Cellular and humoral response after mRNA SARS-CoV-2 vaccination in kidney transplant recipients living with HIV: A cross-sectional study.

Introduction: No data exists on responses to mRNA vaccines in kidney transplant recipients (KTRs) with HIV. We compared these responses in HIV-positive (HIV+KTR+) and negative KTRs (HIV-KTR+), and in people living with HIV (PLWH) without kidney transplantation (HIV+KTR-).

Methods: In across-sectional study of 33 patients receiving mRNA SARS-CoV-2 vaccination, we evaluated the humoral response to mRNA SARS-CoV-2 vaccination using a Luminex platform (IgG and IgM), and cellular response with specific T cell response (S-and N- protein) by ELISpot.

Living Kidney Donation Practices in Europe: A Survey of DESCaRTES and EKITA Transplantation Working Groups.

Thorough evaluation of potential kidney donors ensures safety and graft quality, but European data on donor practices are lacking. An online survey was conducted to assess European practices regarding kidney function, risk assessment and follow-up. 56% of respondents (125 practitioners, 16 countries, ∼3700 donations annually) use eGFR, 34% use creatinine clearance and 70% use measured GFR.

A multicenter prospective cohort study evaluating impact of an active delisting strategy to enable kidney transplantation in wait-listed candidates with calculated Panel Reactive Antibody ≥ 99.9.

Introduction: In kidney transplant candidates with calculated Panel Reactive Antibody (cPRA)≥99.9%, looking for perfect HLA compatibility may delay transplantation beyond a reasonable waiting time. However, the presence of preformed donor-specific antibody (DSA) does not always lead to antibody-mediated rejection.

Implementation of the in-house technique for the determination of donor-derived cell-free DNA in daily clinical practice: Experience from the Hospital Clinic of Barcelona.

Background And Objective: The introduction of donor-derived free DNA (ddcfDNA) has emerged as an accurate non-invasive biomarker to diagnose rejection, compared to classical ones. Here we evaluate our experience after its implementation in our center as an in-house technique.

Materials And Methods: Single-center cross-sectional study with extraction of cell-free DNA in blood and quantification of the ddcfDNA using the AlloSeqcfDNA assay (CareDx) at the time of performing biopsies 'per protocol' or 'per indication' between December 2020 and December 2023.

Evaluating Risk in Kidney Living Donors.

Kidney donation is a safe procedure for carefully screened donors. The growing shortage of organs and improved survival rates among recipients of living donor transplants have broadened the criteria for acceptable living donors, including older individuals and those with pre-existing health conditions. Consequently, ensuring both the short- and long-term safety of living donors is of paramount importance.

Blood Gene Expression Profiling and Donor-derived Cell-free DNA to Noninvasively Diagnose Clinical and Subclinical Kidney Transplant Rejection: A Real-life Appraisal Study.

Background: Peripheral blood biomarkers aim to noninvasively diagnose kidney allograft rejection, but most lack robust independent validation. TruGraf is intended to exclude subclinical cellular rejection (TCMR), whereas donor-derived cell-free DNA Viracor-TRAC has proven value in excluding antibody-mediated rejection (AMR). We aim to validate both biomarkers for accurate rejection diagnosis in a real-world clinical setting.

Searching for the minimum required dose of daratumumab to induce effective plasma cell depletion in antibody-mediated rejection of the kidney graft: a case report.

There is no established treatment for late or chronic antibody-mediated rejection of a kidney graft. Rituximab-based treatment is not effective, since long-lived high-affinity plasma cells do not express CD20 and do not depend on previous maturation steps to generate donor-specific antibodies. Conversely, daratumumab, an anti-CD38 monoclonal antibody, directly targets plasma cells, with proven efficacy in multiple myeloma.

Pathophysiology of rejection in kidney transplantation.

Introduction: Rejection remains a major obstacle to successful kidney transplantation. The complex pathophysiology of rejection depends on a fine-tuned interplay between the innate and adaptive immune systems.

Areas Covered: This review provides a comprehensive analysis of the pathophysiology of rejection of kidney grafts, performed through careful selection of most relevant papers available on the topic in the PubMed database.

Antibody-mediated rejection diagnosed in early protocol biopsies in high immunological risk kidney transplant recipients.

Background: Renal transplant recipients with donor-specific anti-HLA antibodies are at an increased risk of antibody-mediated rejection (ABMR). Early protocolized renal biopsies may serve as a strategy to improve diagnosis in this patient population.

Methods: We evaluated 155 highly sensitized renal transplant recipients with cPRA class I + II >90% pre-transplant from 2015 to 2022.

