Predictive Factors for Renal Recovery or End-Stage Renal Disease Post-Heart Transplantation for Patients with Chronic Kidney Disease at Transplant

Post-pubertal outcomes in patients with cloacal malformations: Colorectal, urological, and gynaecological function with patient-reported sexual outcomes.

E. bieneusi microsporidiosis is an opportunistic infection in immunocompromised patients. There is a lack of established treatment strategies. In this report, we present an overview of the available literature and three cases of E. bieneusi infection in renal transplant recipients.

The increasing incidence of urologic malignancy after renal transplantation (RT) has become a leading cause of recipient mortality. However, no recent analyses have been performed to identify the risk factors for post-transplant urologic malignancy (PTUM) and to evaluate the effect of PTUM on RT outcomes. This retrospective, population-based cohort study was based on Organ Procurement and Transplantation Network data. A total of 268,606 recipients underwent RT from January 2000 to December 2019 and met the inclusion criteria. Of these, 2,079 (0.77%), 1,983 (1.20% of male recipients), and 846 (0.32%) patients were diagnosed with renal cancer (RCa), prostate cancer (PCa), and bladder cancer (BCa), respectively, after RT. Urologic malignancy was a major cause of patient death after RT (RCa: 41.5%, PCa: 23.5%, BCa: 50.4%). The 5-year survival rates of the four groups ranking from best to worst were as follows: [95% confidence interval, lower value-upper value], PCa, 93.3% [92.2%-94.4%]; cancer-free, 87.2% [87.0%-87.3%]; RCa, 87.2% [85.8%-88.7%]; BCa, 81.0% [78.4%-83.7%] (P < 0.001 for all, except cancer-free vs. RCa, P = 1.00). The effects of PTUM on RT outcomes differ depending on the type of malignancy. Thus, a personalized approach to screening may be an appropriate strategy to address the multitude of complex issues that RT recipients encounter.

Background and aimsVascular in renal transplant recipients, although uncommon, may pose risks to graft function and patient outcomes. This study investigated the prevalence and characteristics of saphenofemoral junction (SFJ) reflux and lower-limb venous parameters in kidney transplant recipients.MethodsIn this cross-sectional study, patients with a history of kidney transplantation referred to Sina Hospital in Tehran, Iran, from January 2022 to 2024 were included. Duplex ultrasound was used to assess the presence of SFJ reflux, SFJ reflux time, and the diameters of the great saphenous vein (GSV), common iliac vein, external iliac vein, and common femoral vein.ResultsA total of 280 patients were evaluated, with a mean age of 39.52 ± 10.18years; 227 patients were male (81.1%). The transplanted kidney was located on the right side in 192 patients (68.6%). SFJ reflux was identified in 30 patients (10.7%), of whom 56.7% had bilateral reflux. There was no significant relationship between SFJ reflux and the side of the transplanted kidney (p = 0.273). The GSV diameter was increased in 29.3% of patients on the transplant side and in 24.6% on the contralateral side. The diameters of the common iliac veins were normal in all patients. External iliac vein diameter was increased in 14.3% of patients on the transplant side and in 16.8% on the contralateral side.ConclusionSFJ reflux was observed in 10.7% of kidney transplant recipients. No significant association was found between SFJ reflux and the side of the transplanted kidney. Lower-limb venous diameter parameters did not differ significantly between the transplant side and the contralateral side.

Bovine Carotid Artery Is a Viable Iliac Artery Conduit During Solid Organ Transplantation.

A Nomogram Predicts the Need for Internal Iliac Vein Dissection During Renal Transplantation: A Multicenter Collaborative Study.

Pharmacogenetics (PGx) is increasingly recognized as an important component of personalized medicine. In kidney transplantation, where immunosuppressive therapies and comedications often have narrow therapeutic index, preemptive PGx could complement therapeutic drug monitoring to improve individualized care. This study aimed to investigate the value of implementing PGx testing in the pretransplant assessment of renal transplant recipients. This single-center retrospective study included 110 adult patients who underwent a pretransplant PGx assessment between January 1, 2022, and June 30, 2023. The analysis focused on 16 pharmacogenes shared between the local routine PGx panel and the publicly available ClinPGx guideline support interface, with some genes analyzed using hotspot-only coverage. Medication lists were extracted at 2 time points: pretransplant and post-transplant (or last follow-up for patients on waiting list). Theoretical actionability was defined as the presence of at least 1 actionable genotype, and effective actionability as at least 1 actionable gene-drug pair according to international guidelines. Theoretical actionability was observed in 109 of 110 patients (99%). Effective actionability concerned 29 of 110 patients (26%) at the pretransplant assessment and 19 of 41 (46%) at the post-transplant stage. The most frequent actionable gene-drug pairs at the latter stage included CYP2C19-proton pump inhibitors (38%), CYP3A5-tacrolimus (25%), SLCO1B1-statins (13%), CYP2D6-tramadol (8%), and ABCG2-allopurinol (8%). Preemptive PGx embedded in the pretransplant evaluation identifies clinically relevant gene-drug interactions. In combination with therapeutic drug monitoring, this approach has the potential to optimize immunosuppressive drugs initiation and support pharmacological management in kidney transplantation.

