Search

Aims: Post-transplant diabetes is a prevalent and consequential complication following kidney transplantation, which significantly augments the risk of cardiovascular disease, graft loss, infection, and mortality, thereby profoundly impacting both graft and patient survival. However, the early stages of post-transplant diabetes often go unnoticed or receive inadequate management. Consequently, this study systematically assesses the incidence of new-onset diabetes after kidney transplantation with the aim to enhance medical staff awareness regarding post-transplantation diabetes and provide clinical management guidance. Methods: We conducted a comprehensive search across multiple databases including PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed until September 21, 2023. Data extraction was performed using standardized tables and meta-analysis was conducted using Stata 16.0 software. A random effects model was employed to estimate the combined prevalence along with its corresponding 95% confidence interval. The source of heterogeneity was explored using subgroup analysis and sensitivity analysis, while publication bias was assessed through funnel plot and Egger's test. This study has been registered with PROSPERO under the registration number CRD42023465768. Results: This meta-analysis comprised 39 studies with a total sample size of 16,584 patients. The prevalence of new-onset diabetes after transplantation was found to be 20% [95% CI (18.0, 22.0)]. Subgroup analyses were conducted based on age, gender, body mass index, family history of diabetes, type of kidney donor, immunosuppressive regimen, acute rejection episodes, hepatitis C infection status and cytomegalovirus infection. Conclusions: The incidence of post-kidney transplantation diabetes is substantial, necessitating early implementation of preventive and control measures to mitigate its occurrence, enhance prognosis, and optimize patients' quality of life. Clinical trial registration: PROSPERO: CRD42023465768. [ABSTRACT FROM AUTHOR]

Objective: Kidney transplantation is the gold standard therapeutic alternative for patients with end‐stage renal disease; nevertheless, it is not without potential complications leading to considerable morbidity and mortality such as post‐transplant diabetes mellitus (PTDM). This narrative review aims to comprehensively evaluate PTDM in terms of its diagnostic approach, underlying pathophysiological pathways, epidemiological data, and management strategies. Methods: Articles were retrieved from electronic databases using predefined search terms. Inclusion criteria encompassed studies investigating PTDM diagnosis, pathophysiology, epidemiology, and management strategies. Results: PTDM emerges as a significant complication following kidney transplantation, influenced by various pathophysiological factors including peripheral insulin resistance, immunosuppressive medications, infections, and proinflammatory pathways. Despite discrepancies in prevalence estimates, PTDM poses substantial challenges to transplant. Diagnostic approaches, including traditional criteria such as fasting plasma glucose (FPG) and HbA1c, are limited in their ability to capture early PTDM manifestations. Oral glucose tolerance test (OGTT) emerges as a valuable tool, particularly in the early post‐transplant period. Management strategies for PTDM remain unclear, within sufficient evidence from large‐scale randomized clinical trials to guide optimal interventions. Nevertheless, glucose‐lowering agents and life style modifications constitute primary modalities for managing hyperglycemia in transplant recipients. Discussion: The complex interplay between PTDM and the transplant process necessitates individualized diagnostic and management approaches. While early recognition and intervention are paramount, modifications to maintenance immunosuppressive regimens based solely on PTDM risk are not warranted, given the potential adverse consequences such as increased rejection risk. Further research is essential to refine management strategies and enhance outcomes for transplant recipients. [ABSTRACT FROM AUTHOR]

Obesity and related comorbidities heighten risks for complications in kidney transplant settings. While pre-transplant patients often have access to nutrition counseling and health support, literature is limited on patients' perceptions of weight and motivation to lose weight prior to transplantation. We conducted a survey among ≥18-year-old patients on the kidney transplant waitlist at a single center. Questions addressed weight perception, motivation for weight loss, available resources, and engagement in physical activity. Medical records provided demographic and clinical data. Statistical tests analyzed quantitative data, while free-text responses were thematically grouped and described. Of 1055 patients, 291 responded and were matched with demographic data. Perceived weight changes correlated with actual changes in body mass index (BMI) (<24.9) were more receptive to weight center resources (<30 kg/m²) are most interested in weight loss resources and demonstrate motivation. Furthermore, pre-transplant nutrition counseling correlates with healthier behaviors. Integrating patients' perspectives enhances pretransplant protocols by encouraging active involvement in health decisions. [ABSTRACT FROM AUTHOR]

• Erysipelas may be dangerous complication after kidney transplantation. • Erysipelas after kidney transplantation may be caused by unusual pathogens. • Differential diagnosis between different etiologic factors of erysipelas is very important. Erysipelas/cellulitis are severe skin infections that are especially dangerous for immunocompromised patients. The most common cause of these diseases is streptococcal infection, but sometimes they may be caused by other Gram-positive or negative bacteria or other factors. Proper diagnosis and treatment should be implemented accurately to prevent dangerous complications. We present a case of severe bullous erysipelas caused by Escherichia coli and discuss the diagnosis, differential diagnosis, and treatment of cellulitis in kidney transplant patients. [ABSTRACT FROM AUTHOR]

Background: Pulmonary complications pose significant challenges in renal transplant recipients due to immunosuppression and diverse underlying renal diseases. Understanding their epidemiology, clinical presentation, microbial spectrum, and risk factors is crucial for optimal management. Methods: We conducted a prospective observational study over 24 months, following 458 renal transplant recipients. Data on demographics, clinical presentation, underlying renal diseases, and microbial spectrum were collected. Risk factors influencing pulmonary complications were analyzed. Results: Among the cohort, 45 incidents (9.8%) of pulmonary complications occurred, with fever (66.7%) being the most common symptom. The majority of complications (51%) occurred over six months post-transplantation, with infectious complications predominating (89%). Risk factors included leucopenia (24.4%), CMV infection (8.9%), HCV infection (8.9%), ART (20%), and NODAT (11.1%). Conclusion: Early detection and targeted antimicrobial therapy are essential in managing pulmonary complications in renal transplant recipients. Multidisciplinary approaches are crucial for optimizing patient outcomes. Further research is needed to explore the long-term implications on graft function and survival. [ABSTRACT FROM AUTHOR]

Background/Objectives: Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim of our analysis was to find whether there were higher incidences of infectious complications after kidney transplantation (KT) in groups with different induction immunosuppressive treatment and also to find independent risk factors for recurrent infections. Materials: We retrospectively evaluated all patients with induction treatment with basiliximab after kidney transplantation from 2014 to 2019 at our center relative to age- and sex-matched controls of patients with thymoglobulin induction immunosuppression. Results: Our study consisted of two groups: basiliximab (39) and thymoglobulin (39). In the thymoglobulin group we observed an increased incidence of recurrent infection in every observed interval; however, acute rejection was seen more often in the basiliximab group. A history of respiratory diseases and thrombocytopenia were identified as independent risk factors for recurrent bacterial infections from the first to sixth month after KT. Decreased eGFR from the first month, infections caused by multi-drug-resistant bacteria, and severe infections (reflected by the need for hospitalization) were identified as independent risk factors for recurrent bacterial infections from the first to the twelfth month after KT. Conclusions: We found that in the group of patients with thymoglobulin induction immunosuppressive treatment, infectious complications occurred significantly more often during the entire monitored period with decreased incidence of acute humoral and cellular rejection occurred more often. [ABSTRACT FROM AUTHOR]

This article discusses the use of intra-arterial methylprednisolone (IAM) as a treatment for pediatric gastrointestinal post-transplant lymphoproliferative disorder (PTLD). PTLD is a group of lymphoid disorders that occur in transplant recipients, particularly pediatric patients, and is characterized by uncontrolled B cell proliferation. The main treatment for PTLD is reduction of immunosuppression, but this can come with risks. IAM has been shown to be effective in controlling acute gastrointestinal bleeding in steroid-refractory transplant recipients, and this article describes the first use of IAM in a pediatric patient with PTLD. The patient experienced prompt cessation of bleeding and resolution of previous FDG uptake regions on a PET scan, although new regions of FDG uptake were observed. IAM was administered five times without complications. The article suggests that IAM can be a rapid and effective option for managing acute gastrointestinal bleeding in PTLD patients, particularly those on concurrent chemotherapy. Further research is needed to evaluate the utility of IAM in a larger pediatric population. [Extracted from the article]

