Living donor transplant: Right vs left kidney

Khan et al’ single-centre, retrospective study on the use of right or left kidneys in living-donor renal transplantation, offers the opportunity to further discuss a complex and debated topic in clinical transplantation. In brief, the authors confirm that, despite the historical preference for left kidneys, attributed to their anatomical advantages during donor nephrectomy and recipient transplantation, right kidneys can provide excellent outcomes when donors and recipients are carefully selected, and a meticulous surgical technique is applied in every step of the process. Usefully, the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation, such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis. Although limited by the selective use of minimally invasive (MI) nephrectomy for left kidneys, this work underscores the importance of expanding the living-donor pool, challenging the traditional taboos, and facilitating access to transplantation for a wider population of patients around the globe. Properly designed studies with larger sample size, comparable MI surgical techniques, prospective data collection, and long-term donor and recipient outcomes are warranted.

Integrative analyses of 16S rDNA sequencing and serum metabolomics demonstrate significant roles for the oral microbiota and serum metabolites in post-kidney transplant diabetes mellitus

Oral microbiota and serum metabolites play crucial roles in diabetes, but their relationship with post-transplant diabetes mellitus (PTDM), a common complication post-kidney transplantation, is not well characterized. This study investigated the relationship of oral microbiota and serum metabolites with PTDM using integrative analysis of 16S rDNA sequencing and serum metabolomics. We recruited 61 kidney transplant recipients, including 30 in the PTDM group and 31 in normal glucose tolerance controls. Oral samples and serum samples were collected from all the kidney transplant patients to perform 16S rDNA sequencing and serum metabolomics analysis. We annotated 689 oral microbial species, including 134 species unique to the PTDM group and 157 species unique to the control group. PTDM group showed upregulation of 36 metabolites and downregulation of 19 metabolites. Based on the random forest machine learning algorithm, genera such as UCG-005 (AUC = 0.9355), Succinivibrio (AUC = 0.8108); Akkermansia (AUC = 0.7742), Anaerovibrio (AUC = 0.2667), and Schwartzia (AUC = 0.2667), and serum metabolites such as LPI 18:0 (AUC: 0.8086), methylglyoxal (AUC: 0.7946), Vulgarin (AUC: 0.7828), 2-mercaptobenzothiazole (AUC: 0.7591), and PI(18:0/20:3(5Z,8Z,11Z)) (AUC: 0.7419) showed high diagnostic potential and may serve as clinical biomarkers. Furthermore, clinical indicators in PTDM patients, such as creatinine, cystatin C, and urea, showed a significant association with the differential oral microbiota and serum metabolites. Dysbiosis in the oral microbiota of the PTDM patients was associated with changes in the serum metabolites and alterations in their functions. These findings provide new insights toward identifying mechanisms by which oral microbiota and serum metabolites contribute to the development of PTDM.IMPORTANCEThis study reveals an imbalance in oral microbiota in patients with post-transplant diabetes and uncovers the potential relationship between oral microbiota and serum metabolites. These findings provide new insights into the role of oral microbiota and serum metabolites in the treatment of post-transplant diabetes, offering relevant biomarkers for clinicians and future research.

JC Polyomavirus in Prostate Cancer-Friend or Foe?

Background/Objectives: Recently, many researchers have evaluated various viruses, including polyomaviruses (JCV, BKV) and EBV, as potential factors playing a role in the development and/or progression of prostate cancer (PCa), one of the most common cancers in men. Therefore, we aimed to assess the frequency of the JCPyV DNA in tissue collected from PCa patients. Methods: We detected the presence of viral DNA (PCR) in 49.6% of clinical samples, including 71.9% with single EBV infection and 28.1% with EBV/JCV co-infection. We did not detect BKV or a single JCV infection. Therefore, we compared patients with EBV mono-infection with EBV/JCV co-infected patients in the context of risk group, Gleason score, and TNM classification. Results: Our results showed differences in clinicopathological features between single EBV infection and EBV/JCV co-infection. In the group of patients with single EBV infection, most patients were classified as medium/high risk, while in the group with EBV/JCV co-infection, most patients were classified as low risk. Conclusions: Among patients with single EBV infection, a more advanced stage of cancer was observed than in EBV/JCV co-infection. Moreover, the level of anti-EBVCA and anti-EBNA antibodies as well as EBV load was higher in the case of single infection compared to EBV/JCV co-infection. Higher antibody levels were detected in more advanced tumor stages in single EBV infection. Does JCV only "reside" in prostate cells or is it a co-factor in EBV infection? In light of these studies, there is a need to clarify the role of JCV virus in the development and/or progression of prostate cancer.

Pretransplant Physical Activity and Cardiovascular Risk Factors in Kidney Transplant Candidates: A Cross-Sectional Study

Background/Objectives: Individuals with chronic kidney disease often face significant physical and clinical challenges, such as muscle weakness, fatigue, and reduced cardiorespiratory capacity, that impact their quality of life. Physical activity has emerged as an effective intervention to counteract these effects, with clinical guidelines recommending exercise as a standard treatment for kidney transplant recipients. The aim of this study was to assess pretransplant physical activity levels in a cohort of transplant patients and analyze their relationships with cardiovascular risk factors. Methods: A cross-sectional, analytical, and correlational study was conducted from September 2020 to June 2022 with a sample of 122 kidney transplant recipients assessed before kidney transplantation. Sociodemographic data, anthropometric data, comorbidities, renal replacement therapy types, and clinical and analytical data were collected from the patients' clinical records. Physical activity was assessed via the International Physical Activity Questionnaire. Results: The average time spent waiting for transplantation was 423 ± 405 days, which was longer (387 ± 524) in the group of those under 65 years than in those over 65 years (194 ± 256) (p = 0.010). The median energy expenditure was 1742 (IQR = 1719) METs. In addition, 15.6% of the participants reported inactivity. Men reported higher physical activity levels (median: 2076 METs/week; IQR: 2037) than women did (median: 1386 METs/week; IQR: 1238). A higher level of physical activity was found in non-dialysis patients, overweight patients, and those with a history of stroke. A significant positive correlation was found between physical activity levels and serum urea. Conclusions: Increased physical activity levels were observed in men and in participants under 65 years of age. Patients with cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, overweight and obesity, reported lower activity levels, whereas those with a prior history of cerebrovascular accidents engaged in more physical activity. This study highlights the importance of assessing physical activity and promoting exercise for chronic kidney disease patients awaiting kidney transplantation. Further research is needed to explore the evolution of physical activity in this population and its impact post-transplantation.

Dialysis and the risk of early urological cancer: A nationwide population-based cohort study in Taiwan

Patients with end-stage renal disease (ESRD) are predisposed to a higher risk of developing malignancies. This study aimed to explore the association between chronic dialysis with ESRD treated and the subsequent development of urothelial cell carcinoma or renal cell carcinoma (UC/RCC). Data spanning 13 years were retrieved from Taiwan's National Health Insurance Research Database. A total of 11,820 patients with ESRD undergoing maintenance dialysis between January 1, 2000, and December 31, 2013, and 35,460 controls matched for sex, age, and index year, were identified. After adjusting for confounding factors, Cox proportional hazards analysis was performed to compare the risk of UC/RCC during the 13-year follow-up period, and Kaplan-Meier analysis was used to evaluate the cumulative UC/RCC incidence between the ESRD and non-ESRD cohorts. The average time before developing UC/RCC was 4.18 years after dialysis initiation in the ESRD group compared to 5.39 years in the control group. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the hazard ratio for UC/RCC was 1.186 (95% confidence interval, 1.071-1.448; P = .005). Stratified by age, the odds ratios (ORs) for developing UC/RCC were 2.105, 1.498, 1.371, and 0.925 among patients with ESRD aged 40 to 49, 50 to 59, 60 to 69, and ≥ 70 years, respectively. Stratification by comorbidities revealed ORs of 1.204, 1.179, 1.186,1.172, 1.211, and 1.210 for patients without diabetes mellitus, hyperlipidemia, obesity, coronary artery disease, chronic obstructive pulmonary disease, and hematuria, respectively. The mean time to UC/RCC occurrence was 4.18 years after dialysis. Furthermore, younger male patients undergoing dialysis with fewer comorbidities were at higher risk of developing UC/RCC. Early or more intensive surveillance for urological cancers post-dialysis initiation is recommended for patients undergoing dialysis with longer life expectancies or a higher likelihood of undergoing renal transplantation.

Deciphering human endogenous retrovirus expression in colorectal cancers: exploratory analysis regarding prognostic value in liver metastases

BACKGROUND

Human Endogenous RetroVirus (HERV) expression in tumours reflects epigenetic dysregulation of cancer and an oncogenic factor through promoter/enhancer action on genes. While more than 50% of colorectal cancers develop liver metastases, HERV has not been studied in this context.

METHODS

We collected 400 RNA-seq samples from over 200 patients with primary and liver metastases, including public data and a novel set of 200 samples.

FINDINGS

We observed global stability of HERV expression between liver metastases and primary colorectal cancers, suggesting an early oncogenic footprint. We identified a list of 17 HERV loci for liver metastatic colorectal cancer (lmCRC) characterization; with tumour-specificity validated in single-cell metastatic colorectal cancer data and normal tissue bulk RNA-seq. Eleven loci produced HERV-derived peptides as per tandem mass spectrometry from primary colorectal cancer. Six loci were associated with the risk of relapse after lmCRC surgery. Four, HERVH_Xp22.32a, HERVH_20p11.23b, HERVH_13q33.3, HERVH_13q31.3, had adverse prognostic value (log-rank p-value 0.028, 0.0083, 9e-4, 0.05, respectively) while two, HERVH_Xp22.2c (log-rank p-value 0.032) and HERVH_8q21.3b (in multivariable models) were associated with better prognosis. Moreover, the markers showed a cumulative effect on survival when expressed. Some were associated with decreased cytotoxic immune cells and most of them correlated with cell cycle pathways.

