Renal resistance during hypothermic machine perfusion: A scoping review of variability and determinants, with a meta-analysis of predictive value for transplant outcomes.

Comment on “The association between the Kidney Donor Profile Index and one-year outcomes in Brazilian kidney transplant recipients of standard criteria donors”

Serological ABO typing in transfusion medicine and organ transplantation, can face limitations in cases involving large volume transfusions, transplants, weak subgroups, or hematological malignancies. ABO genotyping can help resolve ABO type, and there is a need for a fast, reliable, and cost-effective testing approach. We investigate a commercially available medium-throughput quantitative polymerase chain reaction (qPCR) ABO genotyping assay and evaluated routine samples from a tertiary academic transplant laboratory, samples previously ABO genotyped in the immunohematology and genomics reference laboratory, and samples showing discordant/mixed field reactivity in the hospital blood bank. Results were compared with serologic typing and Sanger sequencing, or next-generation sequencing (NGS) for some. For routine transplant samples (n = 89), the qPCR assay demonstrated 100% concordance with serologic phenotypes and Sanger sequencing with one no-call result. For complex reference laboratory samples (n = 32), 91% concordance with serologic phenotype and 72% concordance with predicted phenotype and genotype by Sanger sequencing was achieved. qPCR identified variants encoding: A1, A2, A3, and cisAB. In blood bank problem samples (n = 29), 79% were resolved by qPCR. The qPCR assay's rapid turnaround time and automated interpretation make it particularly suitable for inclusion in the investigation and resolution of ABO serological typing problems. Its capabilities also align well with recent UNOS (United Network for Organ Sharing) guidance for deceased kidney donor ABO typing resolution and can potentially improve patient safety in transplantation settings, and aid in the evaluation of typing discrepancies in transfusion medicine practice.

Early post-transplant renal function is a key determinant for predicting long-term graft survival and overall patient prognosis after kidney transplantation. Existing predictive models primarily focus on deceased-donor kidney transplantation (DDKT) recipients or rely on post-transplant variables, making it difficult to predict early renal function recovery in the living-donor kidney transplantation (LDKT) setting. This study conducted a retrospective cohort analysis of 3,335 living kidney transplant recipients from Institution A, Institution B, and Institution C. Data from Institution A and Institution B were used as the training set and internal set, while Institution C data were used for external validation. The Comprehensive Model was developed using pre-transplant characteristics of both the donor and recipient, while The Basic-Parameter Model was developed using only recipient age, sex, body surface area (BSA), donor age, and donor whole kidney volume. Model performance was evaluated using Mean Absolute Error (MAE) and Root Mean Square Error (RMSE), and The Basic-Parameter Model was implemented as a Nomogram and a mobile calculator app. The Comprehensive Model demonstrated high predictive accuracy with an MAE of 0.15 and RMSE of 0.36 in the internal set, and maintained generalizability with an MAE of 0.14 and RMSE of 0.18 in the external set. The Basic-Parameter Model performed similarly to The Comprehensive Model, with comparable predictive accuracy. Additionally, a Nomogram and mobile app were developed, demonstrating their potential utility as clinical decision-making tools. This study developed a practical model for predicting early renal function recovery using basic pre-transplant variables from both recipients and donors. The model demonstrated high generalizability through external validation and can be easily implemented in clinical practice as a predictive tool. The Nomogram and mobile app provide real-time decision support, enhancing their applicability in clinical settings.

Blood pressure (BP) monitoring is crucial to detect and manage postdonation hypertension early; however, obtaining accurate BP readings and regular BP monitoring remains challenging. While office BP (OBP) measurement is almost universal, implementing accurate OBP readings by utilizing automatic office BP (AOBP) can be challenging due to its time-consuming. Moreover, OBP cannot be performed regularly, especially in a telemedicine setting. Out-of-office BP (OOOBP) can overcome the challenges in obtaining accurate OBP readings and monitoring BP. While 24-h ambulatory BP monitoring remains the gold standard for diagnosing hypertension in living kidney donors (LKDs), its availability is limited. Since OOOBP relies on the patients' BP measurement technique, technologies can help facilitate and enable LKD to check their BP accurately and regularly, including self-measured BP monitoring (SMBPM) and automatic remote BP monitoring. Cuffless BP monitoring offers convenience to the patients; further validation is required. Utilizing technologies for BP measurement is a proposed intervention to increase adherence to BP measurement and monitoring. While several BP measurement modalities can provide accurate BP readings, some facilitate better accuracy, especially unattended BP measurements and should be implemented for BP monitoring to mitigate cardiovascular outcomes in LKD.