Cancer is a common complication after kidney transplantation. Kidney transplant recipients (KTR) have a 2- to 4-fold higher risk of developing cancer compared to the general population and post-transplant malignancy is the third most common cause of death in KTR. Moreover, it is well known that certain cancer types are overrepresented after transplantation, especially non-melanoma skin cancer. Immune checkpoint inhibitors (ICI) have revolutionized the treatment of cancer, with remarkable survival benefit in a subgroup of patients. ICI are monoclonal antibodies that block the binding of specific co-inhibitory signaling molecules. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), and its ligand programmed cell death ligand 1 (PD-L1) are the main targets of ICI. Solid organ transplant recipients (SOTR) have been excluded from clinical trials owing to concerns about tumor response, allo-immunity, and risk of transplant rejection. Indeed, graft rejection has been estimated as high as 48% and represents an emerging problem. The underlying mechanisms of organ rejection in the context of treatment with ICI are poorly understood. The search for restricted antitumoral responses without graft rejection is of paramount importance. This review summarizes the current knowledge of the use of ICI in KTR, the potential mechanisms involved in kidney graft rejection during ICI treatment, potential biomarkers of rejection, and how to deal with rejection in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Cold ischemia‐reperfusion injury (IRI) is an unavoidable complication of kidney transplantation. We investigated the role of regulatory T cells (Treg) in cold IRI and whether the interleukin (IL)‐2/anti‐IL‐2 antibody complex (IL‐2C) can ameliorate cold IRI. Methods: We developed a cold IRI mouse model using kidney transplantation and analyzed the IL‐2C impact on cold IRI in acute, subacute and chronic phases. Results: Treg transfer attenuated cold IRI, while Treg depletion aggravated cold IRI. Next, IL‐2C administration prior to IRI mitigated acute renal function decline, renal tissue damage and apoptosis and inhibited infiltration of effector cells into kidneys and pro‐inflammatory cytokine expression on day 1 after IRI. On day 7 after IRI, IL‐2C promoted renal regeneration and reduced subacute renal damage. Furthermore, on day 28 following IRI, IL‐2C inhibited chronic fibrosis. IL‐2C decreased reactive oxygen species‐mediated injury and improved antioxidant function. When IL‐2C was administered following IRI, it also increased renal regeneration with Treg infiltration and suppressed renal fibrosis. In contrast, Treg depletion in the presence of IL‐2C eliminated the positive effects of IL‐2C on IRI. Conclusion: Tregs protect kidneys from cold IRI and IL‐2C inhibited cold IRI by increasing the renal Tregs, suggesting a potential of IL‐2C in treating cold IRI. Key Points: Interleukin (IL)‐2/anti‐IL‐2 antibody complex attenuated acute renal injury, facilitated subacute renal regeneration and suppressed chronic renal fibrosis after cold ischemia‐reperfusion injury (IRI) by increasing the renal Tregs.IL‐2/anti‐IL‐2 antibody complex decreased reactive oxygen species‐mediated injury and improved antioxidant function.This study suggests the therapeutic potential of the IL‐2/anti‐IL‐2 antibody complex in kidney transplantation‐associated cold IR. [ABSTRACT FROM AUTHOR]

Introduction: Delayed graft function (DGF) is a frequent complication following kidney transplant. This study aimed to assess the association between early post‐operative lactate variation and DGF. Methods: This was a single center, retrospective cohort study between February 2021 and December 2022 in Saint–Louis Hospital (APHP, France). Venous lactate levels were measured immediately (H0) and 4 h (H4) after kidney transplant. The primary outcome was the occurrence of DGF (need for renal replacement therapy between transplantation and day 7). Secondary outcome was the occurrence of complications (i.e., death, vascular thrombosis, hemorrhagic shock, urological complications (hematoma, urinoma), local or systemic infection) between transplant and day 7. Results: Two hundred 12 patients were included, and 38 (17.9%) developed DGF. Venous lactate variation between H0 and H4 was higher in patients who developed DGF (−30 (IQR −83, −6)% vs. −15 (IQR −62, −11)%, p =.037), but the variation of level was more often positive (corresponding to an increased lactate production over time between H0 and H4) in patients who developed DGF ((28(85%) vs. 94(62%), p =.011). In multivariate logistic regression, positive venous lactate level variation between H0 and H4 was strongly associated with a reduced risk of developing DGF (OR.30 [.09–.79], p =.024). We did not find any association between post‐operative hyperlactatemia and occurrence of complications between transplant and day 7. Discussion: DGF is a frequent complication following kidney transplantation. Its early prediction could help physicians optimize treatment and protect the kidney. Early venous lactate variation after kidney transplant could help to predict the occurrence of DGF. [ABSTRACT FROM AUTHOR]

Background: Lymphoceles are amongst the most common complications following kidney transplantation. Therefore, effective strategies to prevent their development are needed. The ligation of lymphatic vessels has proven to be a successful concept for that purpose. However, whether electrocauterization or suture ligation is more effective is unclear. Methods: We conducted a meta-analysis using a random effects model with the log risk ratio as the primary outcome measure. Additionally, an analysis using a random effects model with the raw mean difference in lymphatic sealing time between suture ligation and electrocauterization was performed. Adequate studies were found in a literature search conducted in PubMed, CENTRAL and Web of Science as well as from independent sources. Results: A total of 8 studies including 601 patients were included in the analysis. The estimated average log risk ratio based on the random effects model was µ = −0.374 (95% CI: −0.949 to 0.201), which did not differ significantly from zero (z = −1.28, p = 0.2). The lymphatic sealing time was 7.28 (95% CI:1.25–13.3) minutes shorter in the electrocauterization group. Conclusions: We conclude that neither technique is superior for the purpose of lymphocele prevention post kidney transplantation, and secondary criteria like time savings, cost and surgeons' preference should be considered in the decision for an optimal outcome. [ABSTRACT FROM AUTHOR]