INTERPRETATION

These findings provide insights into the lmCRC transcriptome landscape by suggesting prognostic markers and potential therapeutic targets.

FUNDING

This work was supported by funding from institutional grants from Inserm, EFS, University of Bourgogne Franche-Comté, national found "Agence Nationale de la Recherche - ANR-JCJC: Projet HERIC and ANR-22-CE45-0007", and "La ligue contre le cancer".

Surgical and Infectious Complications Following Kidney Transplantation: A Contemporary Review

Kidney transplantation significantly improves outcomes in patients with end-stage renal disease; however, postoperative complications remain a substantial concern. This review summarizes the incidence, risk factors, and management strategies for common complications after kidney transplantation. Reported incidence varies widely due to differences in definitions, diagnostic methods, and study designs. Ureteral stenosis occurs in 2.8-18.0% of recipients, vesicoureteral reflux in 0.5-86%, and urinary leakage in 1.1-7.2%. Lymphatic complications, including lymphocele and lymphorrhea, range from 0.6% to 35.2%, with one-third of complications requiring intervention. The incidence of urinary tract infections ranges from 20 to 43%, while asymptomatic bacteriuria is reported in up to 53% of recipients. Surgical site infections have a median incidence of 3.7%, and incisional hernias develop in 2.5-10% of cases, depending on follow-up duration. Vascular complications affect approximately 10% of recipients, with renal artery stenosis and thrombosis being the most prevalent. Neurologic complications, such as femoral nerve palsy and immunosuppression-related neurotoxicity, though less frequent, can impair recovery. Management strategies vary depending on severity, ranging from observation to surgical intervention. Preventive measures-including optimized ureteral stenting protocols, early catheter removal, careful immunosuppression, and appropriate antimicrobial use-play a crucial role in reducing complication risk. Despite advances in transplantation techniques and perioperative care, these complications continue to affect graft survival and patient outcomes. Further research is needed to standardize definitions and establish evidence-based protocols.

The Prevalence and Outcomes of BK Polyoma Virus Nephropathy in Living Donor Kidney Transplant Recipients

Background

BK polyomavirus nephropathy (BKPyVN) remains an important cause of allograft dysfunction and loss. There is little data about prevalence and outcome of BKPyVN infection from India in living donor kidney transplant recipients.

Materials and Methods

This is a retrospective analysis of all biopsy-proven BKPyVN among kidney transplant recipients at our center from January 2010 to January 2022. We compared them to age, sex, and type of immunosuppression received matched (1:2) non-BKPyVN-infected recipients transplanted during the same period.

Results

During the study period, 2465 patients underwent kidney transplants at our center, of which 26 (1.05%) developed biopsy-proven BKPyVN. Four recipients (16%) lost their graft over a median period of 65 (IQR, 57-83) months from the time of diagnosis. The mean serum creatinine at the recent follow-up was higher in the BKPyVN arm as compared to controls (2.05 ± 1.39 vs 1.35 ± 0.46, p = 0.001.) Both BKPyVN and control arms had similar death-censored graft survival (82% vs 94%, p = 0.09) and patient survival (88% vs 96%, p = 0.184).

Conclusion

BKPyVN was uncommon in our kidney transplant recipients. Most patients were able to maintain their kidney function for many years, albeit at a somewhat reduced level compared with the controls, and about a fifth of our patients lost their graft.

Peritoneal dialysis and kidney transplantation: Your questions answered

Peritoneal dialysis (PD) and kidney transplantation are important therapeutic options in patients with advanced kidney disease. This article delineates the relationship between PD and kidney transplantation in several key domains, including: (1) Comparative merits and limitations of PD versus center-based hemodialysis prior to kidney transplantation, (2) Patient outcomes after kidney transplantation in individuals receiving PD prior to kidney transplantation, (3) Perioperative management strategies of patients receiving PD at the time of kidney transplantation, and (4) The relative advantages and clinical outcomes of PD use following kidney allograft failure compared to other modalities. This article aims to provide comprehensive guidance for optimizing care across the PD-kidney transplant transitions continuum.

Frontiers and Controversies in De Novo Gastrointestinal Tumors After Organ Transplantation: Current Progress and Future Directions

The increasing success of organ transplantation has significantly improved survival for patients with end-stage diseases, yet it introduces a complex dilemma: the elevated risk for the development of de novo gastrointestinal (GI) tumors. The sustained immunosuppression required to maintain graft function paradoxically undermines the body's natural defenses against cancer, leading to a higher incidence, aggressive progression, and atypical presentations of GI tumors among transplant recipients compared with the general population. This presents a pressing challenge: balancing the dual imperatives of preventing graft rejection and effectively managing malignancies. Current treatment paradigms, including surgical approaches, chemotherapy, radiation therapy, and the emerging role of immunotherapy, are fraught with complexities due to the altered immune landscape in these patients. This review underscores the critical need to understand the multifaceted relationship between post-transplantation immunosuppression and tumorigenesis, providing a comprehensive exploration of epidemiologic shifts, pathophysiologic insights, and the intricacies of the tumor microenvironment in this unique patient population. Understanding and managing GI tumors in transplant recipients is not only a clinical challenge, but also a necessary frontier in transplant oncology, promising to refine therapeutic strategies and improve the longevity and quality of life for this growing patient cohort.

Outcomes of pancreas transplantation over two decades: a single-center retrospective cohort study

Purpose

Pancreas transplantation (PT) is a definitive treatment for diabetes mellitus (DM), restoring endogenous insulin secretion and improving glycemic control. Despite its efficacy, PT is less common in South Korea compared to Western nations. This study aims to report the clinical outcomes of PT over 2 decades at a single center, focusing on surgical techniques, complications, and graft survival.

Methods

A retrospective analysis of 69 PT recipients at Seoul National University Hospital between January 2002 and December 2023 was conducted. Data on recipient and donor demographics, surgical details, immunosuppressive regimens, and graft outcomes were collected. Graft survival was evaluated using Kaplan-Meier analysis, with subgroup comparisons using the log-rank test. Graft failure was defined as graft removal, PT re-registration, insulin dependence exceeding 0.5 units/kg/day for more than 90 days, or patient death.

Results

Among the 69 recipients, 50 (72.5%) had type 1 DM, and 18 (26.1%) had type 2 DM. Simultaneous pancreas-kidney (SPK) transplantations comprised 84.1% (n = 58), and pancreas-after-kidney (PAK) transplantations accounted for 10.1%. The 1-year and 5-year death-censored pancreas graft survival rates were 92.7% and 89.6%, respectively, with no significant difference between SPK and PAK (P = 0.330). Graft failure occurred in 10 patients, primarily due to pancreatitis and rejection. Donor-related factors, particularly anoxic brain injury, were significantly associated with lower graft survival (P = 0.045).

Conclusion

PT outcomes in this cohort align with international standards, emphasizing the importance of donor selection and tailored immunosuppression. Expanding PT indications to include selective type 2 DM patients could benefit South Korea's PT programs with adequate resource allocation.

Global, regional, and national burden of Visceral leishmaniasis, 1990-2021: findings from the global burden of disease study 2021

BACKGROUND

Leishmaniasis is a vector-borne parasitic disease caused by protozoa of the Leishmania genus; it is transmitted through the bites of infected phlebotomine sandflies. Clinically, it manifests in three primary forms: cutaneous, mucocutaneous, and visceral leishmaniasis (VL). Among these, VL represents the most severe form, characterized by high morbidity and mortality, and poses a considerable public health burden, particularly in endemic regions. This study utilizes data from the Global Burden of Disease (GBD) study 2021 to conduct a comprehensive analysis of the global epidemiological trends and burden of VL from 1990 to 2021, aiming to generate evidence-based insights to inform prevention and control strategies.

METHODS

Using GBD 2021 data, this study examined trends in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of VL across 204 countries and territories, stratified by age, sex, and sociodemographic index (SDI) levels. Average annual percent change (AAPC) was calculated to describe trends in age-standardized rates and indicator counts from 1990 to 2021.

RESULTS

From 1990 to 2021, the global age-standardized incidence rate (ASIR; AAPC = -0.25, 95% confidence interval (CI) -0.25, -0.24), age-standardized prevalence rate (ASPR; AAPC = -0.06, 95% CI -0.06, -0.05), age-standardized mortality rate (ASMR; AAPC = -0.03, 95% CI -0.04, -0.02), and DALY rate (AAPC = -2.38, 95% CI -2.44, -2.33) for VL all showed a declining trend. The ASMR was highest among children under 5 years old and decreased progressively with age. VL remains a critical and under-recognized tropical disease in Latin America, the Middle East, Africa, and South Asia.

CONCLUSIONS

VL disproportionately affects males and presents the highest risk in children under 5 years. Enhanced global collaboration in infectious disease control, with a focus on regions such as Latin America, Africa, the Middle East, and South Asia, is essential to further reduce the burden of VL.