Utility of SARS-CoV-2 Subgenomic RNA in Kidney Transplant Recipients Receiving Remdesivir.

Introduction: There is no reliable microbiological marker to guide responses to antiviral treatment in kidney transplant recipients (KTR) with COVID-19. We aimed to evaluate the dynamics of subgenomic RNA (sgRNA) RT-PCR before and after receiving treatment with remdesivir compared with genomic RNA (gRNA) RT-PCR and its use as a surrogate marker of viral replication.

Methods: We analyzed gRNA and sgRNA at baseline and after remdesivir treatment in KTR who received remdesivir for SARS-CoV-2 infection from November 2021 to February 2022.

Effectiveness and Safety of Postoperative Hospital at Home for Surgical Patients: A Cohort Study.

Objective: To determine the feasibility and effectiveness of a Hospital at Home (HaH) enabled early transfer pathways for surgical patients.

Background: HaH serves as a safe alternative to traditional hospitalization by providing acute care to patients in their homes through a comprehensive range of hospital-level interventions. To our knowledge, no studies have been published to date reporting a large cohort of early home-transferred patients after surgery through a HaH unit.

Early kinetics of donor-derived cell-free DNA after transplantation predicts renal graft recovery and long-term function.

Background: Ischemia-reperfusion injury (IRI) upon transplantation is one of the most impactful events that the kidney graft suffers during its life. Its clinical manifestation in the recipient, delayed graft function (DGF), has serious prognostic consequences. However, the different definitions of DGF are subject to physicians' choices and centers' policies, and a more objective tool to quantify IRI is needed.

Outcomes in older kidney recipients from older donors: A propensity score analysis.

Background: The age of patients referred for kidney transplantation has increased progressively. However, the precise influence of age on transplant outcomes is controversial.

Methods: Etrospective study in which graft and recipient survival were assessed in a cohort of ≥75 years old kidney recipients and compared with a contemporary younger one aged 60-65 years through a propensity score analysis.

Physiopathological role of extracellular vesicles in alloimmunity and kidney transplantation and their use as biomarkers.

Antibody-mediated rejection is the leading cause of kidney graft dysfunction. The process of diagnosing it requires the performance of an invasive biopsy and subsequent histological examination. Early and sensitive biomarkers of graft damage and alloimmunity are needed to identify graft injury and eventually limit the need for a kidney biopsy.

European Society for Organ Transplantation (ESOT)-TLJ 3.0 Consensus on Histopathological Analysis of Pre-Implantation Donor Kidney Biopsy: Redefining the Role in the Process of Graft Assessment.

The ESOT TLJ 3.0. consensus conference brought together leading experts in transplantation to develop evidence-based guidance on the standardization and clinical utility of pre-implantation kidney biopsy in the assessment of grafts from Expanded Criteria Donors (ECD).

Extracorporeal Photopheresis Improves Graft Survival in a Full-Mismatch Rat Model of Kidney Transplantation.

Extracorporeal photopheresis (ECP) is an immunomodulatory therapy based on the infusion of autologous cellular products exposed to ultraviolet light (UV) in the presence of a photosensitizer. The study evaluates the ECP efficacy as induction therapy in a full-mismatch kidney transplant rat model. Dark Agouti to Lewis (DA-L) kidney transplant model has been established.

Immune Profiling of Peripheral Blood Mononuclear Cells at Pancreas Acute Rejection Episodes in Kidney-Pancreas Transplant Recipients.

Profiling of circulating immune cells provides valuable insight to the pathophysiology of acute rejection in organ transplantation. Herein we characterized the peripheral blood mononuclear cells in simultaneous kidney-pancreas transplant recipients. We conducted a retrospective analysis in a biopsy-matched cohort ( = 67) and compared patients with biopsy proven acute rejection (BPAR; 41%) to those without rejection (No-AR).

Humoral and Cellular Immune Responses After a 3-dose Course of mRNA-1273 COVID-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study.

Unlabelled: In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine.

Methods: Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose' and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively.

Medical Aspects of mTOR Inhibition in Kidney Transplantation.

The advances in transplant immunosuppression have reduced substantially the incidence of kidney graft rejection. In recent years, the focus has moved from preventing rejection to preventing the long-term consequences of long-standing immunosuppression, including nephrotoxicity induced by calcineurin inhibitors (CNI), as well as infectious and neoplastic complications. Since the appearance in the late 1990s of mTOR inhibitors (mTORi), these unmet needs in immunosuppression management could be addressed thanks to their benefits (reduced rate of viral infections and cancer).