Between 15–20% of patients with end stage renal disease (ESRD) do not know the cause of the primary kidney disease and can develop complications after kidney transplantation. We performed a genetic screening in 300 patients with kidney transplantation, or undiagnosed primary renal disease, in order to identify the primary disease cause and discriminate between overlapping phenotypes. We used a custom-made panel for next-generation sequencing (Agilent technology, Santa Clara, CA, USA), including genes associated with Fabry disease, podocytopaties, complement-mediated nephropathies and Alport syndrome-related diseases. We detected candidate diagnostic variants in genes associated with nephrotic syndrome and Focal Segmental Glomerulosclerosis (FSGS) in 29 out of 300 patients, solving about 10% of the probands. We also identified the same genetic cause of the disease (PAX2: c.1266dupC) in three family members with different clinical diagnoses. Interestingly we also found one female patient carrying a novel missense variant, c.1259C>A (p.Thr420Lys), in the GLA gene not previously associated with Fabry disease, which is in silico defined as a likely pathogenic and destabilizing, and associated with a mild alteration in GLA enzymatic activity. The identification of the specific genetic background may provide an opportunity to evaluate the risk of recurrence of the primary disease, especially among patient candidates living with a donor kidney transplant. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) infections are a common complication after kidney transplantation (KTx) and negatively affecting patient outcome. Valganciclovir (VGC) prophylaxis is often limited by drug‐induced side effects and dose reduction due to decline in kidney function. Method: In the present study, episodes of CMV viremia in the first year after KTx in a cohort of 316 recipients were analyzed retrospectively to identify risk factors linked to persistent infections. Results: In the studied cohort, 18.7% of patients showed a high‐risk (HR) constellation (D+/R–) for CMV infections. CMV viremia affected 22% of our cohort, with HR patients being the most affected cohort (44.1%). Within this group, most viremic events (65.3%) occurred while patients were still on prophylactic therapy, showing significantly higher viral loads and a longer duration compared to seropositive recipients. Conclusion: The analysis at hand revealed that detection of viremia under ongoing antiviral prophylaxis bears an increased risk for sustained viral replication and antiviral drug resistance in HR patients. We identified low estimated glomerular filtration rate (eGFR) and lower dose VGC prophylaxis post‐KTx as a risk factor for breakthrough infections in HR patients in our single center cohort. These patients might benefit from a closer CMV monitoring or novel prophylactic agents as letermovir. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Proper diagnosis and treatment of vascular stenosis which is a possible complication of renal transplant is important in improving patients' quality of life and prognosis. One known consequence among recipients of renal transplants is graft renal artery stenosis. Early identification and therapy are crucial to avoid graft malfunction and the serious consequences that might arise due to elevated hypertension in several organs. We report a rare case of transplant renal artery stenosis in a mid‐aged woman who presented with edema, hypertension, and increased creatinine 2 months after kidney transplant. The patient had normal renal arterial resistive index (RI) and perfusion index (PI), and there was only a modest decrease in perfusion on duplex ultrasound. Following the patient's renal stenting treatment, angiographic resolution was observed. After 14 days of regulated blood pressure following renal artery stenting, she was discharged from the hospital with her edema resolved. Considering complications in patients with clinical manifestations such as hypertension resistant to treatment and graft dysfunction, vascular stenosis is a notable issue to consider even in the context of normal renal arterial RI, PI, and duplex ultrasound. Proper diagnosis and treatment are of importance to improve patients' quality of life and prognosis. [ABSTRACT FROM AUTHOR]

Background: Pneumocystis jirovecii pneumonia (PJP) is a common and troublesome complication of kidney transplantation. In the era of prophylaxis, the peak incidence of PJP after kidney transplantation and specific characteristics of late-onset PJP have always been debated. Methods: We performed a retrospective study by analysing the data of post-transplantation pneumonia in adult kidney transplantation recipients between March 2014 and December 2021 in The Affiliated First Hospital of University of Science and Technology of China (USTC). A total of 361 patients were included and divided into early-onset PJP, late-onset PJP and non-PJP groups. The characteristics of each group and related risk factors for the late-onset patients were investigated. Results: Some patients developed PJP 9 months later with a second higher occurrence between month 10 and 15 after transplantation. Compared with non-PJP, ABO-incompatible and cytomegalovirus (CMV) viremia were significantly associated with late onset of PJP in multivariate analysis. The use of tacrolimus, CMV viremia, elevated CD8(+) T cell percent and hypoalbuminemia were risk factors for late PJP. Receiver operating characteristic curve analysis demonstrated that a combination of those factors could increase the sensitivity of prediction remarkably, with an area under the curve of 0.82, a sensitivity of 80% and a specificity of 83%. Conclusions: PJP could occur months after kidney transplantation. ABO-incompatible transplant recipients are at high risk of PJP. In the later stages of transplantation, CMV viremia, T lymphocyte subsets percentage and serum albumin levels should be monitored in patients using tacrolimus. [ABSTRACT FROM AUTHOR]

Aim: Increased venous thrombosis and arterial embolism rates are observed in the general population during or after COVID‐19. Data regarding the kidney transplant population are scarce. In this study, we aim to investigate the thrombotic complications and risk factors associated with thrombotic complications in kidney transplant patients. Methods: This retrospective observational study included adult kidney transplant recipients diagnosed with COVID‐19 between March 2020 and June 2022. The endpoint was the occurrence of thromboembolic events. Results: Four hundred and sixty‐nine patients were followed for a median of 10.8 months after COVID‐19. Forty patients (8.5%) died. Thromboembolic complications developed in 51 (11.9%) of the surviving patients. Twenty‐four patients with thromboembolic events were receiving prophylactic anticoagulation before the event. The patients with mild, moderate, and severe COVID‐19 were 292, 129, and 48, respectively. Patients with moderate COVID‐19 had a significantly higher percentage of thromboembolic complications than patients with mild COVID‐19. Older age, prior heart disease, and moderate COVID‐19 were significantly associated with thromboembolic events. The incidence of thromboembolic events after COVID‐19 is 10.9 per 100 patient‐year. Conclusion: Thromboembolic complications were observed at increased rates in kidney transplant recipients after COVID‐19. Therefore, prospective and cohort studies for post‐COVID‐19 complications regarding the treatment modalities are urgently needed. [ABSTRACT FROM AUTHOR]

The iliac fossa is the most commonly used site to place the graft in renal transplantation in adults. However, iliac fossa may not be used in various conditions. Thus, orthotopic renal transplantation becomes a viable alternative for these selected patients. Given the technically challenging surgery and limited number of patients, data on the long‐term outcomes on this regard are scarce. This narrative review serves as an update on the clinical outcomes after orthotopic renal transplantation, focusing on overall recipient survival and renal graft survival, as well as postoperative complications. We found that studies to date showed a comparable survival rate in both recipients and renal grafts in the postoperative follow‐up period after orthotopic renal transplantation with a lower complication rate compared to the published data on heterotopic renal transplantation. The results of our review may encourage transplant centers to reevaluate their policies to consider orthotopic renal transplantation as an alternative technique in cases where heterotopic kidney transplantation is not possible. [ABSTRACT FROM AUTHOR]

This article discusses a study that examined the effects of prebiotic supplementation on the gastrointestinal microbiota in kidney transplant recipients. The study found that prebiotic supplementation led to significant improvements in gut microbial richness and diversity in these patients. The researchers also observed changes in the relative abundances of certain bacterial families and metabolic pathways. However, the study had limitations, such as a small sample size and potential confounding factors. Further research is needed to better understand the effects of prebiotic supplementation in different subpopulations of kidney transplant recipients and its impact on health outcomes. [Extracted from the article]

Renal transplantation is the treatment of choice for improved survival and quality of life in patients with end-stage renal disease. However, perirenal fluid collections are common surgical complications after renal transplant, with about 0.6 to 18% of patients developing a lymphocele. Conventional treatments include percutaneous aspiration and drainage, laparoscopic fenestration, and open surgical decompression stepwise. Recently, a new image-guided percutaneous transperitoneal balloon fenestration technique has been described as an alternative to the laparoscopic or surgical technique. We present the case of a 25-year-old male patient diagnosed with a lymphocele after 2 months of transplantation and no resolution of the lymphocele with percutaneous aspiration and drainage. We used this new technique under ultrasound and fluoroscopy guidance, which resulted in the resolution of the lymphocele at 1 month postprocedure. This case report highlights this new technique's potential role in successfully managing the posttransplant lymphocele in a minimally invasive manner. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease (CKD) may affect the human microbiome via increased concentrations of uremic toxins such as urea and creatinine. Methods: We have profiled the oral microbiota in patients with CKD before and one week after kidney transplantation. Living kidney donors were also longitudinally tracked over a similar period, allowing direct comparison between a group undergoing transplant surgery alone (donors) (n=13) and a group additionally undergoing the introduction of immunosuppressive agents and the resolution of CKD (recipients) (n=45). Results: Transplantation was associated with a similar pattern of decreasing alpha diversity in the oral microbiome in recipients and donors via Kruskal-Wallis testing, within one week of transplantation. Amplicon sequence variants (ASVs) associated with Haemophilus parainfluenzae, Aggregatibacteria segnis, Peptostreptococcus and Actinobacillus were significantly decreased in recipients within a week of transplantation. Discussion: A reduction in ASVs in these genera could influence the risk of bacterial endocarditis, a rare but high-mortality kidney transplantation complication. A range of factors may drive the observed changes in oral microbiome including both factors associated with surgery itself and the decreases in salivary urea, administration of macrolide antibiotic immunosuppressants, and disruption to immune function that characterise kidney transplant. [ABSTRACT FROM AUTHOR]