COVID-19 Vaccine Perception in Liver Transplant Recipients: Patient-Reported Outcomes and Real-Life Experience from the Bergamo Center

BACKGROUND

Bergamo was the most severely affected Italian province at the onset of the 2020 COVID-19 pandemic. The liver transplant (LT) patient population should be among the more sensitized to the concept of health prevention. Long-term data on both perception and outcomes of SARS-CoV-2 vaccination in LT recipients since the COVID-19 vaccine became available in Italy are still lacking.

METHODS

From May to October 2023, a survey on actively followed LT recipients at our institution was carried on by the local patient' advocacy (Associazione Amici del Trapianto di Fegato) to define the rate of vaccinated subjects, SARS-CoV-2 infections and self-reported COVID-19-related outcomes.

RESULTS

Out of the consecutive 753 adult LT recipients invited to the survey, 356 responded (47.3%) [71% male, 63 years old (20-85), LT performed a mean of 9 years (1-26) before vaccination] and were included in the analysis. All patients received the first vaccine dose between December 2020 and January 2022 (81.7% Cominarty®, 17.7% Spikevax®, 0.3% Vaxzevria® and 0.3% Jcovden®). In the following years, adherence to the vaccination policy decreased progressively over time: the second, third, fourth, and fifth vaccine doses were administered to 99%, 94%, 72%, and 22% of the LT population by October, 2023. In total, 43 (12%) and 93 (26%) patients reported a COVID-19 episode before and after [13 (7-21) months] the first vaccination, respectively; none of the LT recipients reported a second COVID-19 infection after the following vaccination cycles. Forty-six (13%) reported short-term post-vaccination mild adverse events but none developed either acute or chronic rejection episodes or hospitalization for COVID-19-related symptoms. A total of 64% of LT recipients resulted positive for anti-nucleocapsid serological test in 2023.

CONCLUSIONS

COVID-19 vaccines are safe and effective in LT recipients, underlining once again the importance of vaccination in this special population at higher risk of complications from communicable infectious diseases.

Novel insights and an updated review of metabolic syndrome in immune-mediated organ transplant rejection

Metabolic syndrome (MetS) is a group of symptoms that are characterized by abnormal changes in metabolic substances such as glucose, lipids, proteins, and bile acids. MetS is a common complication after organ transplantation and can further affect the survival and physiological function of the graft by reprograming the patient's immune environment. Additionally, MetS can influence the occurrence of post-transplant complications, such as infections. In recent years, research into the epidemiology and mechanisms of MetS has grown significantly. In this review, we summarize the mechanisms of MetS after transplantation and the mechanisms of hyperglycemia, insulin resistance, hyperlipidemia, abnormal bile acids, and abnormal amino acids on the body's immune cells as related to the effect of metabolic disorders on immune rejection after liver, kidney, heart, skin and other organ transplantation. Finally, we provide an overview of current treatment strategies and offer insights into potential future therapies for managing MetS in transplant recipients.

Incidence of major urological cancers in patients on dialysis: a systematic review and meta-analysis

BACKGROUND

Studies have demonstrated an elevated risk of urological malignancies in individuals undergoing dialysis, which consequently leads to unfavorable prognoses and diminished quality of life for patients with end-stage kidney disease. Nevertheless, the absence of standardized recommendations for cancer screening and limited utilization of conventional screening methods within the dialysis population remain prevalent issues.

METHODS

A meta-analysis was conducted on cohort studies published prior to June 2024, aiming to quantify the cancer risk among individuals undergoing dialysis. Random-effects meta-analyses were employed to combine standardized incidence rates (SIRs) along with their corresponding 95% confidence intervals, considering a p-value of less than 0.05 or an I² value exceeding 50%. Subgroup analyses, heterogeneity tests, and sensitivity analyses were performed as well.

RESULTS

A total of 10 studies, consisting of 12 cohort studies, were ultimately identified, encompassing a collective patient population of 1,362,196 individuals. Compared to the general population, the pooled SIRs for all cancers except non-melanoma skin cancer (NMSC), major urological cancers (MUCs), cancers of the kidney/renal pelvis, bladder cancers and prostate cancers were 1.40 (95% CI: 1.28-1.54), 1.76 (95% CI: 1.45-2.14), 4.73 (95% CI: 3.96-5.64), 1.89 (95% CI: 1.61-2.21) and 0.94 (95% CI: 0.79-1.11), respectively. The cancer risk was notably elevated in specific subgroups of women, younger patients (age at first dialysis, 0-34 years), during the initial year of dialysis, and among Asian patients. SIRs differed when considering different primary renal diseases. However, high heterogeneity was observed among the studies investigating cancers during dialysis, while this heterogeneity did not have a substantial impact on the pooled SIRs for overall cancer, as determined through sensitivity analysis.

CONCLUSIONS

Compared with the general population, the dialysis population had a significantly increased risk of developing urological malignancies, particularly cancers of the kidney/renal pelvis. Our findings indicate a substantial increase in risks among female, young, Asian patients, during the first year of dialysis and highlight variations in SIRs based on primary renal disease. These results suggest the potential for adopting a more personalized approach to cancer screening in chronic dialysis patients. Given the considerable heterogeneity observed, further rigorous investigations are warranted to enhance our understanding in this area.

Dietary Guidelines Post Kidney Transplant: Is This the Missing Link in Recovery and Graft Survival?

The physiology of a transplanted kidney is affected from the moment it is separated from the donor. The risk of complications arising from surgery are highly associated with ischemic-reperfusion injury (IRI) due to the effects of hypoxia and oxidative stress during the procurement, preservation and reperfusion procedures. Hypoxia promotes the formation of reactive oxygen species (ROS) and it seems apparent that finding ways of optimising the metabolic milieu for the transplanted kidney would improve recovery and graft survival. Studies have demonstrated the benefits of nutrition and antioxidant compounds in mitigating the disturbance of energy supply to cells post-transplant and at improving long-term graft survival. Particularly in patients who may be nutritionally deficient following long-term dialysis. Despite the high incidence of allograft failure, a search of the literature and grey literature reveals no medical nutriti on therapy guidelines on beneficial nutrient intake to aid transplant recovery and survival. This narrative review aims to summarise current knowledge of specific macro and micronutrients and their effect on allograft recovery and survival in the perioperative period, up to 1-year post transplant, to optimise the metabolic environment and mitigate risk to graft injury.

Cancer risks in people on dialysis and kidney transplant recipients: a Catalan cohort study, 2003-21

Background

People with kidney failure have a higher risk of cancer compared with age- and sex-matched individuals in the general population, yet data from southern Europe are limited. This study explores cancer incidence in the kidney failure population in Catalonia.

Methods

We identified cancer cases through linkage of the Catalan Kidney Registry with Catalan cancer databases. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers in people on dialysis and kidney transplant recipients.

Results

We described the epidemiology of cancer in 21 595 people on dialysis and 8037 kidney transplant recipients in Catalonia (2003-21). Cancer risk was more than two times higher in people on dialysis (SIR 2.11, 95% CI 2.02-2.19) and nearly four times higher in kidney transplant recipients (SIR 3.82, 95% CI 3.65-3.99) compared with the general population. Risks varied by cancer site, with a significantly higher incidence of kidney and thyroid cancers in the dialysis cohort, and skin cancer in the transplant cohort. The highest cancer risks were observed in the youngest, those with glomerular diseases, and those with the longest time since transplantation.

Conclusions

People with kidney failure face a high burden of cancer, particularly after kidney transplantation. Understanding the epidemiology of cancer in the kidney failure population is crucial for shaping health policies.

Testis and penile cancers in kidney transplant recipients: A systematic review of epidemiology, treatment options and oncological outcomes by the EAU-YAU Penile and Testis Cancer Working Group

INTRODUCTION

Kidney transplant (KT) recipients are at an elevated risk of developing de novo cancers. However, penile (PeCa) and testis cancers have received limited attention in this setting.

OBJECTIVE

To summarize the epidemiology, treatment options, and oncological outcomes of penile and testis cancer in KT recipients.

EVIDENCE ACQUISITION

We conducted a systematic review of prospective, retrospective and national transplant registries studies published up to December 2023. Data on the incidence of penile and testis cancers among KT recipients, diagnostic protocols, screening recommendations, and therapeutic strategies tailored for KT recipients were collected. The risk of bias (RoB) of included studies was determined using the Newcastle and Ottawa scale.

EVIDENCE SYNTHESIS

Overall, 21 studies involving 67924 KT male recipients were included. PeCa was diagnosed in 33 patients, yielding an incidence ranging from 0.04% to 0.3%. Additionally, 67 cases of testicular cancer were recorded, with an incidence ranging from 0.03% to 0.55%. Most tumors were localized, and histology variants were uncommon. While the surgical treatment of the primary tumor remains consistent with that of the general population, the use of radiotherapy and cytotoxic treatments are less frequently reported in this setting. These therapies should be considered on an individualized basis to minimize the risk of graft injury.

CONCLUSIONS

Penile and testis cancers are relatively uncommon among KT recipients. General screening protocols and deviation from current treatment guidelines are not recommended in localized diseases. Given the risk of graft damage, any non-cytotoxic option should be preferred in locally advanced cases.

Visceral leishmaniasis in kidney transplant recipients and candidates: an integrative review of the last 20 years

INTRODUCTION

Leishmaniasis is a potential concern for solid organ transplant (SOT) recipients, particularly those from endemic regions. Among SOT procedures, kidney transplantation (KT) is the most common. This study aims to synthesize the evidence about visceral leishmaniasis (VL) in KT candidates and recipients, with a focus on risk factors and associated outcomes.