There is a lack of robust evidence regarding immunosuppressive therapy in children and adolescents after kidney transplantation (KTx), and as such, international practice is highly variable. Recent clinical practice recommendations advocating individualized immunosuppressive strategies that incorporate newer agents are often not implemented. This can potentially contribute to reduced patient and renal allograft survival. The guideline was developed between January 1, 2024, and December 12, 2025, according to the Guidance Manual of the German Association of Scientific Medical Societies by the German Societies for Pediatric Nephrology, Nephrology, Transplantation, and Pediatrics, the German Kidney Association, the International Pediatric Transplant Association, the European Society for Pediatric Nephrology and the Members of the Cooperative European Pediatric Renal Transplant Initiative. This evidence- and consensus-based guideline provides up-to-date, state-of-the-art recommendations for immunosuppressive therapy after KTx in pediatric kidney transplant recipients. It is based on the best available evidence and the consensus of the relevant German Medical Societies, Members of the Cooperative European Paediatric Renal Transplant Initiative, and the working group on transplantation of the European Society for Paediatric Nephrology, and the International Pediatric Transplant Association. The formal consensus reached is particularly significant in cases of weak or inconclusive evidence and where recommendations are based solely on expert opinion.

BACKGROUNDStandard immunosuppressive regimens result in low rejection rates in the first year after transplantation. However, long-term survival rates after renal transplantation remain relatively poor and are associated with drug-induced side effects.AIMTo assess the effects of switching from traditional mycophenolate mofetil (MMF) combined with steroids and tacrolimus to a low-dose regimen of everolimus and tacrolimus in post-kidney transplant patients, with the aim of reducing the adverse effects of MMF and high-dose calcineurin inhibitors.METHODSThis was a retrospective, single-center study of patients who received a combination therapy of steroids + tacrolimus (low dose) + everolimus (low dose) after kidney transplantation (KT). Data was obtained from patients who underwent KT between 2007 and 2019. Everolimus was initiated at 0.25 mg twice daily, aiming for pre-dose concentrations of 5-7 ng/mL (combined trough levels of tacrolimus and everolimus). Improvement in graft survival was assessed by measuring serum creatinine, urinary protein, and lipid profiles. Safety studies were conducted to observe drug-induced side effects.RESULTSWe included 36 patients from a single center. After switching to everolimus, there was a significant reduction in serum creatinine levels which remained stable over one year. Cholesterol levels also improved and remained stable in most patients. Half of the patients reported improvement in their cholesterol levels and continuous stability. Vomiting (47.1%) and diarrhea (32.4%) were the most common adverse effects of MMF treatment. Other side effects included urinary tract infections (20.6%) and anemia (5.9%).CONCLUSIONCombination therapy with everolimus (low dose) + tacrolimus (low dose) was superior to MMF + tacrolimus in terms of a lower incidence of side effects and stable serum creatinine levels over long-term follow-up.

Ischemia-reperfusion injury is a risk factor for delayed graft function (DGF). During reperfusion, the damaged tissues and cells are exposed to blood, thereby contributing to complement activation. The aim of this study was to investigate if complement activation correlates with the duration of DGF in donation after circulatory death (DCD) kidney transplants and whether it provides additional information beyond regular histology. In day-10 protocol, biopsies from 64 DCD recipients, complement deposition (C4d, C3d, C5b-9) was assessed by immunohistochemistry, quantified and correlated with fDGF duration (early graft function [≤7 d], intermediate [8-20 d], and prolonged duration [≥21 d]), as well as with Banff classification. C4d and C3d deposition was not different between fDGF durations. In contrast, C5b-9 deposition was higher in recipients with prolonged DGF (median 8.1%) compared with those with early graft function (median 5.6%) and intermediate DGF (median 5.6%). Kidneys from expanded criteria donors exhibited significantly higher C5b-9 deposition compared with standard criteria donors (P = 0.001), but no correlation with warm or cold ischemia times. Banff classification scores showed only significant associations of C4d with interstitial inflammation (i), total inflammation (ti), and arteriolar hyalinosis (ah). Similar results were found with semiquantitative complement scoring in specific kidney compartments. No significant associations were observed between C5b-9 deposition and any of the Banff scores. C5b-9 deposition is increased in DCD kidneys with prolonged fDGF, representing a marker not reflected by Banff scoring. Higher C5b-9 levels in expanded criteria donors kidneys suggest that intrinsic donor factors contributes to early complement activation after transplantation.