Background: BK polyomavirus (BKV) infection is a common complication of kidney transplantation. While BKV has been described in non‐kidney transplant recipients, data are limited regarding its epidemiology and outcomes in pancreas transplant recipients. Methods: We conducted a retrospective cohort study of adults who underwent pancreas transplantation from 2010–2020. The primary outcome was BKV DNAemia. Secondary outcomes were estimated glomerular filtration rate (eGFR) reduction by 30%, eGFR < 30 mL/min/1.73 m2, endstage kidney disease, and pancreas allograft failure. Cox regression with time‐dependent variables was utilized. Results: Four hundred and sixty‐six patients were analyzed, including 74, 46, and 346 with pancreas transplant alone (PTA), pancreas‐after‐kidney, or simultaneous pancreas–kidney transplants, respectively. PTA recipients experienced a lower incidence of BKV DNAemia (8.8% vs. 32.9%; p <.001) and shorter duration of DNAemia (median 28.0 vs. 84.5 days). No PTA recipients with BKV DNAemia underwent kidney biopsy or developed endstage kidney disease. Lymphopenia, non‐PTA transplantation, and older age were associated with BKV DNAemia, which itself was associated with pancreas allograft failure (adjusted hazard ratio 2.14, 95% confidence interval 1.27–3.60; p =.004). Among PTA recipients, BKV DNAemia was not associated with eGFR reduction or eGFR < 30 mL/min/1.73 m2. Conclusions: BKV DNAemia was common among PTA recipients, though lower than a comparable group of pancreas–kidney recipients. However, BKV DNAemia was not associated with adverse native kidney outcomes and no PTA recipients developed endstage kidney disease. Conversely, BKV DNAemia was associated with pancreas allograft failure. Further studies are needed to estimate the rate of BKV nephropathy in this population, and further evaluate long‐term kidney outcomes. [ABSTRACT FROM AUTHOR]

• Kidney transplant incisions are challenging due to tissue swelling from copious intravenous fluids. • An extra drain placed under the skin reduced infections from 17% to 3%. • Improved results were observed in the group with the extra drain despite having more risk factors for wound infections. Wound infections following kidney transplantation are common, with a reported incidence of 5%–19%. In the first few days after surgery, these patients receive extremely high doses of immunosuppression and high volumes of intravenous fluids, and they represent a specific subgroup of surgical patients that may benefit from using prophylactic subcutaneous drains. We analyzed a nonrandomized series of 112 consecutive kidney transplants between January 2017 and December 2019: those who received a subcutaneous drain in addition to the standard retroperitoneal drain (SQ drain group) vs those with a retroperitoneal drain alone (standard group). The SQ drain group had a significantly higher median BMI (31.2 vs 25.8, P <.0001) and a trend towards more patients having diabetes and receiving thymoglobulin on induction. Nonetheless, 1/36 (3%) of patients in the SQ drain group had a documented wound infection requiring packing compared to the standard group 13/73 (17%) (P =.032). When multivariate regression analysis accounted for the potential confounders BMI, thymoglobulin use, and diabetes, the protective effect of the SQ drain was more significant (P =.001). An SQ drain may be a simple and inexpensive method to reduce the rate of wound complications in kidney transplant recipients; prospective studies are warranted. [ABSTRACT FROM AUTHOR]

A 53-year-old man underwent a living donor kidney transplantation in the right iliac fossa 25 years prior to presentation. He had been noting an inguinal bugle that became more prominent as the day progressed, and it regressed at night. Upon further investigations, an ultrasound of the allograft revealed moderate-to-severe hydronephrosis. A computed tomography scan revealed herniation of the bladder and part of the transplanted ureter within the supravesical/direct inguinal space. Lichtenstein-like fashion of repair was performed, and the patient continues to enjoy satisfactory graft function with no recurrence. The case illustrates a rare hernia as a late complication of the kidney transplant incision leading to ureteric obstruction and a successful attempt at operative repair. [ABSTRACT FROM AUTHOR]

Background: Histiocytic sarcoma (HS) is defined as neoplasm resembling morphological and immunophenotypic characteristics of mature histiocytes. It is a rare form of lymphoid neoplasms. Despite advances in treatment and diagnosis of histiocytic sarcoma, majority of cases had poor prognosis due to progressive nature of the disease. In the following article, all reported cases of histiocytic sarcoma in renal transplant patients are reviewed. Methods: In our literature review, all relevant reports were collected electronically by entering the necessary keywords. A Boolean approach using Medical Subject Heading (MeSH) keywords was implemented. After establishing the inclusion/exclusion criteria, article titles and abstracts were evaluated by Systematic Reviews and Meta-Analyses (PRISMA) standards for 2020. All cases of histiocytic sarcoma in renal transplant patients were included. Result: Based on our inclusion and exclusion criteria 4 case reports were yielded in this review. Two were males and 2 were females with the mean age of 42.25 years. Fever was the most common symptom. Although tumor originated from the native kidney on one patient, the site of the primary tumor was thorax, oropharynx, and transplanted kidney in the rest. Metastasis was detected in all cases. Prednisone was used for all cases. EBV was positive in 2 cases and negative in one of them. Histology was diagnostic and similar in all cases. Immunohistochemistry was done for 3 cases. Although chemotherapy was done for 3 patients, all 4 cases ended in mortality. Conclusion: Despite the fact that neoplasms are post renal transplant complications, histiocytic sarcoma is a scarce and fatal entity in such patients. Histological and immunohistochemistry tests are the corner stone in diagnosis of histiocytic sarcoma. [ABSTRACT FROM AUTHOR]

BACKGROUND: Urinary tract infections (UTI) are the most common infectious complications after kidney transplantation (KTx) with highest incidence in the first three months of transplantation. UTI in transplant recipients increase morbidity and mortality, risk of graft failure and incidence of acute rejection episodes. According to published data, urinary tract infections significantly affect graft survival. The aim of our study was to identify possible risk factors for the development of UTI. MATERIAL AND METHODS: We retrospectively analyzed a cohort of patients who received kidney transplantation between January 2014 and December 2016 in the Transplant Center of Louis Pasteur University Hospital in Košice. One hundred and fifty-three patients after kidney transplantation were included in the study. RESULTS: A total of 47 Caucasian patients (30%) developed UTI, namely - acute pyelonephritis after KTx. We identified independent risk factors associated with UTI such as female gender OR (7.98, 95% CI 2.88-22.12, p < 0.001), diabetes mellitus (OR 5.26, 95% CI 2.01-13.74, p = 0.001; 95% CI 4.57-53.82, p < 0.001) urologic complication (OR 15.68, 95% CI 4.57-53.82; p < 0.001) and acute rejection episode (OR 3.15, 95% CI 1.13-8.76, p = 0.027). The most common microbiological agent was Escherichia coli. CONCLUSION: We identified the aforementioned risk factors of urinary tract infections in the files of our patients. Statistically, the most significant risk factors are the female gender, and presence of urological complications. The urological complications and BMI of the patients are considered modifiable factors. Based on our analysis, we confirmed a significantly higher number of ACR patients who overcame infection which is in accordance with the published data on association of UTI with the development of acute cellular rejection (ACR) (Tab. 2, Fig. 1, Ref. 15). [ABSTRACT FROM AUTHOR]

Background: Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6–18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication. Methods/design: This is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial. Discussion: The high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety. Trial registration: ClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02–18-2021). [ABSTRACT FROM AUTHOR]

