Advancements in pediatric cancer treatment protocols have significantly improved long-term survival. This has been accompanied by a growing recognition of morbidity and mortality associated with late effects of treatment, including kidney disease. Surviving cancer in childhood implies exposure to multiple nephrotoxic insults, some of which carry a greater risk for the development of chronic kidney disease and progression to kidney failure than others. In childhood cancer survivors who develop kidney failure, a kidney transplant is a potential life-prolonging treatment option. However, the optimal timing of transplant in relation to remission, particularly when weighing morbidity associated with increased time on dialysis against the risk of cancer recurrence associated with transplant immunosuppression, remains controversial. This review explores nephrotoxicity and kidney-related complications of cancer treatment, kidney disease screening guidelines, and considerations for kidney transplant in childhood cancer survivors including timing from remission to transplant, cancer recurrence in the setting of post-transplant immunosuppression, and transplant outcomes.

Anti-DQ donor-specific antibodies (DSAs) are associated with an increased risk of antibody-mediated rejection (AMR) after kidney transplantation, but previous studies focused on antibodies targeting the β-chain, neglecting the also polymorphic α-chain. This study aimed to assess the frequency, characteristics, and pathogenicity of preformed anti-DQα DSAs in 2041 patients receiving a kidney transplant between 2010 and 2015 across 3 French transplantation centers. Donor and recipient 4-digit human leucocyte antigen typing and single-antigen bead mean fluorescence intensity data were compared with determine the specificity of anti-DQ antibodies. Associations between preformed anti-DQα DSAs and AMR were analyzed using Cox proportional hazard models. Patients with preformed anti-DQα DSAs were then matched to a control group of patients without preformed DSAs, to compare microvascular inflammation in 3-mo biopsies. After analysis of single-antigen bead data, we found that 122 kidney transplant recipients had preformed anti-DQα and anti-DQβ DSAs. Anti-DQα DSAs accounted for 35.2% of anti-DQ DSAs, with a median peak mean fluorescence intensity of 1331 (IQR 677-2896), targeting most frequently the DQA1*05 antigen (83.7%), and consistently the donor α/β heterodimer. In multivariable analyses, the presence of anti-DQα DSAs was associated with a higher risk of AMR, independently of DSAs targeting other loci (HR = 2.61; 95% CI, 1.31-6.01; P = 0.025). Moreover, patients with preformed anti-DQα DSAs had higher microvascular inflammation scores in their 3-mo biopsy than matched patients without DSAs (P < 0.001). Anti-DQα DSAs are independently associated with AMR after kidney transplantation, underscoring the importance of considering them in transplant allocation of and management of immunosuppression.

Immunogenicity and safety of recombinant zoster vaccine (RZV) were evaluated in the long-term and after revaccination in kidney transplant (KT) recipients on daily chronic immunosuppressive treatment. This phase 3b, single-arm, multicenter trial, evaluated KT recipients for varicella zoster virus (VZV) glycoprotein E (gE)-specific humoral and cell-mediated immune (CMI) responses and safety ∼4-8 years post-primary RZV series (two doses) given at ≥18 years of age; and after revaccination (two doses, one month apart), ∼6-8 years post-primary RZV series. Solicited and unsolicited adverse events (AEs) were recorded for seven and 30 days after each revaccination dose. Serious AEs (SAEs), including biopsy-proven allograft rejection and potential immune-mediated diseases, were recorded throughout the study. 68 participants were enrolled and 47 revaccinated. Persistent humoral and CMI responses remained ≥2.4-fold and ≥6.1-fold above pre-vaccination levels. One revaccination dose provided robust humoral (22.3-fold) and CMI (276.2-fold) above pre-vaccination responses. No vaccine-related SAEs were observed. This study demonstrates sustained immunogenicity against VZV gE for up to ≥8 years, functional immune memory with a robust anamnestic response at 6-8 years, and an acceptable safety profile after revaccination, reinforcing RZV's value for herpes zoster prevention in adult KT recipients on daily immunosuppression. NCT04176939.

Intragraft clonal expansion of cytotoxic CD8+ and CD4+ T cells in antibody-mediated kidney transplant rejection.

