Journal of

Clinical Medicine

Editorial
Special Issue: New Advances in Kidney Transplantation
Eytan Mor 1,2

1 Transplant Center, Department of Surgery B, Sheba Medical Center, Ramat Gan 5266202, Israel;
[email protected]
2 Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel

This Special Issue in renal transplantation covers a variety of clinical and research areas
in kidney transplantation. The recent decade is associated with an ongoing shortage of
organs for transplantation with efforts to increase the organ pool with DCDs and extended
criteria donors. However, with the increasing success rate of kidney transplants, there is
also a growth in the candidate list because of removal of the age barrier and transplantation
of high risk patients with other comorbidities. The future seems promising with the
development of innovative non-invasive technologies introducing biomarkers for diagnosis
of rejection and ischemic reperfusion injury, use of cell therapy for tolerance induction,
development of artificial organs, and overcoming immune and non-immune barriers in
xenotransplantation. This Special Issue will touch some of these topics that are in the
frontiers of the modern era of kidney transplantation.
On the clinical side, there are two papers covering the effect of age and other demo-
graphics criteria on long-term outcome after transplant.
The first paper, by Dr Yemini et al., is from my group, and it discusses the “Long-Term
Results of Kidney Transplantation in the Elderly: Comparison between Different Donor
Settings” [1]. Our paper shows that in a selected population in that age group (>60 y)
live-donor transplantation is associated with very good long-term results. As for deceased
donor kidney transplantation in the elderly the old-to-old allocation seems to be a rational
approach associated with an acceptable outcome.
In a “Systematic Review and Meta-Analysis on The Impact of Recipient Demographics
Citation: Mor, E. Special Issue: New on Outcomes from Living Donor Kidneys” [2], Dr. Bellini et al. shows that gender mismatch
Advances in Kidney Transplantation.
between male recipients and female donors has negative impact on graft survival. African
J. Clin. Med. 2022, 11, 4190. https://
ethnicity and obesity do not influence recipient and graft survival but negatively affect
doi.org/10.3390/jcm11144190
DGF and rejection rates.
Received: 4 July 2022 As for the effect of immunosuppression on malignancy Dr. Imamura et al. preformed
Accepted: 17 July 2022 a long term multi-center study showing that “Everolimus Reduces Cancer Incidence and
Published: 19 July 2022 Improves Patient and Graft Survival Rates after Kidney Transplantation” [3].
Publisher’s Note: MDPI stays neutral
Two other papers focus on pretransplant sensitization. The first paper is by Righini and
with regard to jurisdictional claims in his colleagues on the “Impact of the Type of Dialysis on Time to Transplantation: Is It Just a
published maps and institutional affil- Matter of Immunity?” [4]. In that paper, they drew on almost 30 year experience to show
iations. that the clinical variables that significantly correlated with longer time to transplantation
were the level of presensitization (PRA max and antibodies width) as well as type of
dialysis. The lower sensitization rate in the PD population has led to a shorter waiting time
until transplant compared to HD group. Another paper, “Apheresis Efficacy and Tolerance
Copyright: © 2022 by the author. in the Setting of HLA-Incompatible Kidney Transplantation” [5] by Dr. Noble and his
Licensee MDPI, Basel, Switzerland. colleagues, showed that the efficacy of plasmapheresis in lowering preformed anti-HLA
This article is an open access article antibody levels correlated with the volume of plasma exchanged or filtered and that IA
distributed under the terms and was the most efficient technique for antibody removal compared to plasma exchange (PE)
conditions of the Creative Commons
and double filtration plasmapheresis (DFPP). They concluded that apheresis is an effective
Attribution (CC BY) license (https://
desensitizing measure that allows kidney transplantation in that high immunological risk
creativecommons.org/licenses/by/
group of patients.
4.0/).