Background: Ischemia/reperfusion injury (IRI), acute rejection (AR), and delayed graft function (DGF) might occur as major complications following kidney transplantation. Thus, the identification of biomarkers for the IRI, AR, and/or DGF development becomes crucial as it may help to guide post-transplant management. Natural killer (NK) cells, hepatic interstitial T-lymphocytes (T-Li), and NK-T cells are crucial in both innate and adaptive immunity after abdominal solid organ transplantation. Hence, the aim of this study was to evaluate the impact of the immune system after graft reperfusion during KT in adults in order to identify predictive biomarkers. Methods: The NK, T-Li, and NK-T phenotypes and concentrations were retrospectively analyzed in a consecutive series of liver perfusates obtained after organ procurement flushing the abdominal cavity recovered from deceased brain donors (DBDs). Their percentage was compared with the renal transplant recipients' characteristics with kidneys taken from the same DCDs. The hepatic perfusate cells were purified by density gradient centrifugation. Flow cytometric investigation was used to determine their phenotype with the following immunological markers in order to determine the relative percentage of T-Li, NK-T, and NK cells: CD3, CD4, CD8, and CD56. Results: 42 DBDs' liver perfusates were analyzed. The related clinical outcomes of kidney transplant recipients from 2010 to 2020 performed at our Institute were evaluated. Time in days of delayed functional recovery of transplanted kidneys (DGF) (p = 0.02) and the onset of secondary infection from a cytomegalovirus (p = 0.03) were significantly associated with the T-Li percentage. An increased relative risk (HR) of organ survival was significantly associated with the percent cell concentration of T-Li and time to DGF, on COX analysis, were (HR = 1.038, p = 0.04; and HR = 1.029, p = 0.01, respectively). None relevant clinical outcomes in kidney transplant patients were associated with the specificity of the NK and NK-T cell proportions. Conclusions: A new potential role of T-Li cells was detected in the context of hepatic perfusate from DBDs. It could detect potential impacts in organ allocation, surgical procuring techniques, and in the analysis of IRI pathophysiological events. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ureteral obstruction is a common complication after kidney transplantation. Ureteral obstruction caused by inguinal hernia, however, is a rare complication of transplantation and requires urgent surgical repair to prevent allograft loss. CASE PRESENTATION: A 58-year-old man presented with allograft dysfunction 18-years after renal transplant. He was compliant with medications and given the long duration of allograft survival, a primary renal etiology was suspected. Thus, the initial work-up included allograft biopsy that was unremarkable. Three months later, worsening allograft function prompted further evaluation. At this time, allograft ultrasound and computed tomography led to the diagnosis of ureteral obstruction due to uretero-inguinal herniation of left kidney transplant secondary to bilateral sliding inguinal hernias. The patient was also found to have incidental renal cell carcinoma of the left native kidney. A percutaneous nephrostomy tube was placed and then followed by surgical repair with ureteral reimplantation, herniorrhaphy with mesh, and left native nephrectomy. CONCLUSIONS: Mechanical obstruction can occur years after kidney transplantation. Even though it is uncommon, ureteral obstruction due to inguinal herniation is critical. Early detection of this complication and surgery can salvage the allograft and prolong function. [ABSTRACT FROM AUTHOR]

• For the average patient with end-stage renal disease, kidney transplantation improves quality of life and prolongs survival compared with patients on the transplant waiting list who remain on dialysis. • Patients ≥65 years of age represent an increasing proportion of adults with end-stage renal disease and kidney transplantation. • A more rigorous pretransplant evaluation, focusing on cardiovascular disease and strict exclusion criteria, is recommended for patients ≥65 years. For the average patient with end-stage renal disease, kidney transplantation improves quality of life and prolongs survival compared with patients on the transplant waiting list who remain on dialysis. Patients ≥65 years of age represent an increasing proportion of adults with end-stage renal disease, and kidney transplantation outcomes remain controversial in this population. The aim of this study was to evaluate factors that may increase 1-year mortality after renal transplantation in older recipients. A retrospective study that included 147 patients (75.5% men) ≥65 years old (mean age 67.5 ± 2 years) who were transplanted between January 2011 and December 2020. The mean follow-up was 52.6 ± 27.2 months. Rehospitalization (<1 year) occurred in 39.5% of patients. Infectious complications were present in 18.4% of patients. The overall mortality rate was 23.1%, and 1-year mortality was 6.8%. As 1-year mortality predictors, we found a positive correlation with factors related to kidney transplant, such as cold ischemia time (P =.003), increasing donor age (P =.001); and factors related to the receptor such as pretransplantation dialysis modality as peritoneal dialysis (P =.04), cardiovascular disease (P =.004), delayed graft function (P =.002), early cardiovascular complications after kidney transplant (P <.001), and early rehospitalizations (P <.001). No correlation was found between 1-year mortality and age, sex, race, body mass index, and type of kidney transplant. A more rigorous pretransplant evaluation, focusing on cardiovascular disease and strict exclusion criteria, is recommended for patients ≥65 years old. [ABSTRACT FROM AUTHOR]

Introduction. Inguinal herniation of the ureter is a rare entity that occurs either as a complication of renal transplantation or spontaneously. Patients may suffer from obstructive uropathy or groin pain due to the unusual ectopic course of the ureter. This case report highlights the importance of recognizing a ureteroinguinal hernia. Methods. In this case report, we present a 75-year-old man with a surgical history of a right inguinal hernia repair who was referred to our center with burning left inguinal pain that persisted for two weeks. The patient's history and physical examination were consistent with an inguinal hernia. The suspected indirect inguinal hernia was found on preoperative imaging to be a tubular structure distinct from the intestine or adjacent organs. An open exploration of the inguinal canal was performed to prevent further hernia development. Results. The unusual structure in the inguinal canal turned out to be an ectopic ureter originating from the left upper pole moiety of the left duplex kidney (i.e., with duplicated ureters) and containing concentrated urine, as confirmed on a postoperative computerized tomography urogram. Conclusion. It is crucial to perform a thorough clinical examination and utilize adequate imaging modalities before surgical procedures when encountering unidentified structures. [ABSTRACT FROM AUTHOR]

Objective: To determine whether kidney transplants performed during weekends have worse outcomes than those performed during weekdays. Methods: For this systematic review, PubMed, EMBASE, and the Cochrane Library (January 2000 to January 2023) were searched. We examined the survival rates of patients and grafts for hospital inpatients admitted during weekends and those admitted during weekdays. To be included, the study had to be in English and had to provide discrete survival data around weekends versus weekdays, including patients who were admitted as inpatients over the weekend. Results: Five studies (n = 163,506 patients) were examined. The hazards ratio (HR) of the survival rate of patients with weekend transplantation was 1.01 (95% confidence interval [CI], 0.96 to 1.06) when compared with patients with weekday transplantation. Patients who had renal transplant on weekends had an overall allograft survival HR of 1.01 (95% CI, 0.99 to 1.03) and death-censored allograft survival HR of 1.01 (95% CI, 0.98 to 1.04). Comparison of length of hospital stay, rejection, surgical complications, and vascular complications between renal transplants on weekends and those on weekdays showed no statistical difference. Conclusion: Hospital inpatients admitted for renal transplantation during weekends have a survival rate similar to that of inpatients admitted during weekdays. The weekend effect of renal transplantation was very weak; hence, transplantations done during weekends and weekdays are both appropriate. [ABSTRACT FROM AUTHOR]

