDNA did not differ before and after conversion in a subgroup of 12 KTR with previous calcineurin inhibitor therapy and no rejection (12.5 vs. 25.3 copies/mL, p = 0.34). In this subgroup, 3/12 (25%) patients showed increase of absolute dd-cfDNA above the prespecified cut-off (50 copies/mL) despite improving eGFR. Increase in dd-cfDNA after conversion to belatacept is common and could point towards subclinical allograft injury. To detect subclinical TCMR changes without vascular lesions, additional biomarkers or urinary dd-cfDNA should complement plasma dd-cfDNA. Resolving CNI toxicity is unlikely to be detected by decreased dd-cfDNA levels. In summary, the sole determination of dd-cfDNA has limited utility in the guidance of patients after late conversion to belatacept. Further studies should focus on patients undergoing early conversion and include protocol biopsies at least for patients with increased dd-cfDNA. Full article
(This article belongs to the Special Issue Novel Insights in Renal Transplantation—Volume 2)
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