METHODS

This integrative review analyzed studies from the past 20 years, focusing on disease profile, treatment, prognosis, and risk of asymptomatic infection.

RESULTS

A total of 32 articles were included. Of the KT recipients, 85.7% were male, with an average age of 42.5 years. The average timespan since symptom onset was 54.7 months. Renal function impairment was reported in 64% of patients, with an associated mortality rate of 15%. Post-treatment relapse occurred in 10-37.5% of patients. Among KT candidates, 13.9% were seropositive for Leishmania spp.

CONCLUSION

VL is an infrequent condition among KT recipients, limiting the quality of the available evidence. Early detection and prompt treatment are crucial for improving outcomes. While renal function impairment is common, it rarely leads to graft rejection. In the reviewed studies, the coexistence of VL and cutaneous or mucocutaneous forms was linked to higher mortality. Recurrences are common and require individualized management strategies. Hemotransfusion poses a potential infection risk, although routine screening in blood banks is not yet recommended.

Osteosarcopenia in Chronic Kidney Disease: An Overlooked Syndrome?

BACKGROUND

Healthy ageing relies on maintaining physiological systems, particularly the musculoskeletal system (MKS). After 50, declines in bone density, muscle mass and strength increase the risk of osteoporosis and sarcopenia, leading to frailty, fractures and higher healthcare costs. Osteosarcopenia, combining osteoporosis and sarcopenia, is rising because of the ageing population. Chronic kidney disease (CKD) exacerbates this condition through disruptions in mineral metabolism, hormonal imbalances and inflammation, further compromising musculoskeletal health.

AIMS

This review examines the pathophysiology of osteosarcopenia associated with CKD, focusing on the role of mineral and hormonal disturbances, chronic inflammation and endocrine dysfunction. It aims to increase clinical awareness and highlight the need for early diagnosis and intervention to mitigate the burden of osteosarcopenia on the quality of life and healthcare systems in ageing CKD populations.

METHODS

A narrative review of the current literature was conducted, summarising evidence on the mechanisms underlying osteosarcopenia in CKD, including mineral metabolism alterations, inflammatory processes and hormonal imbalances.

RESULTS

Osteosarcopenia is a recognised consequence of CKD, contributing to increased morbidity and mortality. The pathophysiology of osteosarcopenia in CKD is multifactorial, involving disruptions in mineral metabolism, inflammation, endocrine dysfunction and physical inactivity. CKD-mineral and bone disorder (CKD-MBD) leads to alterations in calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF-23) and vitamin D metabolism, resulting in impaired bone mineralisation and increased fracture risk. Simultaneously, CKD accelerates muscle wasting through systemic inflammation, anabolic resistance and metabolic derangements, increasing the risk of sarcopenia. Sarcopenic obesity, inflammaging and hormonal dysregulation further exacerbate bone muscle deterioration. Emerging evidence suggests that osteosarcopenia in CKD is a consequence of interconnected pathophysiological pathways rather than isolated conditions. Diagnosis remains challenging because of overlapping clinical features, necessitating integrated assessment tools. Targeted therapeutic strategies, including mineral metabolism correction, resistance exercise and anabolic interventions, are essential to mitigate osteosarcopenia's progression and improve patient outcomes in CKD.

CONCLUSIONS

Osteosarcopenia is a growing concern in ageing CKD populations. Early diagnostic strategies and targeted interventions are essential to mitigate the impact of osteosarcopenia on patient outcomes and reduce associated healthcare costs. Increased clinical awareness and research into effective therapies are crucial for improving the quality of life for individuals affected by CKD and osteosarcopenia.

Long-term outcomes of pancreatic islet transplantation alone in type 1 diabetes: a 20-year single-centre study in Italy

BACKGROUND

Islet transplantation has the potential to cure type 1 diabetes by restoring endogenous insulin production. However, its success relies on balancing improved glycaemic control with the risks of immunosuppressive therapy. This study aimed to evaluate long-term outcomes of islet transplantation alone for type 1 diabetes, focusing on the effects of islet mass and immunosuppressive regimens on graft survival and insulin independence, and weighing glycaemic control benefits against the risks of immunosuppressive therapy.

METHODS

This cohort study retrospectively analysed individuals aged 18-67 years with type 1 diabetes who received intraportal islet transplantation alone at IRCCS Ospedale San Raffaele, Milan, Italy. Inclusion criteria comprised adults with type 1 diabetes diagnosed before the age of 55 years with severe recurrent hypoglycaemia or glycaemic instability. Major exclusion criteria included a HbA1c of more than 12·5%, a BMI of more than 30 kg/m2, and insulin requirements exceeding 1·2 IU/kg per day, along with contraindications to immunosuppressive therapy. Participants were recruited from the hospital's islet transplant registry. Follow-up was conducted through regular clinical visits, with data collected retrospectively. Outcomes assessed included patient survival, graft survival, insulin independence, glycaemic control, and adverse events. Data were analysed using an intention-to-treat method, mixed-effects models, Kaplan-Meier estimates, and Cox and logistic regression to identify factors linked to metabolic success and reduced risks.

FINDINGS

79 patients underwent intrahepatic or intraportal islet transplantation alone between Feb 16, 2001, and June 1, 2023, and received a total of 159 islet infusions, with a median total islet mass of 9637 islet equivalents (IEQ) per kg. Complications were infrequent and mostly involved minor bleeding, with only 3% (two of 79) of patients requiring surgical intervention. Glycaemic control improved significantly after infusion, with a reduction of HbA1c by -10·04 mmol/mol (-13·63 to -6·46), and a decrease in daily insulin requirements by -13·35 units per day (-17·04 to -9·65). The intention-to-treat analysis showed a median graft survival (fasting C peptide ≥0·3 ng/mL) of 3·9 years (95% CI 1·6 to 6·2) and 44% (35/79) insulin independence for a median of 6 years (95% CI 2·88 to 9·08). Patients receiving more than 10 000 IEQ/kg with BAS, FK506, and Rapa therapy had a median graft survival of 9·7 years (3·1-16·0) and 73% (16 of 22) insulin independence. Kaplan-Meier estimates indicated graft survival rates of 86% at 1 year, 65% at 5 years, 47% at 10 years, 47% at 15 years, and 40% at 20 years. Overall survival was 92% (73 of 79) over a median follow-up of 13·1 years, with a 20-year survival probability of 84%. Adverse events related to immunosuppressive therapy were reported in 44% (35 of 79) of patients, with allosensitisation rates increasing from 6% at baseline to 42% after therapy discontinuation.

INTERPRETATION

This analysis of a large islet transplantation alone cohort provides valuable insights into factors influencing outcomes and highlights potential risks, supporting informed clinical decision making and the optimisation of future β-cell replacement strategies.

FUNDING

None.

A novel histologic index for polyomavirus nephropathy in comparison with the Banff scoring system: Clinical validation, prognostic implication, and correlation with plasma viral load

BK Polyomavirus nephropathy (PVN) with definitive diagnosis on biopsy, presents incidentally or with varying degrees of graft dysfunction. Banff working group on PVN has proposed a novel scoring system in renal biopsies, to identify patients with higher risk of graft failure. In this study, we attempted to validate the Banff scoring system at index biopsies and correlate with a novel index score, plasma BK-virus load and graft outcome. 48 patients with index biopsies of PVN diagnosed from 2019 to 2022, with simultaneous plasma BKV-virus loads and SV-40 stains were chosen. Biopsies were scored for Banff PVN Class and by novel PVN index. Inter-observer reproducibility was tested between 3 renal pathologists for all parameters and findings were correlated with graft outcome, in a median follow-up of 42 months. Banff PVN classes 2 and 3 and novel index 3 were associated with higher percentage of graft failure and persistent viremia. The novel index score showed a stronger and consistent temporal association with plasma BK-virus levels. Kappa scores revealed a 68 % agreement for Banff PVN class scoring. Our study highlights the prognostic utility of Banff PVN scheme and novel PVN index in correlation with plasma BKV viremia and graft outcome.

The Enhanced Recovery After Surgery Pathway Is Safe, Feasible and Cost-Effective in Delayed Graft Function After Kidney Transplant

Background/Objectives: Enhanced recovery after surgery (ERAS) pathways are still underutilized in kidney transplantation (KT), and their feasibility after delayed graft function (DGF) is unknown. We aimed to evaluate safety and cost savings after ERAS implementation in KT recipients with DGF. Methods: A retrospective analysis of KT recipients enrolled in the ERAS program with DGF (≥1 dialytic treatment during the first postoperative week or creatinine≥ 2.5 mg/dL on postoperative day 10) between 2010 and 2019 was performed. Recipient, donor, and transplant data, outcomes, and 1-year post-KT costs were collected, comparing recipients within the ERAS target (≤5 days, "early discharge group") to those discharged later (>5 days, "late discharge group"). Results: Out of 170 KT recipients with DGF, 33 (19.4%) were in the "early discharge group" and 137 (80.5%) in the "late discharge group". Recipient, donor, and transplant characteristics were similar in the two groups. The length of hospital stay (LOS) of the "early discharge group" was significantly shorter, with fewer in-hospital dialysis sessions (p < 0.001) compared to the "late discharge group". One year post-KT, no significant differences were observed in postoperative complications, readmissions, or number of outpatient visits. Five-year graft and patient survival along with five-year graft function were similar between the two cohorts. First-year costs were significantly higher in the "late discharge group" (p < 0.001), with a median excess cost (Δ) of EUR 4515.76/patient. Factors influencing first-year costs post-KT were LOS for KT, recipient age, and use of expanded-criteria grafts. Conclusions: The ERAS approach is safe in KT recipients with DGF and allows for economic savings, while its implementation does not cause worse clinical outcomes in recipients.

