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Medicina
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Kidney Transplantation—Clinical and Surgical Challenges
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Kidney Transplantation—Clinical and Surgical Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 21861

Special Issue Editors

Dr. Evaldo Favi

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Guest Editor
1. Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
2. Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
Interests: kidney transplantation; organ donation; immunosuppression; vascular access; polyomavirus
Special Issues, Collections and Topics in MDPI journals
Dr. Mariano Ferraresso

E-Mail Website
Guest Editor
1. Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Interests: kidney transplantation; organ donation; immunosuppression; vascular access
Special Issues, Collections and Topics in MDPI journals
Dr. Gabriella Moroni

E-Mail Website
Guest Editor
Nephrology and Dialysis, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Interests: lupus nephritis; glomerulonephritis; kidney transplantation; retroperitoneal fibrosis; systemic vasculitis

Special Issue Information

Dear Colleagues,

Kidney transplantation is universally considered as the treatment of choice for end-stage renal disease. In the last two decades, tremendous advances in surgical care and immunosuppressive therapy have led to a significant reduction in peri-operative mortality and morbidity as well as cell-mediated rejection rates. However, long-term allograft survival has not improved as we would have expected. Currently, the main causes of premature transplant loss are death with function, antibody-mediated rejection, polyomavirus-associated nephropathy, and calcineurin-inhibitor nephrotoxicity. Albeit less frequent, late vascular and urological complications such as renal artery stenosis, post-biopsy arteriovenous fistulas, ureteric stricture or allograft neoplasms also play a role.

The present Special Issue intends to explore the impact of clinical and surgical complications on long-term renal allograft survival as well as to analyse possible prevention and treatment strategies. Both common and rare complications will be considered, with the option of including narrative reviews and case reports of particular interest or exceptional didactical value.

“Kidney Transplantation—Clinical and Surgical Challenges” will give specialists involved in the care of renal transplant recipients the opportunity to share their experience or point of view on several relevant topics with the primary aims of improving global knowledge and patients’ outcomes.

Dr. Evaldo Favi
Prof. Ferraresso Mariano
Dr. Gabriella Moroni
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • kidney transplantation
  • organ donation
  • organ allocation
  • immunosuppression
  • allograft survival
  • patient survival
  • rejection
  • malignancy
  • complications
  • polyomavirus
  • cytomegalovirus

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Published Papers (6 papers)

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Editorial

Jump to: Review

3 pages, 238 KiB  
Editorial
Clinical and Surgical Challenges in Kidney Transplantation: Toward a Personalized Approach?
by Evaldo Favi and Roberto Cacciola
Medicina 2022, 58(5), 604; https://doi.org/10.3390/medicina58050604 - 27 Apr 2022
Viewed by 1498
Abstract
The continuously evolving practice of solid organ transplantation (SOT) in general and kidney transplantation (KT) in particular embodies the complexity of a composite, multi-step healthcare service [...] Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)