Kidney transplantation is the best option for end-stage chronic kidney disease. Transplant viability is conditioned by drugs' nephrotoxicity, ischemia–reperfusion damage, or acute rejection. An approach to improve graft survival is the identification of post-transplant renal function prognostic biomarkers. Our objective was to study three early kidney damage biomarkers (N-acetyl-d-glucosaminidase, NAG; neutrophil gelatinase-associated lipocalin, NGAL; and kidney injury molecule-1, KIM-1) in the initial period after transplantation and to identify possible correlations with main complications. We analysed those biomarkers in urine samples from 70 kidney transplant patients. Samples were taken on days 1, 3, 5, and 7 after intervention, as well as on the day that renal function stabilised (based on serum creatinine). During the first week after transplant, renal function improved based on serum creatinine evolution. However, increasing levels of biomarkers at different times during that first week could indicate tubular damage or other renal pathology. A relationship was found between NGAL values in the first week after transplantation and delayed graft function. In addition, higher NAG and NGAL, and lower KIM-1 values predicted a longer renal function stabilisation time. Therefore, urinary NAG, NGAL, and KIM-1 could constitute a predictive tool for kidney transplant complications, contributing to improve graft survival rates. [ABSTRACT FROM AUTHOR]

Laparoscopic donor nephrectomy (LDN) is the preferred method for kidney retrieval in live donor kidney transplantation. The surgical technique of LDN has improved over the years, but ureteral complications are still common after kidney transplantation. The relationship between the surgical technique in LDN and ureteral complications has been debated. This study aims to discuss ureteral complications and risk factors in kidney transplantation in a group of patients performed with a standard technique. A total of 751 live donor kidney transplantations were included in the study. Age, sex, body mass index, concomitant metabolic diseases, nephrectomy side, multiple renal arteries, and several complete or incomplete duplicated ureters of donors were recorded. The recipient's age, sex, body mass index, duration of dialysis, the daily volume of urine before transplantation, accompanying metabolic diseases, and postoperative ureteral complications were also recorded. Of the 751 patient donors included in the study, 433 (57.7%) were female, and 318 (42.3%) were male. Of the 751 recipients, 291 (38.7%) were female, and 460 (61.3%) were male. In the 751 recipients, there were 8 (1.0%) ureteral complications, all of which were ureteral strictures. No ureteral leaks or urinomas were noted in this series. There was no statistically significant relation between donor age, donor body mass index, donor side, presence of hypertension in the donor, presence of diabetes mellitus in the donor, or ureteral complications. The mean duration of dialysis and preoperative daily urine volume were associated with increased ureteral complications with statistical significance. Recipient factors may affect ureteral complication rates in live donor kidney transplantation, donor nephrectomy technique, and gonadal vein preservation. [ABSTRACT FROM AUTHOR]

Objective: Post‐transplantation diabetes mellitus (PTDM) is a common complication in renal transplant recipients (RTRs). Gut microbiome plays important roles in a variety of chronic metabolic diseases, but its association with the occurrence and development of PTDM is still unknown. The present study integrates the analysis of gut microbiome and metabolites to further identify the characteristics of PTDM. Methods: A total of 100 RTRs fecal samples were collected in our study. Among them, 55 samples were submitted to Hiseq sequencing, and 100 samples were used for non‐targeted metabolomics analysis. The gut microbiome and metabolomics of RTRs were comprehensively characterized. Results: The species Dialister invisus was significantly associated with fasting plasma glucose (FPG). The functions of tryptophan and phenylalanine biosynthesis were enhanced in RTRs with PTDM, while the functions of fructose and butyric acid metabolism were reduced. Fecal metabolome analysis indicated that RTRs with PTDM had unique metabolite distribution characteristics, and two differentially expressed specific metabolites were significantly correlated with FPG. The correlation analysis of gut microbiome and metabolites showed that gut microbiome had an obvious effect on the metabolic characteristics of RTRs with PTDM. Moreover, the relative abundance of microbial function is associated with the expression of several specific gut microbiome and metabolites. Conclusions: Our study identified the characteristics of gut microbiome and fecal metabolites in RTRs with PTDM, and we also found two important metabolites and a bacterium were significantly associated with PTDM, which might be used as novel targets in the research field of PTDM. [ABSTRACT FROM AUTHOR]

Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months posttransplantation (M3). However, many adverse events occurring earlier might be missed, and stratification at 1 month post-transplantation (M1) has not been investigated. We retrospectively analyzed case data from 589 patients who had undergone kidney transplantation between 2011 and 2021 at three German transplant centers. Tacrolimus metabolism was estimated by use of the C/D ratio at M1, M3, M6, and M12. C/D ratios increased substantially during the year, particularly between M1 and M3. Many viral infections and most graft rejections occurred before M3. Neither at M1 nor at M3 was a low C/D ratio associated with susceptibility to BKV viremia or BKV nephritis. A low C/D ratio at M1 could not predict acute graft rejections or impaired kidney function, whereas at M3 it was significantly associated with subsequent rejections and impairment of kidney function. In summary, most rejections occur before M3, but a low C/D ratio at M1 does not identify patients at risk, limiting the predictive utility of this stratification approach. [ABSTRACT FROM AUTHOR]

Early-on post kidney transplantation, there is a high risk of graft rejection and opportunistic viral infections. A low tacrolimus concentration/dose (C/D) ratio as a surrogate marker of fast tacrolimus metabolism has been established for risk stratification 3 months posttransplantation (M3). However, many adverse events occurring earlier might be missed, and stratification at 1 month post-transplantation (M1) has not been investigated. We retrospectively analyzed case data from 589 patients who had undergone kidney transplantation between 2011 and 2021 at three German transplant centers. Tacrolimus metabolism was estimated by use of the C/D ratio at M1, M3, M6, and M12. C/D ratios increased substantially during the year, particularly between M1 and M3. Many viral infections and most graft rejections occurred before M3. Neither at M1 nor at M3 was a low C/D ratio associated with susceptibility to BKV viremia or BKV nephritis. A low C/D ratio at M1 could not predict acute graft rejections or impaired kidney function, whereas at M3 it was significantly associated with subsequent rejections and impairment of kidney function. In summary, most rejections occur before M3, but a low C/D ratio at M1 does not identify patients at risk, limiting the predictive utility of this stratification approach. [ABSTRACT FROM AUTHOR]

Ureteral complications such as urinary leak, ureteral necrosis or ureteral stenosis are common complications after renal transplantation with major short- and long-term issues, including graft impairment and graft loss. At present, there is no agreement on the optimal management of ureteral complications. The aim of the current study was to evaluate the safety and efficacy of the self-expanding, large-caliber Allium ureteral stent in patients with ureteral complications following renal transplantation. In this retrospective study, the electronic database of Charité University Hospital was screened for patients receiving the self-expandable Allium ureteral stent in the transplant ureter after kidney transplantation between January 2016 and March 2022. Descriptive statistics were used to describe the outcomes. There were six men and four women with a median age of 61 years (interquartile range, 55 to 68 years). Nine out of 10 patients had ureteric stenosis, which was diagnosed at a median of two years (interquartile range 10 months to 9 years) following renal transplantation. The median operating time was 49 min (interquartile range, 30 to 60 min). Endoscopic Allium stent placement was successful in all patients with ureteric stenosis. The median length of stay in the hospital was four days (interquartile range 2 to 7 days). Only one patient (#5) had a postoperative grade IIIb Clavien–Dindo complication. Patients had follow-ups every 3 months with ultrasound and serum creatinine. Dislocation of the Allium stent was seen in four patients; all occurred within three months. Ultimately, three patients required ureteric re-implantation, two of which had early dislocation of the stent. Six patients are managed with a permanent Allium stent. The median dwell time was 11 months (interquartile range 3 to 20 months) and maximum dwell time was 23 months. The overall success rate was 60% (6 out of 10). According to our data, the Allium stent represents a safe and minimally invasive option with a success rate of 60%. It might, therefore, represent an alternative to DJ stents, nephrostomies or immediate re-implantation. As all dislocations occurred within three months, frequent early postoperative follow-up is required. [ABSTRACT FROM AUTHOR]