High Rate of Antibody Response to Multiple Doses of the COVID-19 Vaccine in Liver Transplant Recipients: Analysis of Predictive Factors

BACKGROUND

The COVID-19 pandemic highlighted the vulnerability of immunocompromised individuals, including liver transplant recipients (LTRs), who often exhibit reduced vaccine immunogenicity. While initial vaccine doses and subsequent boosters improved immune response, LTRs were prioritized for vaccination. Studies have shown increased antibody response after each booster dose. Vaccine hesitancy, defined as delayed or refused vaccination despite availability, poses a public health challenge, often fueled by misinformation. This study aimed to evaluate anti-spike antibody responses in vaccinated LTRs after two initial doses and at least one booster, also assessing adherence to subsequent doses.

METHODS

We conducted a retrospective observational study at a transplant center in Milan, Italy, between January 2021 and December 2023. LTRs who had received four or more doses of mRNA vaccines (Pfizer or Moderna) were included. Anti-spike antibody levels were measured 60-80 days after each dose. Data on vaccination status were collected in January 2024. Statistical analysis was performed to compare antibody responses and identify predictive factors.

RESULTS

LTRs showed a significant increase in anti-spike antibody responses after the first booster compared to the second dose with a trend versus a further increase following the fourth dose in a subgroup of the patients receiving two booster doses. However, adherence to booster doses decreased over time. In LTRs, predictors of a weaker response after the second dose were chronic kidney disease and metabolic etiology at transplant.

CONCLUSIONS

The study highlighted that in LTRs, multiple doses of the COVID-19 vaccine led to a continuous increase in anti-spike antibody responses. The progressive decline in adherence of LTRs "to further booster doses" should be related to the fact that after the spread of vaccination programs worldwide, COVID-19 is still a current infection, but it is much less severe than before.

Kidney Transplant: More than Immunological Problems

Kidney transplantation (KT) represents a pivotal intervention for patients with chronic kidney disease (CKD), significantly improving survival and quality of life. However, KT recipients face an array of non-immunological complications, collectively amplifying cardiovascular (CV) and metabolic risks. This review explores the intersection of cardio-metabolic syndrome and KT, emphasizing the recently introduced cardiovascular-kidney-metabolic (CKM) syndrome. CKM syndrome integrates metabolic risk factors, CKD, and CV disease, with KT recipients uniquely predisposed due to immunosuppressive therapies and pre-existing CKD-related risks. Key issues include post-transplant hypertension, obesity, dyslipidemia, post-transplant diabetes mellitus (PTDM), and anemia. Immunosuppressive agents such as corticosteroids, calcineurin inhibitors, and mTOR inhibitors contribute significantly to these complications, exacerbating metabolic dysfunction, insulin resistance, and lipid abnormalities. For instance, corticosteroids and calcineurin inhibitors heighten the risk of PTDM, while mTOR inhibitors are strongly associated with dyslipidemia. These pharmacologic effects underscore the need for tailored immunosuppressive strategies. The management of these conditions requires a multifaceted approach, including lifestyle interventions, pharmacological therapies like SGLT2 inhibitors and GLP-1 receptor agonists, and close monitoring. Additionally, emerging therapies hold promise in addressing metabolic complications in KT recipients. Proactive risk stratification and early intervention are essential to mitigating CKM syndrome and improving outcomes. This comprehensive review highlights the importance of integrating cardio-metabolic considerations into KT management, offering insights into optimizing long-term recipient health and graft survival.

A Comprehensive Exploration of the Biological Effects of Adipose-Derived Stem Cells in the Treatment of Systemic Sclerosis

Systemic sclerosis (SSc) is a complex autoimmune disease characterized by vasculopathy and tissue fibrosis affecting the skin and internal organs. Genetic and environmental factors influence susceptibility, severity, and onset. Current treatments are limited and not always effective, leading researchers to investigate new approaches, such as the use of adipose-derived mesenchymal stem cells (ADSCs) through fat grafting. This review seeks to understand how ADSCs may impact the development and progression of SSc, with a particular focus on how these cells could alter immune responses and reduce fibrosis. ADSCs have been found to affect various immune cells, including T cells, B cells, macrophages, and dendritic cells, by releasing cytokines, chemokines, and growth factors. These interactions generally suppress inflammation and promote a regulatory immune environment. Additionally, ADSCs can influence the extracellular matrix, helping to prevent fibrosis through signaling molecules like exosomes. ADSCs show promise as a treatment for SSc due to their ability to modulate the immune system and reduce fibrosis. Early clinical studies are encouraging, but more research is needed to fully understand how they work and to develop effective treatment protocols.

Impact of Severe Persistent BK Polyomavirus on Graft Function and Quality of Life Outcomes in Kidney Transplant Recipients

BACKGROUND

The risk factors and outcomes associated with severe persistent BK polyomavirus (BKPyV) in kidney transplant recipients (KTR) are unknown.

METHODS

This is a single-center retrospective study of KTR with severe persistent BKPyV compared to (1) KTR with low/no BKPyV-DNAemia and (2) KTR with high BKPyV-DNAemia. Severe persistent BKPyV was defined as BKPyV load reaching > 6 log10 (1 000 000 copies/mL) for ≥ 90 days. Low/no BKPyV was defined as BKPyV load remaining < 3 log10 (1000 copies/mL), and high BKPyV was defined as BKPyV load ≥ 3 log10 without meeting criteria for severe persistent BKPyV.

RESULTS

Out of 2586 KTR, 22 had severe persistent BKPyV and were compared to 1843 KTR with low/no BKPyV and 721 KTR with high BKPyV. A low absolute lymphocyte count during the first month posttransplant was associated with an increased risk of severe persistent BKPyV relative to those with low/no BKPyV and high BKPyV (OR 0.91, 95%CI 0.84, 0.99). KTR with severe persistent BKPyV had significantly lower eGFR at 2 years posttransplant relative to low/no and high BKPyV groups eGFR (36 vs. 61 and 59 mL/min; p < 0.001 for both). Additionally, KTR with severe persistent BKPyV required more lab draws and incurred significantly higher total lab-associated costs relative to KTR with low/no BKPyV and high BKPyV ($7516 vs. $4631, p < 0.001; $7516 vs. $5811, p < 0.001, respectively).

CONCLUSIONS

Severe persistent BKPyV is uncommon but associated with poor outcomes including impaired renal function, a higher burden of labs, and lab-associated costs. Future studies are needed to determine underlying factors that predict severe persistent BKPyV.

Comparing surgical outcomes between robot-assisted laparoscopic and open partial nephrectomy for allograft kidney tumors: a retrospective, single-center study

BACKGROUND

Kidney transplantation is considered the best long-term option for patients with end-stage renal disease; however, immunosuppression increases the risk of developing malignancies. Approximately 0.2-0.5% of kidney transplant recipients experience renal cell carcinoma (RCC) in their allografts. Recently, nephron-sparing surgery has become widely accepted because of its favorable survival outcomes and low risk of recurrence.

METHODS

In this study, we retrospectively evaluated the peri- and postoperative outcomes of robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) for allograft RCC, analyzing five and six patients who underwent OPN and RAPN, respectively, from 1998 to 2023.

RESULTS

The estimated blood loss was significantly lower in the RAPN group than in the OPN group (6.5 mL [interquartile range (IQR): 1-15] vs. 350 mL [IQR: 139-560], P = 0.006), whereas the operative and renal arterial clamping times were similar. Additionally, the perioperative complication rate and severity were lower in the RAPN group, resulting in a significantly shorter postoperative hospital stay than the OPN group (3 days [IQR: 2-5] vs. 10 days [IQR: 8-12], P = 0.01). Postoperative renal function and oncological outcomes were similar between the two groups.

CONCLUSIONS

RAPN for allograft RCC demonstrated advantages in terms of estimated blood loss and postoperative hospital stay compared with OPN, even though the patients' backgrounds were not adjusted. Therefore, RAPN may be a viable option for managing T1 allograft tumors.

Exploring the Impact of Diabetes on Kidney Transplant: Patient Outcomes and Management Strategies

Diabetic kidney disease (DKD) is a serious consequence of diabetes mellitus (DM). If not managed effectively, DKD often develops into end-stage renal disease (ESRD). The most successful treatment for ESRD is kidney transplantation, offering improved quality of life and survival rates. For insulin-dependent diabetic patients with ESRD, simultaneous pancreas-kidney transplantation (SPKT) offers a treatment alternative that treats both kidney failure and the underlying diabetes. However, SPKT involves more complicated surgery, prolonged operative time, and a higher risk of complications. This review aims to highlight the impact of DM on kidney transplant recipients (KTRs) regarding post-transplant complications, graft survival, mortality rates, and the role of glucose-lowering medications and immunosuppressants. The incidence of urinary tract infections, cardiovascular complications, and diabetic foot disease was higher among KTRs. A decrease in graft survival rate at five years was observed among diabetics compared to non-diabetics, with similar graft survival rates among type 1 and type 2 DM. The mortality rate was notably higher among diabetic patients, with cardiovascular complications being the leading cause. The emergence of new-onset diabetes mellitus post-transplantation (NODAT) is a significant cause of concern. Certain risk factors, including a family history of DM, age >45 years, obesity, male gender, and immunosuppressive medications, have been linked to this phenomenon. Immunosuppression is a substantial challenge among diabetics as certain medications such as tacrolimus have shown to be considerably diabetogenic compared to cyclosporine and belatacept, and it is also postulated that corticosteroids can lead to hyperglycemia. Some studies proved that glucose-lowering medications, including insulin degludec, glucagon-like peptide-1 receptor agonists, thiazolidinediones, and sodium-glucose cotransporter 2 inhibitors, are safe and effective among KTRs. However, these studies are debatable and of low confidence. Hence, it is imperative to conduct large clinical trials and establish definitive guidelines to manage pre-existing diabetes and NODAT among KTRs with multidisciplinary care to help clinicians improve patient outcomes.