Review

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16 pages, 430 KiB  
Review
Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?
by Luca Nardelli, Antonio Scalamogna, Piergiorgio Messa, Maurizio Gallieni, Roberto Cacciola, Federica Tripodi, Giuseppe Castellano and Evaldo Favi
Medicina 2022, 58(2), 214; https://doi.org/10.3390/medicina58020214 - 1 Feb 2022
Cited by 13 | Viewed by 3386
Abstract
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available [...] Read more.
Kidney transplantation (KT) is recognized as the gold-standard of treatment for patients with end-stage renal disease. Additionally, it has been demonstrated that receiving a pre-emptive KT ensures the best recipient and graft survivals. However, due to an overwhelming discrepancy between the organs available and the patients on the transplant waiting list, the vast majority of transplant candidates require prolonged periods of dialysis before being transplanted. For many years, peritoneal dialysis (PD) and hemodialysis (HD) have been considered competitive renal replacement therapies (RRT). This dualistic vision has recently been questioned by evidence suggesting that an individualized and flexible approach may be more appropriate. In fact, tailored and cleverly planned changes between different RRT modalities, according to the patient’s needs and characteristics, are often needed in order to achieve the best results. While home HD is still under scrutiny in this particular setting, current data seems to favor the use of PD over in-center HD in patients awaiting a KT. In this specific population, the demonstrated advantages of PD are superior quality of life, longer preservation of residual renal function, lower incidence of delayed graft function, better recipient survival, and reduced cost. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
14 pages, 678 KiB  
Review
Allograft Vesicoureteral Reflux after Kidney Transplantation
by Alessandra Brescacin, Samuele Iesari, Sonia Guzzo, Carlo Maria Alfieri, Ruggero Darisi, Marta Perego, Carmelo Puliatti, Mariano Ferraresso and Evaldo Favi
Medicina 2022, 58(1), 81; https://doi.org/10.3390/medicina58010081 - 5 Jan 2022
Cited by 6 | Viewed by 3438
Abstract
Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the [...] Read more.
Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
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11 pages, 329 KiB  
Review
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in Kidney Transplantation
by Valentina Binda, Evaldo Favi, Marta Calatroni and Gabriella Moroni
Medicina 2021, 57(12), 1325; https://doi.org/10.3390/medicina57121325 - 3 Dec 2021
Cited by 2 | Viewed by 2694
Abstract
Due to complex comorbidity, high infectious complication rates, an elevated risk of relapsing for primary renal disease, as well as inferior recipient and allograft survivals, individuals with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) are often considered as poor transplant candidates. Although several aspects [...] Read more.
Due to complex comorbidity, high infectious complication rates, an elevated risk of relapsing for primary renal disease, as well as inferior recipient and allograft survivals, individuals with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) are often considered as poor transplant candidates. Although several aspects of recurrent and de novo AAVs remain unclear, recent evidence suggests that kidney transplantation (KT) represents the best option, which is also the case for this particular subgroup of patients. Special counselling and individualized approaches are strongly recommended at the time of enlistment and during the entire post-transplant follow-up. Current strategies include avoiding transplantation within one year of complete clinical remission and thoroughly assessing the recipient for early signs of renal or systemic vasculitis. The main clinical manifestations of allograft AAV are impaired kidney function, proteinuria, and hematuria with ANCA positivity in most cases. Mixed results have been obtained using high-dose steroids, mycophenolate mofetil, or cyclophosphamide. The aim of the present review was to summarize the available literature on AAVs in KT, particularly focusing on de novo pauci-immune glomerulonephritis. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
17 pages, 670 KiB  
Review
The Management of Immunosuppression in Kidney Transplant Recipients with COVID-19 Disease: An Update and Systematic Review of the Literature
by Roberta Angelico, Francesca Blasi, Tommaso Maria Manzia, Luca Toti, Giuseppe Tisone and Roberto Cacciola
Medicina 2021, 57(5), 435; https://doi.org/10.3390/medicina57050435 - 30 Apr 2021
Cited by 29 | Viewed by 4226
Abstract
Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy [...] Read more.
Background and Objectives: In the era of the coronavirus disease 2019 (COVID-19) pandemic, the management of immunosuppressive (IS) therapy in kidney transplant (KT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires attention. It is not yet understood whether IS therapy may protect from the cytokine storm induced by SARS-CoV-2 infection or a temporary adjustment/withdrawal of IS therapy to restore the immune system may be necessary. We performed a systematic literature review to investigate the current management of IS therapy in KT recipients with COVID-1. Materials and Methods: Out of 71 articles published from 1 February 2020 until 30 October 2020, 554 KT recipients with SARS-CoV-2 infection were identified. Results: Modifications of IS therapy were based on the clinical conditions. For asymptomatic patients or those with mild COVID-19 symptoms, a “wait and see approach” was mostly used; a suspension of antimetabolites drugs (347/461, 75.27%) or mTOR inhibitors (38/48, 79.2%) was adopted in the majority of patients with symptomatic COVID-19 infections. For CNIs, the most frequent attitude was their maintenance (243/502, 48.4%) or dose-reduction (99/502, 19.72%) in patients asymptomatic or with mild COVID-19 symptoms, while drug withdrawal was the preferred choice in severely symptomatic patients (160/450, 31.87%). A discontinuation of all IS drugs was used only in severely symptomatic COVID-19 patients on invasive mechanical ventilation. Renal function remained stable in 422(76.17%) recipients, while 49(8.84%) patients experienced graft loss. Eight (1.44%) patients experienced a worsening of renal function. The overall mortality was 21.84%, and 53(9.56%) patients died with functioning grafts. Conclusion: A tailored approach to the patient has been the preferred strategy for the management of IS therapy in KT recipients, taking into account the clinical conditions of patients and the potential interactions between IS and antiviral drugs, in the attempt to balance the risks of COVID-19-related complications and those due to rejection or graft loss. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
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9 pages, 323 KiB  
Review
New-Onset Diabetes after Kidney Transplantation
by Claudio Ponticelli, Evaldo Favi and Mariano Ferraresso
Medicina 2021, 57(3), 250; https://doi.org/10.3390/medicina57030250 - 8 Mar 2021
Cited by 39 | Viewed by 5455
Abstract
New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, [...] Read more.
New-onset diabetes mellitus after transplantation (NODAT) is a frequent complication in kidney allograft recipients. It may be caused by modifiable and non-modifiable factors. The non-modifiable factors are the same that may lead to the development of type 2 diabetes in the general population, whilst the modifiable factors include peri-operative stress, hepatitis C or cytomegalovirus infection, vitamin D deficiency, hypomagnesemia, and immunosuppressive medications such as glucocorticoids, calcineurin inhibitors (tacrolimus more than cyclosporine), and mTOR inhibitors. The most worrying complication of NODAT are major adverse cardiovascular events which represent a leading cause of morbidity and mortality in transplanted patients. However, NODAT may also result in progressive diabetic kidney disease and is frequently associated with microvascular complications, eventually determining blindness or amputation. Preventive measures for NODAT include a careful assessment of glucose tolerance before transplantation, loss of over-weight, lifestyle modification, reduced caloric intake, and physical exercise. Concomitant measures include aggressive control of systemic blood pressure and lipids levels to reduce the risk of cardiovascular events. Hypomagnesemia and low levels of vitamin D should be corrected. Immunosuppressive strategies limiting the use of diabetogenic drugs are encouraged. Many hypoglycemic drugs are available and may be used in combination with metformin in difficult cases. In patients requiring insulin treatment, the dose and type of insulin should be decided on an individual basis as insulin requirements depend on the patient’s diet, amount of exercise, and renal function. Full article
(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges)
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