The aim of this review is to discuss end-stage renal disease (ESRD) and renal transplant complications and present the nuclear medicine imaging findings. The conditions discussed are renal osteodystrophy, metastatic calcification, and renal transplant complications, such as vascular occlusion and acute tubular necrosis. A total of eight nuclear medicine imaging scintigraphy primarily of bone and renal scintigraphy were selected and the imaging features of the complications are discussed. This article highlights the role of nuclear medicine imaging in diagnosis, quantitative and qualitative assessment of renal function, and monitoring of complications associated with ESRD and renal transplant. [ABSTRACT FROM AUTHOR]

With this 24-months stability, we believe that the gut, circulating (blood), and oral microbiomes of LKD may have limited impact to assess long-term risks of cardiovascular and kidney disease in LKD. Changes in the post-transplantation gut microbiome have been described in kidney transplant recipients (KTR), namely a decrease in overall microbial diversity and an increase in Enterobacteriaceae.[[1]] In addition, gut microbiome may influence tacrolimus dosage, and, in a bidirectional relation, the immunosuppressive therapy and the infection and rejection episodes may alter gut microbiome.[3] In the last decade, several alerts have been raised on the long-term risks of living kidney donors (LKD) regarding kidney and cardiovascular disease.[4] While considering these warnings, additional tools should be explored to help to assess these risks in LKD. [Extracted from the article]

Introduction Vascular complications are severe complications of pediatric kidney transplantation (KT). We aimed to investigate whether a complex bench surgery (BS) affects the outcomes. Methods All pediatric KT performed at the University Hospital of Padua from 2015 to 2019 were analyzed, comparing those in which a standard BS was possible to those that necessitated a complex BS. The rates of vascular complications, patients' outcome, and graft survival were compared in the two groups. Results Eighty KTs were performed in 78 patients with a median age of 11 years (interquartile range [IQR] 4.3–14) and a median body weight of 24 kg (IQR 13–37). Thirty-nine donor kidneys (49%) needed a complex BS due to anomalies of renal veins in 12 (31%) and renal arteries in 16 (41%). The remaining 11 grafts (28%) underwent an elongation of the vein. There was no difference in the rate of primary graft non function (p = 0.97), delayed graft function (p = 0.72), and overall survival (p = 0.27). The rates of vascular complications, bleedings, and venous graft thrombosis were similar (p = 0.51, p = 0.59, p = 0.78, respectively). No arterial thrombosis or stenosis was reported. Conclusion Complex BS did not compromise survival of the graft and did not put the allograft at risk of vascular complications, such as bleedings or thrombosis. [ABSTRACT FROM AUTHOR]

Incisional hernias (IH) constitute a complication after kidney transplant (KT). Patients may be particularly at risk because of comorbidities and immunosuppression. The study aim was to assess the incidence, risk factors, and treatment of IH in patients undergoing KT. This retrospective cohort study included consecutive patients who underwent KT between January 1998 and December 2018. Patient demographics, comorbidities, perioperative parameters, and IH repair characteristics were assessed. Postoperative outcomes included morbidity, mortality, need for reoperation, and length of stay (LOS). Patients who developed IH were compared with those who did not develop one. Forty-seven patients (6.4%) developed an IH after a median delay of 14 months (IQR, 6-52 months) in 737 KTs. On uni- and multivariate analyses, body mass index (odds ratio [OR], 1.080; P =.020), pulmonary diseases (OR, 2.415; P =.012), postoperative lymphoceles (OR, 2.362; P =.018), and LOS (OR, 1.013; P =.044) were independent risk factors. Thirty-eight patients (81%) underwent operative IH repair, and 37 (97%) were treated with a mesh. The median LOS was 8 days (IQR, 6-11 days). Three patients (8%) developed surgical site infections, and 2 patients (5%) presented hematomas requiring surgical revision. After IH repair, 3 patients (8%) had a recurrence. The incidence of IH after KT seems rather low. Overweight, pulmonary comorbidities, lymphoceles, and LOS were identified as independent risk factors. Strategies focusing on the modifiable patient-related risk factors and early detection and treatment of lymphoceles may help to decrease the risk of IH formation after KT. [ABSTRACT FROM AUTHOR]

Purpose: Ureteral strictures are a common complication after kidney transplantation. Open reconstruction is preferred for longsegment ureteral strictures that cannot be resolved endoscopically; however, it is known to have the potential to fail. We report 2 successful cases of robotic reconstruction surgery of a transplant ureter using the native ureter with the aid of intraoperative Indocyanine green (ICG). Materials and Methods: Patients were placed in semi-lateral position. Using Da Vinci Xi, the transplant ureter was dissected, and the stricture site was identified. End-to-side anastomosis of the native ureter to the transplant ureter was performed. ICG was utilized to identify the course of the transplant ureter and confirm the vascularity of the native ureter. Results: Case 1: A 55-year-old female underwent renal transplantation at another hospital. She had recurrent febrile urinary tract infections (UTIs) and a ureteral stricture requiring percutaneous nephrostomy (PCN). The PCN and ureteral stent were removed successfully after surgery. The patient had only 1 febrile UTI episode after surgery. Case 2: A 56-year-old female underwent renal transplantation at another hospital. She had acute pyelonephritis 1-month post-transplantation, and a long-segment ureteral stricture was identified. She developed a UTI with anastomosis site leakage in the early postoperative period, which resolved with conservative treatment. The PCN and ureteral stent were removed 6 weeks after surgery. Conclusions: Robotic surgery for managing long-segment ureteral stricture after kidney transplantation is safe and feasible. The use of ICG during surgery to identify the ureter course and its viability can improve the success. [ABSTRACT FROM AUTHOR]

BACKGROUND. Assessing circadian rhythmicity from infrequently sampled data is challenging; however, these types of data are often encountered when measuring circadian transcripts in hospitalized patients. METHODS. We present ClinCirc. This method combines 2 existing mathematical methods (Lomb-Scargle periodogram and cosinor) sequentially and is designed to measure circadian oscillations from infrequently sampled clinical data. The accuracy of this method was compared against 9 other methods using simulated and frequently sampled biological data. ClinCirc was then evaluated in 13 intensive care unit (ICU) patients as well as in a separate cohort of 29 kidney-transplant recipients. Finally, the consequences of circadian alterations were investigated in a retrospective cohort of 726 kidney-transplant recipients. RESULTS. ClinCirc had comparable performance to existing methods for analyzing simulated data or clock transcript expression of healthy volunteers. It had improved accuracy compared with the cosinor method in evaluating circadian parameters in PER2:luc cell lines. In ICU patients, it was the only method investigated to suggest that loss of circadian oscillations in the peripheral oscillator was associated with inflammation, a feature widely reported in animal models. Additionally, ClinCirc was able to detect other circadian alterations, including a phase shift following kidney transplantation that was associated with the administration of glucocorticoids. This phase shift could explain why a significant complication of kidney transplantation (delayed graft dysfunction) oscillates according to the time of day kidney transplantation is performed. CONCLUSION. ClinCirc analysis of the peripheral oscillator reveals important clinical associations in hospitalized patients. FUNDING. UK Research and Innovation (UKRI), National Institute of Health Research (NIHR), Engineering and Physical Sciences Research Council (EPSRC), National Institute on Academic Anaesthesia (NIAA), Asthma+Lung UK, Kidneys for Life. [ABSTRACT FROM AUTHOR]