Pathophysiology of chronic kidney disease-mineral bone disorder (CKD-MBD): from adaptive to maladaptive mineral homeostasis

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a multifaceted condition commonly seen in people with reduced kidney function. It involves a range of interconnected issues in mineral metabolism, bone health and cardiovascular calcification, which are linked to a lower quality of life and shorter life expectancy. Although various epidemiological studies show that the laboratory changes defining CKD-MBD become more common as the glomerular filtration rate declines, the pathophysiology of CKD-MBD is still largely unexplained. We herein review the current understanding of CKD-MBD, provide a conceptual framework to understand this syndrome, and review the genetic and environmental factors that may influence the clinical manifestation of CKD-MBD. However, a deeper understanding of the pathophysiology of CKD-MBD is needed to understand the phenotype variability and the relative contribution to organ damage of factors involved in CKD-MBD to develop more effective interventions to improve outcomes in patients with CKD.

High detection rate of parasitic load by qPCR targeting 18S rDNA in blood of patients with active leishmaniasis lesions

This study aimed to standardize qPCR techniques using these molecular markers kDNA and 18S rDNA across three sample types: peripheral blood, guanidine-treated blood, and tissue. The secondary objective is to evaluate the performance of 18S rDNA target in samples from 46 patients with confirmed tegumentary leishmaniasis. After obtaining the standard curve from reference strains with Leishmania, qPCR curves were standardizations and the Cts results of the patient samples were described using abstract measures. Specific specification equations (EEG) with normal distribution and identity link function were constructed to compare each type of clinical sample. To identify the differences among samples and techniques, multiple comparisons with Bonferroni post-test was performed. The kDNA and 18S rDNA demonstrated high sensitivity, detecting as few as 10⁻1 parasites/mL. However, 18S rDNA showed limited species discrimination. qPCR performance was evaluated using blood and tissue samples, showing a sensitivity of 54.2% in blood, 12.5% in guanidine-treated blood, and 86.4% in tissue. qPCR agreement with the 18S rDNA target with the three types of samples, positive and negative, in relation to screening were 56.2% in blood, 31.8% in guanidine- blood and tissue 78.6%. As for true positives (PPV), tissue samples presented a probability percentage of individuals being sick of 86.4%, while in blood it was 81.3%. The results underscore the importance of molecular diagnostics in blood samples, improving the accuracy and monitoring of tegumentary leishmaniasis.

Posttransplantation diabetes mellitus (PTDM): pharmacological aspects and genetic predispositions

Posttransplantation diabetes mellitus (PTDM) is a form of diabetes developed after solid organ or stem cell transplantation. This condition shares physiopathological traits with type 2 diabetes, including insulin resistance and β-cells dysfunction and its prevalence varies significantly based on the diagnostic criteria used. Immunosuppressive drugs directly contribute to PTDM risk through intricate impacts on glucose regulation, insulin secretion, and inflammation. In addition, modifiable and non-modifiable environmental risk factors are associated with the onset of this condition. This review aims to provide a comprehensive overview of the multifactorial nature of PTDM in order to highlight candidate genes and variants for pharmacogenetic research. An extensive literature search was conducted to identify studies on pharmacological and genetic factors influencing PTDM development. This review stresses the importance of understanding these interactions for improving PTDM management and underscores the need for further research to refine preventive approaches, ultimately enhancing patient outcomes post-transplantation.

Prophylactic treatment of FSGS recurrence in patients who relapsed on a previous kidney graft

BACKGROUND

Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation and is classically associated with a significant decrease in graft survival. A major risk factor is a prior history of FSGS recurrence on a previous graft. This analysis reports the impact of a prophylactic treatment of FSGS recurrence in very high-risk patients who experienced a recurrence on a previous graft.

METHODS

We performed a retrospective multicentre observational study in 25 French transplantation centres. The inclusion criteria were patients aged more than 18 years who had undergone kidney transplant between 31 December 2004 and 31 December 2020, and who had a history of FSGS recurrence on a previous graft.

RESULTS

We identified 66 patients: 40 received prophylactic treatment (PT+), including intravenous cyclosporine and/or rituximab and/or plasmapheresis, and 26 did not receive any prophylactic treatment (PT-). The time to progression to end-stage kidney disease was similar between groups. The PT+ group was younger at FSGS diagnosis and at the time of kidney retransplantation and lost their previous graft faster. The overall recurrence rate was 72.7% (76.9% in the PT- group and 70.0% in the PT+ group, P = .54). At least partial remission was achieved in 87.5% of patients. The 5-year graft survival was 67.7% [95% confidence interval (CI) 53.4%-78.4%]: 65.1% (95% CI 48.7%-77.4%) in patients with FSGS recurrence vs 77.3% (95% CI 43.8%-92.3%) in patients without recurrence (P = .48).

CONCLUSION

Our study suggests that prophylactic treatment should not be used routinely in patients receiving a second transplantation after recurrence of FSGS on a previous graft. The recurrence rate is high regardless of the use of prophylactic treatment. However, the 5-year graft survival remains satisfactory.

Is High-Intensity Interval Training an Option for Post-Kidney Transplant Physical Rehabilitation Programmes? A Scoping Review

Purpose

To systematically and broadly review the literature to show the available information on high-intensity interval training for kidney transplant recipients as an adjunct to physical rehabilitation.

Methods

A scoping review of high-intensity interval training for post-kidney transplant patients was conducted by searching the PubMed, EMBASE (Elsevier), Scopus (Elsevier), Web of Science, and PEDro databases. Full-text records on the subject were included. Articles not published in English were excluded. The selected articles went through careful production quality analysis using the PEDro scale.

Results

The search identified 26 articles, 3 of which met the inclusion criteria. The material demonstrated satisfaction, confidence, improvement in resting heart rate, and absence of adverse effects from high-intensity interval training for kidney transplant recipients.

Conclusion

Based on this scoping review, high-intensity interval training for kidney transplant patients may be beneficial for physical and mental aspects and complement physical rehabilitation programmes, but there is a need for more studies with robust samples and long-term follow-up to confirm these benefits.

Side Effects of Immunosuppressant Drugs After Liver Transplant

Liver transplantation (LT) is the standard of care for both end-stage liver failure and hepatocellular carcinoma (HCC). Side effects of the main used immunosuppressive drugs have a noteworthy impact on the long-term outcome of LT recipients. Consequently, to achieve a balance between optimal immunosuppression and minimal side effects is a cornerstone of the post-LT period. Today, there are no validated markers for overimmunosuppression and underimmunosuppression, only a few drugs have therapeutic drug monitoring, and immunosuppression regimens vary from center to center and from country to country. Currently, there are many drugs with different efficacy and safety profiles. Using different agents permits a decrease in the dosage and minimizes the toxicities. A small subset of recipients achieves immunotolerance with the chance to stop immunosuppressive therapy. This article focuses on the side effects of immunosuppressive drugs, which significantly impact long-term outcomes for LT recipients. The primary aim is to highlight the balance between achieving effective immunosuppression and minimizing adverse effects, emphasizing the role of personalized therapeutic strategies. Moreover, this review evaluates the mechanisms of action and specific complications associated with immunosuppressive agents. Finally, special attention is given to strategies for reducing immunosuppressive burdens, improving patient quality of life, and identifying immunotolerant individuals.

Bioactive Compounds with Leishmanicidal Potential from Helianthus tuberosus and Vernonanthura squamulosa

Leishmaniasis is a neglected tropical disease caused by protozoan parasites of the genus Leishmania. An estimated 700,000 to 1 million new cases occur annually. Current therapies are limited by high toxicity, cost, prolonged treatment period, and rising resistance in endemic regions. The Asteraceae family has emerged as a promising source of bioactive compounds with proven leishmanicidal activity. In this study, the assessment of the antileishmanial activity of Helianthus tuberosus and Vernonanthura squamulosa extracts, the isolation of the sesquiterpene lactones heliangin and glaucolide A, respectively, and the evaluation of the activity of the compounds were conducted. Dichloromethane extracts of H. tuberosus and V. squamulosa were active on Leishmania amazonensis promastigotes, inhibiting the replication of the parasites in 97.2 ± 3.1% and 89.1 ± 1.1%, respectively, at 100 μg/mL. Heliangin was active against promastigotes of L. amazonensis (IC50 = 9.3 μM) and intracellular amastigotes (IC50 = 0.8 μM), while glaucolide A exhibited moderate activity against promastigotes (IC50 = 46.7 μM) and did not show activity against intracellular amastigotes. Based on these results, heliangin was further evaluated in an animal model of cutaneous leishmaniasis using BALB/c mice infected with L. amazonensis. Heliangin (8 mg/Kg), when administered in combination with Glucantime, significantly reduced lesion progression and parasite load compared to the vehicle-treated group (p < 0.001). These findings show that heliangin is a potential candidate for leishmaniasis treatment, especially in combination with therapeutic drugs.