Closely similar tacrolimus morning troughs and graft function across the recipients' common ABCB1 polymorphisms (c.2677G>T/A, c.1236C>T, c.3435C>T) early after renal transplantation.

Epidermodysplasia verruciformis (EV) is a rare genodermatosis resulting from mutations in the EVER1/EVER2 genes, that increase vulnerability to beta-human papillomavirus (β-HPV) infection. The acquired form (AEV) develops in immunocompromised individuals, particularly organ transplant recipients, and typically manifests as pityriasis versicolor-like macules on sun-exposed areas. However, lesions confined to non-sun-exposed regions, especially the genitalia, are exceedingly uncommon and may be misdiagnosed. We report the case of a 38-year-old woman, nine years post-renal transplantation and on long-term triple immunosuppressive therapy (cyclosporine, mycophenolate mofetil, and prednisolone), who presented with progressive, non-pruritic, well-demarcated hypopigmented macules localized exclusively to her labia majora and mons pubis. The lesions were initially misdiagnosed and unsuccessfully treated as tinea versicolor. A skin biopsy revealed histopathologic features characteristic of EV, including enlarged keratinocytes with blue-gray cytoplasm and perinuclear halos and koilocytotic changes. This case emphasizes that AEV should be considered in the differential diagnosis of genital hypopigmented lesions in immunosuppressed patients. Accurate histopathologic evaluation is crucial for timely recognition, appropriate management, and ongoing surveillance to prevent missed malignant transformation.

Proton pump inhibitors (PPIs) have been widely used for over 35 years. However, in recent decades, numerous adverse drug reactions (ADRs) have been reported, with evidence often inconsistent and heterogeneous across studies. To conduct an overview of systematic reviews/meta-analyses (SR/MAs) to provide a contemporary review of the evidence for the safety of PPIs in patients using them for treating or prophylaxis, to summarise the outcome data, assess the methodological quality and rate the certainty of the evidence and to provide references for clinical decision-making and the subsequent formulation of evidence. We conducted an overview of reviews following the Preferred Reporting Items for Overviews of Reviews guidelines. We identified SR/MAs regarding PPI safety through a search of multiple databases, including the China National Knowledge Infrastructure, Chinese Science and Technology Journal Database and Wanfang Database (WanFang) on 6 December 2025 as well as Embase, PubMed and the Cochrane Library database on 7 December 2025. The participants were human populations who had been administered PPIs; the intervention groups used PPI-based regimens and the control group received different PPI regimens, no-PPIs, H2-receptor antagonists (H2RAs), potassium-competitive acid blockers (P-CAB) or placebo; the outcomes mainly included the specific ADRs associated with PPI use. We used the A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) tool to assess the methodological quality of the included SR/MAs and employed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to evaluate the quality of evidence for the reported outcomes. The focus of the data presentation was descriptive, featuring detailed tabular presentations of characteristics and results at both the review level and the primary studies level. A total of 940 studies were retrieved from various databases according to the search strategies. After eliminating duplicates and the screening process, 36 SR/MAs were finally included. Overall, there was a slight overlap (corrected covered area, CCA of 0.91%) in 483 primary studies included in the 36 SR/MAs. AMSTAR-2 evaluation results showed that 34 SR/MAs were of low quality, and the other two were of critically low quality. The GRADE evaluation results indicated that the certainty of evidence for all outcomes was low or very low. The use of PPIs might be associated with an increased risk of acute kidney injury (AKI) (relative risk (RR) 1.75, 95% CI 1.40 to 2.19), chronic kidney disease (CKD) (RR 1.35, 95% CI 1.15 to 1.56), gastric cancers (GC) (RR 1.67, 95% CI 1.39 to 2.00) and community-acquired pneumonia (CAP) (OR 1.37, 95% CI 1.22 to 1.53). PPI therapy was associated with a higher recurrence rate of Clostridioides difficile infection (CDI) (24% vs 18%) and might increase CDI risk in renal transplant recipients (RR 2.33, 95% CI 1.07 to 5.07). The use of PPIs might heighten the risk of fractures in young patients (aged <29 years) (RR 1.20, 95% CI 1.12 to 1.29). PPI therapy was also linked to hypomagnesaemia in haemodialysis patients (1/36, 2.78%) and renal transplant recipients (1/36, 2.78%). This overview evaluates the safety profile of PPIs, noting associated risks including renal impairment, GC, fractures and infections. Most evidence comes from observational studies, resulting in low or very low certainty evidence that limits definitive causal conclusions. Clinicians and pharmacists may consider greater vigilance with PPI use, and these ADRs may not require de-escalation but de-implementation when inadequate (eg, long-term use or special group use). Future research should focus on high-quality prospective studies and investigate underlying mechanisms to better establish causality and quantify risks. CRD420251059575.