Outcomes of Living Related Kidney Donors Following Donor Nephrectomy in Pakistan.

Background.Delayed graft function (DGF) in deceased-donor kidney transplantation increases morbidity, prolongs hospitalization, and increases healthcare costs. Hypothermic machine perfusion (HMP) has emerged as a promising strategy to reduce DGF; however, large-scale real-world data remain limited.Methods.We performed a retrospective cohort analysis using the Scientific Registry of Transplant Recipients (2014–2024), including adult dialysis-dependent recipients of deceased-donor kidneys preserved using either static cold storage (SCS) or HMP. The primary outcome was DGF, defined as dialysis requirement within 7 d posttransplant. A matched-pairs analysis was conducted using kidneys from the same donor.Results.The overall cohort included 59 859 recipients (46.8% SCS, 53.2% HMP), with 2208 matched pairs identified. In the overall cohort, HMP grafts had longer cold ischemia times and a higher kidney donor risk index. They were more frequently obtained from older and donation after circulatory death donors. Although the overall DGF incidence was higher with HMP (34.4% versus 30.9%, P < 0.001), matched-pairs analysis revealed significantly lower DGF rates with HMP (29.8% versus 36.1%, P < 0.001). Adjusted analyses identified HMP as protective against DGF (overall cohort odds ratio, 0.71; 95% confidence interval, 0.66-0.78; paired cohort OR, 0.68; 95% CI, 0.50-0.93). Additional modifiable risk factors include prolonged cold ischemia time, higher recipient body mass index, and longer dialysis duration.Conclusions.This real-world study demonstrates that HMP is associated with a significant reduction in DGF risk in kidney transplantation compared with SCS, supporting its broader implementation and targeted management of modifiable risk factors.

BackgroundKidney transplantation is the preferred treatment for end-stage renal disease (ESRD), yet challenges persist in long-term graft survival and post-transplant complications. Genomic profiling, especially whole-exome sequencing (WES), offers new opportunities to personalize donor-recipient matching and predict transplant outcomes. This study aimed to explore the genetic landscape of both transplant recipients and donors using WES.MethodsThis prospective cohort study included 64 kidney transplant recipients (51 adults, 13 pediatric) and 61 donors in Kazakhstan. WES was performed to identify monogenic causes of ESRD, evaluate rejection-associated immune polymorphisms (31 SNPs), and screen for post-transplant risk using a 355-gene Transplant Morbidity Panel. Variants were classified following ACMG/AMP guidelines, and allele frequencies were compared to global reference datasets.ResultsAmong recipients, pathogenic/likely pathogenic variants were found in 15.4% of pediatric and 9.1% of adult cases, with additional variants of uncertain significance detected in 23.1% and 23.6%, respectively. WES identified monogenic nephropathies including Alport syndrome, cystinuria, and polycystic kidney disease. In donors, 13.1% carried variants associated with latent renal or systemic conditions despite no clinical manifestation at donation. The APOE p.Cys130Arg variant, linked to lipid dysregulation, was observed more frequently in recipients (allele frequency 0.17) than donors (0.09), though not statistically significant. Among the 31 SNPs evaluated, significant associations with acute rejection were observed for IL1B rs1143634 and TP53 rs1625895 under dominant models. IL1B carriers showed increased rejection risk (OR = 4.62, p = 0.039), whereas TP53 carriers appeared protected (OR = 0.058, p = 0.027). Given the limited number of rejection cases, these findings should be considered exploratory and require validation in larger cohorts. Additionally, 44.3% of recipients carried at least one pathogenic or likely pathogenic variant in the Transplant Morbidity Panel, particularly in genes related to malignancy, cardiomyopathy, and monogenic diabetes.ConclusionsThis study provides one of the first applications of WES in a Central Asian kidney transplant population. Findings highlight the prevalence of monogenic and comorbid risk variants in both recipients and donors and support the use of genomic screening for improving pre- and post-transplant care. The identification of immune-related SNPs and extra-renal findings further underscores the utility of WES for personalized transplant management. Integration of genomics into transplant workflows may help address the ongoing gap between clinical need and transplant outcomes, particularly in low-resource settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04553-x.