Immunosuppressive Therapy-Related Cardiovascular Risk Factors in Renal Transplantation: A Narrative Review

BACKGROUND

Kidney transplantation is the best treatment for patients with chronic renal failure, capable of improving life expectancy and the risk of death from all causes, which, however, remains higher than in the general population. The leading cause of death in transplant patients is cardiovascular events, burdened by a significant impact brought about by anti-rejection therapy. Experimental and clinical studies to date show that in kidney transplant recipients, traditional cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity, tobacco, etc.) may be exacerbated or worsened by the dysmetabolic effects of immunosuppressive drugs, which may also result in additional risk factors such as proteinuria, anemia, and arterial stiffness. The aim of this review was to provide an in-depth evaluation of the effect of immunosuppressive treatments on cardiovascular risk factors.

SUMMARY

We have investigated and described the main cardiovascular risk factors related to immunosuppressive drugs. We searched for relevant scientific articles in medicine, transplant, cardiologic, and nephrological journals in major medical science libraries.

KEY MESSAGES

Immunosuppressive drugs allow graft survival and successful bunking of the transplant; however, they are not without significant side effects and should always be prescribed weighing the risk/benefit ratio and the individual patient's therapeutic needs.

Visceral Leishmaniasis in a 25-Year-Old Female Kidney Transplant Recipient from a Non-Endemic Region: A Case Report from Romania

Visceral leishmaniasis is a rare parasitic infection in non-endemic regions such as Romania. We report the case of a 25-year-old female kidney transplant recipient from Cluj County, Romania, who developed persistent bicytopenia with anemia and thrombocytopenia. Despite no history of travel outside Cluj County and being the only organ recipient from the same donor to experience signs and symptoms, she was diagnosed with visceral leishmaniasis. The second bone marrow aspirate performed revealed Leishmania amastigotes. She was quickly sent to Victor Babes Infectious Disease Hospital in Bucharest for additional tests and treatment. The kidney function of the patient was maintained. This case highlights the importance of considering leishmaniasis in immunosuppressed patients presenting with unexplained cytopenia, even in non-endemic regions. This is the first documented case of visceral leishmaniasis in a kidney transplant recipient in Romania. The present report could serve as a foundation for future educational programs targeted toward informing both healthcare providers and patients about the risks, diagnosis, and management of leishmaniasis in immunosuppressed individuals in non-endemic regions.

Atypical Hemolytic Uremic Syndrome Associated with BNT162b2 mRNA COVID-19 Vaccine in a Kidney Transplant Recipient: A Case Report and Literature Review

Case Report: We report a case of a 37-year-old female with kidney transplant, who was admitted at our hospital due to worsening renal function, nephrotic proteinuria, and anemia developed 21 days after the second dose of BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). Laboratory tests revealed hemolytic anemia, thrombocytopenia, and acute kidney injury. Given the clinical picture of Thrombotic Micro-angiopathy (TMA) and severe renal impairment, plasma exchange (PEX) and dialysis were immediately started. Laboratory workup showed low C3 and C4 levels, normal activity of ADAMTS13, and the absence of anti-factor H antibodies. Molecular biology investigations revealed a heterozygous variant in exon 22 (SCR20) of the CFH gene (c.3628C>T; p.Arg1210Cys) described as an atypical Hemolytic Uremic Syndrome (aHUS) causative mutation. Our patient completed two sessions of PEX followed by eculizumab treatment with hematological improvement but no recovery of renal function. This is the first reported case of aHUS triggered by SARS-CoV-2 vaccination in a kidney transplant patient without recovery of renal function. Conclusion: Although rare, clinicians should be aware of possible nephrological complications that may appear after vaccination.

Secular trends in cytomegalovirus (CMV) risk and outcomes: results from a 10-year longitudinal cohort study in adult kidney transplant recipients

BACKGROUND

The goal of this study was to determine the secular trends in the incidence of CMV sero-mismatch (D+/R -) and if these trends meaningfully impact clinical outcomes.

METHODS

This was a single-center longitudinal cohort study in adult kidney recipients transplanted between Jan 2012 and June 2021 with follow-up through June 2022. Baseline and follow-up data were collected. Univariate and multivariate statistics were used to analyze the data.

RESULTS

2,392 kidney transplants were performed during the study period; 132 patients did not meet inclusion criteria. The mean age was 52 years, 41% were female, 57% were black, and 19% were CMV D + /R -. The odds of being CMV high-risk increased by 6% each year (OR 1.06, 1.02-1.10 p = 0.003); 48% of the variability associated with CMV serostatus was explained by transplant year (R2 = 0.478, p = 0.002). Sequential modeling demonstrated that CMV D + /R - serostatus was a substantial risk factor for CMV infection (HR 5.7, 4.5-7.3), CMV disease (HR 8.4, 3.9-18.0), CMV resistance (HR 17.9, 3.8-84.2), CMV refractory infection (HR 35, 4-280), late CMV infection (HR 12.0, 8.3-17.1), acute rejection, and hospitalization for opportunistic infections. Secular trend analysis demonstrated that CMV infections, CMV resistance, and late CMV increased in incidence since 2012. The risks of CMV resistance and late infection was significantly influenced by D + /R - serostatus and transplant year, indicating that this risk is worsening over time.

CONCLUSION

The CMV D + /R - serostatus remains the single most important risk factor for CMV infection, disease, resistance, refractory infection, and late CMV, which appears to be increasing in magnitude.

Developing clinical prognostic models to predict graft survival after renal transplantation: comparison of statistical and machine learning models

INTRODUCTION

Renal transplantation is a critical treatment for end-stage renal disease, but graft failure remains a significant concern. Accurate prediction of graft survival is crucial to identify high-risk patients. This study aimed to develop prognostic models for predicting renal graft survival and compare the performance of statistical and machine learning models.

METHODOLOGY

The study utilized data from 278 renal transplant recipients at the Ethiopian National Kidney Transplantation Center between September 2015 and February 2022. To address the class imbalance of the data, SMOTE resampling was applied. Various models were evaluated, including Standard and penalized Cox models, Random Survival Forest, and Stochastic Gradient Boosting. Prognostic predictors were selected based on statistical significance and variable importance.

RESULTS

The median graft survival time was 33 months, and the mean hazard of graft failure was 0.0755. The 3-month, 1-year, and 3-year graft survival rates were found to be 0.979, 0.953, and 0.911, respectively. The Stochastic Gradient Boosting (SGB) model demonstrated the best discrimination and calibration performance, with a C-index of 0.943 and a Brier score of 0.000351. The Ridge-based Cox model closely followed the SGB model's prediction performance with better interpretability. The key prognostic predictors of graft survival included an episode of acute and chronic rejections, post-transplant urological complications, post-transplant nonadherence, blood urea nitrogen level, post-transplant regular exercise, and marital status.

CONCLUSIONS

The Stochastic Gradient Boosting model demonstrated the highest predictive performance, while the Ridge-Cox model offered better interpretability with a comparable performance. Clinicians should consider the trade-off between prediction accuracy and interpretability when selecting a model. Incorporating these findings into the clinical practice can improve risk stratification and personalized management strategies for kidney transplant recipients.

Plasma high-sensitivity C-reactive protein measured prior to transplant is related to prediabetes in first-year kidney transplant recipients: A single-center cross-sectional study in Vietnam

AIM

To determine the rate of prediabetes among and the pre-transplant plasma high-sensitivity C-reactive protein (hs-CRP) value predictive of prediabetes in patients during their first year post-living donor kidney transplant.

METHODS

A total of 538 patients underwent living donor kidney transplantation between January 2018 and December 2020, 413 of whom met the inclusion criteria for this study. All patients underwent oral glucose tolerance tests (OGTTs) with 75 g glucose/200 mL solution, starting 3 months post-transplant and repeating the test every 3 months for the first year. Clinical and paraclinical indicators and plasma hs-CRP concentrations were quantified the day prior to the transplant. Prediabetes was diagnosed according to the American Diabetes Association 2018 criteria as a 2-h OGTT result between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).

RESULTS

The rate of prediabetes among the study subjects was 38.3 % (158/413). Body mass index (BMI) and pre-transplant plasma triglycerides, high-density lipoprotein cholesterol (HDLC), and hs-CRP levels were related factors predictive of prediabetes in patients within the first year post-kidney transplant based on multivariate logistic regression and receiver operative characteristic curve models. Hs-CRP was the factor with the best predictive value (area under the curve = 0.89; p < 0.001).

CONCLUSIONS

Pre-transplant plasma hs-CRP levels were a good predictor of prediabetes in the first year post-living donor kidney transplant.