Introduction: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. Methods: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. Results: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). Conclusion: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of medical complications after renal transplantation in recipients. Study Design: Prospective Cohort study. Setting: Nephrology Unit, Bahawal Victoria Hospital, Bahawalpur. Period: December 2018 to March 2022. Material & Methods: All patients undergoing renal transplant during the study period were included. Patients unwilling to be part of this study or losing follow-ups were excluded. At the time of enrollment, all patients underwent pre-transplant work-up and routine investigations. Baseline characteristics of renal transplant recipients and donors were noted while frequency of post renal transplant medical complications was also noted. Results: In a total of 39 renal transplant recipients, 32 (82.1%) were male while the mean age was 30.31±7.21 years. Mean duration of dialysis before transplantation was 6.81±5.15 months (ranging between 0-24 months). Mean age of the live donors was 35.90±9.36 years. Mean duration of follow up was 26.15±11.62 months. Renal graft dysfunction was reported in 10 (25.6%) patients. Most common medical complications reported in post-transplantation period were sepsis 19 (48.7%), anemia 19(48.7%), secondary polycythemia 10 (25.6%), CMV infection 4 (10.3%) and new onset diabetes mellitus 3 (7.7%). Mortality was reported in 2 (5.1%) renal transplant recipients and the cause of mortality in both those patients was sepsis. Conclusion: Medical complications are common after renal transplantation. Sepsis being more common in 1st6-months post-transplant period. Early recognition and management of these complications is essential for decreasing mortality and morbidity of patients. [ABSTRACT FROM AUTHOR]

Background: Renal transplantation is the most effective therapeutic strategy in ESRD patients. One of the renal transplantation complications is gastrointestinal bleeding due to peptic ulcers beside other upper gastrointestinal diseases that have a great impact on patients' morbidity and mortality. Objective: The present study is designed for endoscopic assessment of the prevalence of upper gastrointestinal lesions and also Helicobacter pylori infection in ESRD patients waiting for renal transplantation who have no GI symptoms. Methods: Our cross-sectional research was performed on 85 renal transplant candidates referred to organ transplantation center within 2016 to 2018. Patients who met inclusion criteria and didn't have exclusion criteria underwent upper endoscopy. We performed biopsies in each case and data were classified according to endoscopic results, Helicobacter pylori infection and pathologic findings. Results: In 53 patients (62%) there were significant endoscopic findings. Erosive gastroduodenitis (32.5%) was the most prevalent finding. Abnormal histopathologic findings were found in 73% of patients and Helicobacter pylori infection was detected in 48.2%. We found significant correlation between H. Pylori infection and abnormal pathology (p=0.04). Conclusion: Our results showed that asymptomatic gastrointestinal lesions and Helicobacter pylori infection were significantly prevalent in kidney transplant candidates thus routine upper endoscopy is recommended in them. This can result in early detection and treatment of gastric lesions before transplantation to prevent serious long-term complications. [ABSTRACT FROM AUTHOR]

MYH9-associated disorders represent rare group of autosomal dominant diseases and are caused by pathogenic mutations in the MYH9 gene. Clinically, they are represented by macro-platelet-thrombocytopenia, various degrees of renal dysfunction, hearing loss, and early onset cataracts. We describe the case of 14-year-old boy in medical follow-up from birth for thrombocytopenia. Systolic hypertension and nephrotic proteinuria were detected at preventive health check. Renal biopsy revealed sing of segmental glomerulosclerosis. Dialysis treatment was needed. Before transplantation due to the finding of chronic tonsillitis with positive bacterial capture in the culture examination, tonsillectomy was indicated. Postoperative period was complicated with arterial post-tonsillectomy hemorrhage. Six months after tonsillectomy, the patient underwent primary deceased-donor kidney transplantation without complication. Blood platelets showed fluctuating character in the zone of severe thrombocytopenia. However, no signs of bleeding were present. Three months after successful transplantation gene sequencing of whole exon was performed. The presence of the variant c.2105G>A [p.(Arg702HIS)] in exon 17 of the MYH9 gene has been detected. The variant c.2105G>A may be clinically manifested by progressive proteinuria with rapid deterioration of renal function. This case is an example of the delayed diagnosis of rare disease and highlights the usefulness of genetic testing. [ABSTRACT FROM AUTHOR]

Sevelamer (SV) is frequently used to control hyperphosphatemia in CKD patients. Relatively mild gastrointestinal (GI) intolerance was reported in a minority of patients in preclinical trials. More serious GI morbidity has been reported with general clinical use, including GI bleeding and colonic complications including colitis and perforation. Use of phosphate binders including SV may be required in the setting of delayed graft function (DGF) early post transplant. We report 3 cases of significant GI morbidity in association with SV occurring in transplant recipients within the first 2 weeks after kidney transplantation. One patient had a perforated colonic diverticulum associated with SV crystals. Two patients had severe esophagitis and esophageal ulcerations associated with SV crystals. Two patients had long-term use of SV prior to transplantation; one patient was treated with SV for a short time only after transplantation. SV use may have more serious GI adverse effects in CKD patients than noted in the original clinical trials, and should be considered as a potential cause of GI symptoms in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Posttransplant anemia (PTA) is a common complication of kidney transplantation, associated with reduced graft survival and higher mortality. We aimed to determine the association of PTA with histopathological characteristics of time-zero allograft biopsy and donor clinical characteristics. Methods: We conducted a retrospective, observational cohort study that included 587 patients who underwent kidney transplantation in our center. Hemoglobin levels were assessed at 6 and 12 months after transplantation, and anemia was defined according to World Health Organization criteria. The kidney allograft time-zero biopsy has been done in all investigated cases. The evaluated histopathological parameters of the kidney allografts included glomerulosclerosis, arteriolar hyalinosis (AH), vascular fibrous intimal thickening (CV), interstitial fibrosis, tubular atrophy, and interstitial fibrosis and tubular atrophy. The Banff Classification of Allograft Pathology criteria were followed to assess the allograft histopathological changes. Results: The prevalence of anemia was 31.3% at 6 months after transplantation and 23.5% at 12 months. There was an association between 20-50% glomerulosclerosis and PTA in both time points, independently from estimated glomerular filtration rate. AH and interstitial fibrosis were identified as independent risk factors for anemia 6 months after transplantation. Conclusion: Histopathological features of time-zero kidney biopsy may be predictors of PTA. Among them, our study recognized 20–50% degree of glomerulosclerosis, AH, and CV as the most significant risk factors for PTA. [ABSTRACT FROM AUTHOR]

• Sarcopenia can interfere with kidney transplantation outcomes by increasing surgical wound complications. • Sarcopenia has different aspects such as low muscle mass and low muscle quality, both of which seem to be more accurate in evaluating the risk for wound complications after kidney transplantation. • Renal graft rejection is associated with significant adventitious infiltration of the abdominal wall muscles. Sarcopenia is defined as a loss of muscle mass and strength. Its effects on postoperative outcomes in oncology and geriatrics have already been shown. Approximately 40% of patients in end-stage renal failure are affected with sarcopenia. A recent study suggests that sarcopenia could predict surgical complications after renal transplantation in obese patients. The aim of this study was to evaluate the effect of sarcopenia on parietal complications (eg, wound healing, lymphocele, hematoma). Two indices of muscle fat infiltration (intra-muscular adipose content [IMAC], Hounsfield unit average calculation [HUAC]) and 3 of muscle mass index (total psoas index [TPI], visceral fat area/total abdominal muscle area [VFA/TAMA], and skeletal muscle mass index [SMMI]) were retrospectively measured on pretransplant computed tomography scans for patients undergoing kidney transplantation between 2007 and 2017. Patients were considered sarcopenic when the index was above the third quartile for muscle fat infiltration (IMAC, HUAC) and VFA/TAMA, and under the first quartile for muscle mass (TPI, SMMI). The occurrence of wound healing, collection (hematoma and lymphocele), and acute rejection were compared between sarcopenic and nonsarcopenic patients. Of 484 transplanted patients, 117 patients had a computed tomography scan before transplantation. Patients with a high HUAC had significantly more collections (P =.02) and total parietal complications (P =.09). Patients with a high IMAC had significantly more acute rejection (P =.001). Muscle fat infiltration appears to influence the outcome of renal transplantation. The management of sarcopenia in pretransplantation should be a subject of further research. [ABSTRACT FROM AUTHOR]