Changes to the calculation of the Kidney Donor Profile Index (KDPI) have lowered the KDPI of hepatitis C (HCV+) donor kidneys; therefore, increasing the proportion of pediatric-prioritized kidneys that are HCV+. We aimed to study consent rates for HCV+ kidneys among pediatric kidney transplant candidates. We identified pediatric candidates waitlisted from 2019 to 2024 and excluded those who received a living donor transplant. We used logistic regression to identify candidate characteristics associated with HCV+ offer consent and Cox proportional hazards models to determine the association between HCV+ offer consent and the rate of deceased donor transplantation. Among 3202 candidates included in the analysis, 124 (4%) consented to receive HCV+ deceased donor kidney offers, and 3077 (96%) did not. In adjusted logistic regression, higher candidate age (OR 1.09 per year, 95% CI 1.03-1.15, p = 0.002) and high PRA status (OR 2.76, 95% CI 1.42-5.37, p = 0.003) were associated with a higher odds of consenting to receive HCV+ donor offers, whereas Hispanic ethnicity was associated with lower odds (OR 0.44, 95% CI 0.28-0.72, p = 0.001) of consenting to receive these offers. 2773 candidates (87%) received a transplant. There was no significant association between HCV+ donor offer consent status and transplant rate after adjusting for candidate characteristics. Only 1 received a kidney from a HCV+ donor. Consent to receive HCV+ donor kidney offers was rare among pediatric kidney transplant candidates. Allocation changes that increase the proportion of pediatric-prioritized kidneys that are HCV+ may decrease access to transplant for pediatric candidates.

Initial Clinical Outcomes of Hypothermic Machine Perfusion in Deceased Donor Kidney Transplantation: A Pilot Comparative Feasibility Study from South Korea.

This study aimed to assess the impact of kidney donation and pre-donation factors such as age and BMI, are associated with long-term outcomes like hypertension, diabetes and GFR decline. highlighting the importance of proper donor selection and long-term follow up. This study aims to assess long-term clinical outcomes, such as the development of hypertension, diabetes, proteinuria, and changes in kidney function, in living kidney donors following nephrectomy. A cohort of 87 kidney donors from Erciyes University and a control group of 100 individuals with comparable demographics were monitored. Parameters such as blood pressure, BMI, GFR, and proteinuria levels were documented pre- and post-donation, and outcomes were compared within and between groups. Multiple regression analysis revealed nephrectomy as an independent risk factor for increased hypertension incidence (p = 0.002) and a persistent reduction in GFR exceeding 20% (p < 0.001). Advanced age at donation and post-donation BMI were associated with elevated risks of hypertension and diabetes.

Vitamin C status across the spectrum of chronic kidney disease and healthy controls: a cross-sectional study.

Health-Related Quality of Life After Living Kidney Donation: A Systematic Review and Meta-Analysis.

Kidney transplantation programs in developing countries chiefly depends on live donors, and waiting lists are long for patients lacking ABO compatible (ABOc) donors. ABO incompatible (ABOi) transplantation enhances the donor pool. We report our experience of ABOi kidney transplantation in children. We screened medical records of ABOi and ABOc kidney transplantation performed at this center between January 2019 to December 2023. For desensitization of ABOi kidney allograft recipients a combination of rituximab and either immunoadsorption or plasma exchange along with IVIg was used. Induction regimen comprised either basiliximab or ATG, followed by maintenance therapy with tacrolimus, mycophenolate mofetil and prednisolone. We retrieved data on recipient and donor characteristics, immunosuppression, and post-transplant complications. Allograft and patient survival were estimated using Kaplan-Meier survival analysis. During the 5-years, 7 ABOi and 46 ABOc kidney transplantation were performed. The mean follow up duration was 24.9 ± 17.1 months in ABOi group and 30.3 ± 18.8 months in ABOc group. Patient age, native kidney disease, donor profile and other characteristics were comparable. Rejection free graft survival was similar between ABOi and ABOc groups (p = 0.88). Median (IQR) eGFR at last follow up was 61.4 (46.6, 74.3) ml/min/1.73 m2 in ABOi group and 50.9 (39.7, 68.9) ml/min/1.73 m2 in ABOc group (p = 0.23). Patients and graft survival rates were similar in both groups. Our findings suggest that ABOi kidney transplantation in children in India is feasible and associated with satisfactory outcomes P.