This study assessed de novo human leukocyte antigen (HLA) antibodies associated with blood transfusions in a paediatric kidney transplantation cohort, associated risk factors and outcomes. Patients with kidney disease at Royal Children's Hospital (Melbourne, Australia) who were transfused and/or received a kidney transplant between 2000 and 2018 were included. HLA antibody results from pre- and post-transfusion serum specimens, blood donor typing (where available) and clinical and laboratory data were collected. A control group comprised non-transfused patients from the same cohort. The primary outcome was the incidence proportion of de novo blood donor specific HLA antibodies (bDSA). Secondary outcomes included risk factors, including eplet mismatches with the blood donor, kidney donor and both. Screening identified 123 transfused and 63 non-transfused patients, with 34 and 28, respectively, included. Transfused patients were younger. At mean fluorescence intensity (MFI) cutoff 500, 36.7% of transfused patients developed de novo HLA class 1 bDSA and 23.3% de novo HLA class 2 bDSA. Overall, de novo HLA class 1 and class 2 antibodies were non-significantly higher in the transfused group (64.7%/55.9%) than in the non-transfused group (46.4% for both, p = 0.200 and p = 0.610, respectively). Risk factors identified included younger age (p < 0.05) and rhesus factor D (RhD) negative status (p = 0.021). The number of shared eplet mismatches was associated with corresponding de novo HLA antibodies (p = 0.02). Blood transfusion can be associated with bDSA in paediatric kidney disease, especially with shared blood and kidney donor mismatches. Strategies to avoid sensitisation, such as HLA selection of blood donors, may reduce this risk.

The paradigm shift of virtual crossmatch for deceased donor kidney allocation in the United States, 2015 - 2024.

High levels of IL-6 and IL-8 early after pig-to-nonhuman primate kidney xenotransplantation from α1,3-galactosyltransferase gene-knockout (GTKO) pigs.

Seroepidemiology, clinical correlates, and GRA6-based genotyping of Toxoplasma gondii among immunocompromised patients in northeastern Iran.

Trends in Survival and Unmet Need Across Solid Organ Transplantation.

ObjectivesTo develop a clinically applicable risk prediction score for end-stage kidney disease (ESKD) in Latin American patients with lupus nephritis (LN), using clinical and histopathological data obtained at the time of kidney biopsy.MethodsWe conducted a retrospective cohort study of 433 adults (≥18 years) with biopsy-proven LN at Hospital San Vicente Fundación (Medellín, Colombia) between January 2011 and May 2025. ESKD was defined as eGFR <15mL/min/1.73m2 for ≥3 months, dialysis >3 months, or kidney transplantation. Predictors of ESKD were identified using univariable and multivariable Cox regression and incorporated into a weighted risk score, stratifying patients into low (≤2 points), moderate (3-6), and high (7-10) risk categories.ResultsEighty-eight patients (20.3%) progressed to ESKD at a median of 3 months post-biopsy. Multivariable analysis identified hypertension (HR 1.73), baseline eGFR <60mL/min/1.73m2 (HR 4.40), proliferative LN (HR 4.03), mNIH activity index ≥7 (HR 1.56), and chronicity index ≥3 (HR 2.24) as independent predictors of ESKD. The resulting risk score stratified patients into low (n = 80), moderate (n = 215), and high-risk (n = 138) groups, with ESKD incidences of 0%, 11.6%, and 45.7%, respectively (p < 0.001). The model demonstrated good discriminatory performance, with a Harrell's C-index of 0.83.ConclusionsWe developed a simple yet robust risk score for predicting ESKD in Latin American patients with LN, integrating key clinical and histopathological factors. This tool effectively stratifies patients by risk and may support in guiding treatment decisions in clinical practice.