Indications for genetic testing in adults with focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis (FSGS) is a histological pattern of injury that derives from various pathological processes that affect podocytes, resulting in loss of selectivity of the glomerular filtration membrane, proteinuria and the development of renal failure that progresses to end-stage kidney disease in a significant number of patients. The classification proposed by the 2021 KDIGO guidelines divides FSGS into four categories: primary, secondary, genetic, and FSGS of undetermined cause, thus facilitating its diagnosis and management. Genetic causes of FSGS present significant clinical variability, complicating their identification. Genetic testing is crucial to identify FSGS of genetic cause. The prevalence of genetic FSGS is significant in children and considerable in adults, highlighting the importance of early diagnosis to avoid unnecessary treatments and facilitate genetic counselling. Massive sequencing techniques have revolutionized genetic diagnosis, allowing the identification of more than 60 genes responsible for podocyte damage. This document proposes clinical recommendations for carrying out genetic studies in adults with FSGS, highlighting the need for a correct classification for adequate therapeutic planning and improvement of results in clinical trials.

New Onset Diabetes After Organ Transplantation: Risk Factors, Treatment, and Consequences

New onset diabetes mellitus after organ transplantation (NODAT) is a frequent and serious complication of solid organ transplantation. It significantly impacts graft function, patient survival, and quality of life. NODAT is diagnosed based on the criteria for type 2 diabetes, with the oral glucose tolerance test (OGTT) serving as the gold standard for diagnosis. The development of NODAT is influenced by a range of risk factors, which are classified into modifiable and non-modifiable categories. Post-transplant, regular glycemic monitoring at specific intervals is essential for timely diagnosis and initiation of therapy. Early intervention can help prevent or delay the onset of diabetes-related complications. The treatment strategy for NODAT involves lifestyle modifications and pharmacological interventions. These include medications such as metformin, sulfonylureas, glinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and insulin. Adjusting immunosuppressive therapy-either by reducing dosages or substituting drugs with lower diabetogenic potential-is a common preventative and therapeutic measure. However, this must be performed cautiously to avoid acute graft rejection, which poses a greater risk to the patient compared to NODAT itself. In addition to managing diabetes, addressing comorbidities such as hypertension and dyslipidemia is crucial, as they elevate the risk of cardiovascular events and mortality. Patients with NODAT are also prone to developing common diabetes-related complications, including diabetic nephropathy, neuropathy, retinopathy, and peripheral vascular disease. Therefore, regular follow-ups and appropriate treatment are vital to maintaining quality of life and improving long-term outcomes.

Anti-Human Leukocyte Antigen Antibody Detection from Terasaki's Humoral Theory to Delisting Strategies in 2024

The human leukocyte antigen (HLA) system plays a critical role in transplant immunology, influencing outcomes through various immune-mediated rejection mechanisms. Hyperacute rejection is driven by preformed donor-specific antibodies (DSAs) targeting HLAs, leading to complement activation and graft loss within hours to days. Acute rejection typically occurs within six months post-transplantation, involving cellular and humoral responses, including the formation of de novo DSAs. Chronic rejection, a key factor in long-term graft failure, often involves class II DSAs and complex interactions between the innate and adaptive immune systems. Advancements in HLA antibody detection, particularly single antigen bead (SAB) assays, have improved the sensitivity and characterization of DSAs. However, these assays face challenges like false positives from denatured antigens and false negatives due to low antibody titers or complement competition. Furthermore, molecular mismatch (MM) analysis has emerged as a potential tool for refining donor-recipient compatibility but faces some issues such as a lack of standardization. Highly sensitized patients with calculated panel-reactive antibodies (cPRA) of 100% face barriers to transplantation. Strategies like serum dilution, novel therapies (e.g., Imlifidase), and delisting approaches could refine immunological risk assessment and delisting strategies are essential to expand transplant opportunities for these patients.

Exploring viral mimicry combined with epigenetics and tumor immunity: new perspectives in cancer therapy

Viral mimicry refers to an active antiviral response triggered by the activation of endogenous retroviruses (ERVs), usually manifested by the formation of double-stranded RNA (dsRNA) and activation of the cellular interferon response, which activates the immune system and produces anti-tumor effects. Epigenetic studies have shown that epigenetic modifications (e.g. DNA methylation, histone modifications, etc.) play a crucial role in tumorigenesis, progression, and treatment resistance. Particularly, alterations in DNA methylation may be closely associated with the suppression of ERVs expression, and treatment by demethylation may restore ERVs activity and thus strengthen the tumor immune response. Therefore, we propose that viral mimicry can induce immune responses in the tumor microenvironment by activating the expression of ERVs, and that epigenetic alterations may play a key regulatory role in this process. In this paper, we review the intersection of viral mimicry, epigenetics and tumor immunotherapy, and explore the possible interactions and synergistic effects among the three, aiming to provide a new theoretical basis and potential strategies for cancer immunotherapy.

Evaluation of acute postoperative pain management after living donor nephrectomy during the transition from open access to laparoscopic and minimally invasive robotic surgical approach

Background

Living donor nephrectomies (LDN) at our institution transitioned from open access to laparoscopic and, more recently, to a minimally invasive robotic surgical approach between 2019 and 2022. Concurrently, postoperative analgesia transitioned from regional anesthesia to intravenous patient-controlled analgesia (PCA) and eventually to simple analgesics with additional rescue analgesic agents, as needed, in accordance with individual physicians' preferences. This retrospective study was designed to evaluate the impact of these changes on surgical practice on the analgesic requirements and effectiveness of postoperative pain management.

Methods

Electronic records of all LDN cases operated between January 2019 and March 2022 were accessed, and a comparative analysis of patient demographics, surgical approach, duration of surgery, postoperative pain scores, and the analgesics administered within the first 48 h was performed.

Results

LDN (n = 527) was performed via laparoscopic (n = 432, 82%), robotic (n = 87, 17%), and open (n = 8, 2%) approaches. All patients were administered regular paracetamol 1 g 6 hourly. IV PCA was used in 85% of cases, predominantly in the laparoscopic (99%) and open (75%) groups (LG and OG, respectively); in contrast, the robotic group (RG) was mostly treated without PCA (81.7%). A variety of analgesic techniques were employed for the remaining patients, including epidural (25% of OG) and rectus sheath/transversus abdominis plane (TAP) block (2% of LG). Additional rescue analgesics were administered to 98% of the patients; 92% of LG needed 1-3 analgesic agents, whereas all of the OG and 37% of RG needed 1-2 rescue analgesics. No correlation was found between patient demographics and surgery duration on pain scores or analgesic requirements.

Conclusions

Robotic surgery was associated with the lowest postoperative pain scores and analgesic demand; laparoscopic resection was the most painful of all.

Human umbilical cord mesenchymal stem cells-derived extracellular vesicles ameliorate kidney ischemia-reperfusion injury by suppression of senescent tubular epithelial cells: experimental study

BACKGROUND

Human umbilical cord mesenchymal stem cells-derived extracellular vesicles (HUMSC-EVs) have drawn much interest in kidney transplantation, mainly because of their renoprotection by alleviating cell injury and stimulating tissue repair. Cellular senescence has been proven to play a dual regulatory role in kidney ischemia-reperfusion injury (IRI), and the regulation of HUMSC-EVs on tubular epithelial cell senescence may be a potential therapeutic target.

MATERIALS AND METHODS

In vitro , the hypoxia-reoxygenation of human kidney-2 cells was used to simulate kidney IRI, and the regulation of HUMSC-EVs on human kidney-2 cells was detected. Transcriptome sequencing of human kidney-2 cells was used to explore the potential regulatory mechanism. In vivo , adult male mice were divided into five groups: control group, IRI group, HUMSC-EVs treatment group, senolytics treatment group (dasatinib + quercetin), and combined treatments group (HUMSC-EVs and senolytics). Kidney function, senescent features of tubular epithelial cells, acute kidney injury, and chronic interstitial fibrosis in mice were detected to explore the renoprotection effects of HUMSC-EVs.

RESULTS

Kidney IRI significantly up-regulated expressions of LaminB1, p53, p21, p16, senescence-associated beta-galactosidase, and apoptosis of tubular epithelial cells. In the mouse kidney IRI model, kidney subcapsular injection of HUMSC-EVs significantly improved kidney function, reducing the senescent features of tubular epithelial cells and alleviating acute kidney injury and chronic interstitial fibrosis. HUMSC-EVs mainly achieved renoprotection by regulating Bax/Bcl-2-dependent apoptosis during acute kidney injury and mostly reduced tubular atrophy and kidney interstitial fibrosis by regulating Ras-pERK-Ets1-p53 pathway-dependent cell senescence. Oral administration of senolytics also alleviated kidney injury induced by IRI, while the combined treatments of HUMSC-EVs and senolytics had better renoprotection effects.

CONCLUSIONS

The combination of HUMSC-EVs and senolytics alleviated acute kidney injury and chronic interstitial fibrosis by dynamic regulation of cell senescence and apoptosis, which provides a therapeutic potential strategy for organ preservation and tissue repair in kidney transplantation.

Role of Coagulation Factors in Hepatocellular Carcinoma: A Literature Review

Hepatocyte carcinoma (HCC) is a globally prevalent neoplasm with profound effects on morbidity and mortality rates. This review summarizes the complex interactions between coagulation abnormalities and the pathophysiological mechanisms underlying HCC. Essential coagulation biomarkers, such as P-selectin, thrombomodulin, d-dimer, prothrombin, and von Willebrand factor, are reviewed for their diagnostic, prognostic, and therapeutic significance. The contribution of these biomarkers to tumor progression, metastatic spread, and patient prognosis is highlighted through a synthesis of contemporary research findings. In addition, this review highlights the underlying mechanisms linking coagulation pathways to HCC pathogenesis and explores potential therapeutic targets. An integrative perspective on the role of coagulation markers in HCC may improve clinical management strategies for patients affected by this malignancy.