Incidence and Impact of Elevated Creatine Kinase Following Living Donor Nephrectomy.

Women recipients are at high risk for biopsy-proven acute rejection in spouse kidney transplantation.

Background:Sex-disaggregated data demonstrate that there are more female than male living kidney donors (LKDs), and this is widely thought to be a manifestation of gender inequities. A better understanding of how gender norms, roles, and relations influence the living kidney donation process is needed.Objective:We aimed to develop an analytical tool that can be used to conduct a systematic gender analysis of the living kidney donation process.Design:A participatory research approach was used.Setting:Canada.Participants:Canadian living kidney donors and health care professionals.Methods:Using a participatory research approach, we co-designed a gender analysis matrix (GAM) applicable to the context of living kidney donation. This tool is the first step into conducting a gender analysis of the living kidney donation process. Participants included 11 healthcare professionals, 6 LKDs, 1 patient partner, and a core methodology team (3 qualitative researchers and a gender analysis expert).Results:Following an iterative process, a final LKD-GAM with 4 columns and 4 rows was created. The gender-specific domains are access to resources, division of labor and everyday practices, social norms and beliefs, and decision-making power and autonomy. Context-specific domains are the decision to donate, physical and mental wellbeing, experiences with health services, and broader social and economic impacts of (non-)donation. Key insights for our future work include diversity in our sample (include LKD candidates, men, and different life stages) and unpacking the notions of consent, constrained consent, and subtle coercion.Limitations:The GAM’s scope is likely limited to the Canadian context. The study was also limited by the recruitment of LKDs from a past list of participants and by the lack of cultural and linguistic diversity in the sample.Conclusion:Using a participatory co-design approach, we have developed a robust tool that will inform a multinational qualitative study to better understand factors contributing to gender disparities in living kidney donation.

APOL1 kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Differentiating acute tubular necrosis (ATN) from rejection in pediatric kidney transplant (KT) recipients remains challenging and necessitates invasive biopsy. Doppler ultrasound-derived resistive index (RI) is a noninvasive modality to assess graft status, but its diagnostic utility in children is unclear. This study evaluates RI's ability to distinguish ATN and rejection in KT. In this retrospective cohort (2000-2021), 296 pediatric KT recipients with surveillance or clinically indicated biopsies were categorized into uncomplicated (n = 164), ATN (n = 65), or rejection (n = 67) groups. RI was measured at 24 h, 3, 6, and 12 months post-KT. Linear mixed-effects models assessed temporal trends and associations with complications. Baseline demographics were similar between groups (p > 0.05), but significant differences were observed in cold ischemia time (p = 0.019), time to complication (p < 0.001), and lower graft function in complicated groups (p < 0.001 and p = 0.002). Median RI did not differ between groups in surveillance (p > 0.05) or clinically indicated biopsies (p > 0.05). Established RI thresholds of 0.7 and 0.8 lacked specificity (p > 0.05). In a multivariate model, RI increased temporally posttransplant (3 months: +0.04, p < 0.001; 1 year: +0.05, p < 0.001), inversely correlated with recipient age (p < 0.001), and marginally with donor kidney size (p = 0.009), but showed no association with complications (p > 0.05). RI thresholds and trends do not differentiate ATN and rejection in pediatric KT. Temporal RI rise likely reflects systemic hemodynamic adaptation rather than pathology, limiting its standalone diagnostic utility. Future studies should integrate multimodal approaches with RI, clinical, and biochemical markers to refine noninvasive strategies.

Kidney transplant rejection despite zero eplet DR / DQ Mismatch: A case report.