Comparative Analysis of Immune Activation Following Heart and Kidney Transplantation in Non-Human Primates

Kidney Transplantation is Associated with Improved Survival in Heart and Lung Transplant Recipients with Kidney Failure: A Retrospective Cohort Study

Capnocytophaga canimorsus is a fastidious, capnophilic Gram-negative rod transmitted through exposure to the oral secretions of domesticated dogs and cats and may cause severe infection in immunocompromised hosts. Bacterial peritonitis due to C. canimorsus is rare and has been reported primarily in patients receiving peritoneal dialysis. We describe a 66-year-old man status post simultaneous liver and kidney transplantation who presented with septic shock, neutropenia, acute kidney injury, and worsening ascites. Peritoneal fluid analysis demonstrated neutrophilic ascites consistent with bacterial peritonitis, although cultures were negative. Blood cultures and broad-range bacterial polymerase chain reaction using 16S rRNA gene sequencing identified C. canimorsus, confirming the diagnosis. The patient reported close contact with pet dogs and improved with targeted beta-lactam therapy. This represents the first reported case of C. canimorsus peritonitis in a solid organ transplant recipient and highlights the diagnostic value of molecular testing in culture-negative peritonitis.

Anhydramnios from fetal kidney failure causes lethal pulmonary hypoplasia. Serial amnioinfusions have shown promise in mitigating pulmonary disease from bilateral renal agenesis, but efficacy and safety for other causes of fetal kidney failure are unproven. To assess the efficacy of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia in cases of anhydramnios due to fetal kidney failure. Prospective, nonrandomized clinical trial conducted at 13 US fetal therapy centers from December 2018 to February 2025. Outcomes for maternal-fetal pairs with anhydramnios before 22 weeks' gestation due to fetal kidney failure without bilateral renal agenesis are reported; data collection for surviving infants continued until February 13, 2026. Thirty-two participants underwent serial amnioinfusions with isotonic fluid beginning before 26 weeks' gestation. The primary end point was neonatal survival for 14 days or longer with dialysis access placement. Secondary outcome measures of survival to discharge home and kidney transplant are reported. Twenty-nine of 32 participants (91%) had a live birth, with a median (IQR) gestational age at delivery of 34 weeks 1 day (31 weeks 5 days to 34 weeks 6 days). All participants delivered before 37 weeks' gestation. No unexpected serious maternal adverse events occurred, and the most common maternal complications were preterm prelabor rupture of membranes in 19 participants (56%) and chorioamniotic separation in 10 (29%). The primary outcome occurred in 19 (65.5%) of 29 live-born neonates (95% CI, 45.7%-82.1%). Factors associated with survival to the primary outcome included receiving more amnioinfusions (median [IQR], 14 [9-18] in survivors vs 7 [4-11] in nonsurvivors; P = .01), longer time interval from first amnioinfusion to preterm prelabor rupture of membranes (63.5 [60.5-74.5] days in survivors vs 29.0 [22.0-56.0] days in nonsurvivors; P = .01), gestational age greater than 32 weeks (79% of survivors vs 38% of nonsurvivors; P = .03), and higher birth weight (2029 [1770-2250] g in survivors vs 1635 [1185-1915] g in nonsurvivors; P = .01). Fourteen live-born infants (48%) survived to hospital discharge at a median (IQR) age of 4.7 (3.4-5.7) months. Of the 11 infants surviving to date, 7 (64%) have undergone kidney transplant between ages 2 years to 5 years. Serial amnioinfusions mitigated lethal pulmonary hypoplasia in neonates with anhydramnios due to fetal kidney failure. Significant neonatal morbidity and mortality independent of early lung function was noted. Factors associated with survival were consistent with the Renal Anhydramnios Fetal Therapy trial's bilateral renal agenesis cohort, suggesting common mechanistic pathways for mitigating pulmonary hypoplasia. ClinicalTrials.gov Identifier: NCT03101891.

A potential role for effector T cells with Fc receptors in kidney transplant antibody-mediated rejection.

Transplant of serologic A1 but genotype A2 kidneys to ABO O and B recipients is feasible and safe.

Combined Heart-Kidney Transplant versus Isolated Heart or Kidney Transplant in Amyloidosis

Obesity Management in End-Stage Kidney Disease: Pathways to Improve Kidney Transplant Access.

Should we screen for occult bacterial infection before kidney transplant? Balancing stewardship and patient safety.

Fatal Disseminated Aspergillosis Following Heart and Kidney Transplantation