J. Clin. Med. 2022, 11, 4190. https://doi.org/10.3390/jcm11144190 https://www.mdpi.com/journal/jcm

J. Clin. Med. 2022, 11, 4190 2 of 3

Use of biomarkers in transplantation is another innovative area of interest in recent

years. In this Special Issue there are two papers looking at correlation of biomarker and
outcome after transplant. The first one is “Pretransplant Serum Uromodulin and Its
Association with Delayed Graft Function Following Kidney Transplantation” [6]. In that
paper, Dr. Kemmner et al. evaluated the association between serum uromodulin (sUMOD),
a potential marker for tubular integrity, with DGF in the clinical setting. They report that
higher pretransplant sUMOD was independently associated with lower odds for DGF,
potentially serving as a non-invasive marker to stratify patients according to their risk for
developing DGF early in the setting of kidney transplantation. The second paper is on the
use of “Urinary NGAL Measured after the First Year Post Kidney Transplantation to Predict
Changes in Glomerular Filtration over One-Year Follow-Up” [7] by Dr. Keilar and her
colleagues. In the clinical setting, we are using biochemical markers in the blood (creatinine
levels) and urine (albumin and protein levels) to assess graft function late after transplant.
Introduction of new and more sensitive markers are needed in stable patient who may
develop quiescent graft injury. In their study, Dr. Keilar and her colleagues assessed the
urinary concentrations of neutrophil gelatinase-associated lipocalin (NGAL) as a predictor
of changes in kidney transplant function after the first year after transplantation among
109 patients with stable functioning graft. They found that Urinary NGAL measured
at baseline was twice higher in patients with at least 10% decrease in eGFR over 1-year
follow-up compared to those with stable or improving transplant function. Baseline NGAL
significantly predicted the relative and absolute changes in eGFR.
The last few years have seen the emergence of many new technologies designed to
examine organ function, including new imaging techniques, transcriptomics, genomics,
proteomics, metabolomics, lipidomics, and new solutions in organ perfusion, which has
enabled a deeper understanding of the complex mechanisms associated with ischemia-
reperfusion injury (IRI), inflammatory process, and graft rejection. This issue includes “A
Review of Current and Emerging Trends in Donor Graft-Quality Assessment Technique” [8]
written by Ms. Natalia Warmuzińska and her colleagues that summarizes and assesses the
strengths and weaknesses of current conventional diagnostic methods and a wide range of
new potential strategies with respect to donor graft-quality assessment, the identification
of IRI, perfusion control, and the prediction of DGF. One of the new methods to assess
graft quality is described in another paper by Dr. lau et al. who used “Intraoperative Near-
Infrared Spectroscopy Monitoring of Renal Allograft Reperfusion in Kidney Transplant
Recipients” [9]. In their study they used a handheld near-infrared spectroscopy (NIRS)
device to quantify regional tissue oxygen saturation levels (rSO2 ) in the renal allograft
after reperfusion and compared the rSO2 between recipients of a deceased donor and a
living donor. They showed that rSO2 remained significantly lower in the DDRT group
compared to the LDRT group throughout the 50 min after reperfusion and that reperfusion
rates were significantly faster in the LDRT group during the first 5 min post-reperfusion.
Interestingly, intraoperative rSO2 strongly correlated with allograft function up to 14 days
post-transplantation. They concluded that NIRS may be a useful intra-operative tool to
assess the degree of preservation/reperfusion injury and predict early allograft function.
Lastly, future technologies to develop organs to replace the current source of human
organs for transplant are in the focus of many research groups around the world. Aiming to
achieve future generation of a new kidney Dr. Garcia-Dominguez and his colleagues stud-
ied “The effect of Sildenafil Citrate in enhancing renal organogenesis following metanephroi
allotransplantation” [10]. Sildenafil citrate (SC) is known as a useful inductor of angio-
genesis, offering renoprotective properties due to its anti-inflammatory, antifibrotic, and
antiapoptotic effects. In their animal model Dr. Garcia-Dominguez and his colleagues using
an animal model performed metanephroi allotransplantation after embedding sildenafil
citrate into the retroperitoneal fat. After 21 days the new kidneys’ weights become increased
significantly. Functionality was proven by renin and erythropoietin gene expression and
tubular integrity was evident by highly expressed E-cadherin on Immunofluorescence
J. Clin. Med. 2022, 11, 4190 3 of 3

assay. Histological studies showed mature glomeruli and hydronephrosis showing the new
kidney’s excretory function.

Conflicts of Interest: The author declares no conflict of interest.

References
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One-Year Follow-Up. J. Clin. Med. 2021, 10, 43. [CrossRef] [PubMed]
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