Pneumocystis pneumonia (PCP) is a well-known infectious complication of organ transplantation requiring prophylaxis at least within the first 6 month to 1 year post transplantation. Few data exist comparing the characteristics of Pneumocystis pneumonia associated with kidney, heart, liver or lung transplant recipients. We here conducted a cross-sectional study nested within the surveillance of our national reference center for invasive mycoses to analyze the prospectively declared cases of PCP occurring in solid organ transplant recipients over a period of 11 years. We found that the median occurrence of PCP post-transplantation varies from the organ recipients with PCP occurring earlier in liver recipients and later in other organs reaching a median of 3.9 years in kidney recipients. We also found a clear increase the proportion of positive mycological criteria in PCP cases occurring within 2 years post-transplantation. Age and ICU hospitalization were major variables associated with 3 month-mortality with liver and lung recipient having a better outcome than renal transplant patients upon adjustment including age. A trend toward the role of additional risk factors (such as HIV, Cancer of hematological malignancy) in the outcome of PCP was also observed. Altogether, this study described on a large patient cohort, some key mycological and clinical information associated with PCP in solid organ transplant patients. The characteristics of PCP in kidney and heart recipients seems similar.

Mesenchymal stem cells (MSCs) exhibit significant heterogeneity, which limits their therapeutic efficacy in regenerative medicine. Here, we introduce a self-assembled interleukin-4 (IL-4) peptide hydrogel designed to shift MSC populations toward a homogeneous CD106+ subset with enhanced regenerative and immunomodulatory capabilities. To evaluate their therapeutic potential, MSCs with the IL-4 hydrogel were administered to a murine model of acute kidney injury (AKI) via renal capsule transplantation. Compared with untreated MSCs, encapsulated MSCs exhibited superior engraftment and survival, leading to significant improvements in renal function, as evidenced by reduced serum creatinine levels, attenuated tubular necrosis, and decreased inflammatory infiltrates. These findings highlight the IL-4 peptide hydrogel as a promising platform for overcoming MSC heterogeneity and manufacturing disease-specific MSCs, offering a scalable strategy for advanced cell therapies in AKI and beyond.

Comparative analysis of excessive daytime sleepiness and sleep apnea symptoms in renal transplant recipients and a historical dialysis cohort

Knowledge gaps in chronic kidney disease and kidney transplantation among Jordanian patients: A cross-sectional study using an Arabic-adapted KART 2.0 tool

Cyclosporine is a potent immunosuppressive drug. It has a very complex pharmacokinetics and has many influential factors. Which requiring therapeutic drug monitoring (TDM) to ensure a better compromise between efficacy and toxicity. Measurement of the area under the blood concentration-time curve (AUC 0-12h ) is reflective of total drug exposure. However, the measurement of AUC 0-12h implies many problems. Thus, it is more clinically acceptable to use a single blood sample as a surrogate index of total drug exposure. Our patients are routinely monitored by simultaneous determination of C 0 and C 2 and occasionally by determination of AUC 0-12h . The present investigation aimed to evaluate the effectiveness of our strategy of biomonitoring of cyclosporine and to improve the interpretation of the results based mainly on the comparison of our TDM results with different therapeutic ranges proposed in the literature, and the results of the usual TDM parameters (C 0 /C 2 ) with the reference index (AUC 0-12h ).This study was carried out in two steps: The first step was a retrospective descriptive study, spread over a period of 7 years, of a population of 32 kidney transplant recipients treated with an immunosuppressive regimen combining cyclosporine, steroids, and mycophenolate mofetil (MMF). For the entire population, the AUC 0-12h was calculated using the limited sampling equation established by Einecke et al, 2002. The second step is an analytical cross-sectional study of a subpopulation of 10 kidney transplant recipients. In this subgroup, an estimation was carried out from C 0 , C 1 , and C 3 by the Bayesian estimator developed by the INSERM team of Limoges.The present investigation demonstrated that the AUC 0-12h calculated in our population is not significantly different from that observed in the reference population monitored by AUC 0-12h , given that our clinicians relied mainly on C 0 for cyclosporine biomonitoring in this population, this allowed us to judge biomonitoring by C 0 as potentially effective. This mean AUC 0-12 coincides with the C 2 distribution used to propose the new C 2 margins, suggesting that they are more appropriate for our population.The biomonitoring of cyclosporine in kidney recipients can be performed by a single C 0 assay. Alternatively, the calculation of AUC 0-12h by limited sampling formula or the Bayesian method could be used occasionally. The C 2 assay seems impractical in clinical routine unless used with other concentrations for AUC 0-12h estimation.

Evaluation of the bioassay for detecting early endothelial activation using microvascular cultures in renal transplant recipients.