OBJECTIVES:We aimed to review the current evidence on kidney transplant in patients with posterior urethral valves, focusing on transplant-specific lower urinary tract assessment, bladder optimization, graft outcomes, infection burden, and long-term follow-up. MATERIALS AND METHODS:We searched peer-reviewed literature indexed in PubMed and major guideline sources through March 2026, focusing on studies that addressed posterior urethral valves, valve bladder dysfunction, and kidney transplantation. Contemporary cohort studies, critical reviews, pediatric urology and transplant literature, and guideline-based statements were prioritized. In accordance with journal policy, donors considered in the reviewed transplant literature were either deceased donors or living related donors. RESULTS:Available evidence indicated that posterior urethral valves are not a contraindication to kidney transplant when the lower urinary tract is systematically evaluated and optimized. Low-pressure urine storage and reliable bladder emptying are central determinants of graft protection. Vesicoureteral reflux should be actively assessed and, when clinically significant, treated in the context of native kidney function, infection burden, and bladder strategy; in poorly functioning refluxing native kidneys, native nephroureterectomy may be more appropriate than anti-reflux correction. Clean intermittent catheterization, with or without a catheterizable channel, is often graft-protective, whereas augmentation cystoplasty should be reserved for selected hostile bladders refractory to conservative treatment. The timing of reconstruction and native upper-tract surgery should be individualized according to bladder phenotype, residual urine output, donor type, and anticipated wait time. CONCLUSIONS:Kidney transplant in patients with posterior urethral valves can achieve durable allograft function when bladder phenotyping, stepwise optimization, reflux management, infection prevention, donor-specific surgical planning, and lifelong follow-up are integrated into care. Clinically significant vesicoureteral reflux should prompt consideration of anti-reflux surgery or native nephroureterectomy according to kidney function, residual diuresis, and reconstructive timing. A multidisciplinary strategy extending through transition to adult services offers the best opportunity to protect the allograft.
OBJECTIVES:Infections, especially pneumonia, are among the significant causes of morbidity and mortality in transplant recipients. Pneumonia leads to a complex clinical picture, related not only to the infection itself but also to underlying immunosuppression, conco -mitant diseases, and organ dysfunction. Here, we evaluated the effect of the HALP score (ie, hemoglobin, albumin, lymphocyte, and platelet ) on prognosis in patients who developed pneumonia after kidney transplant. MATERIALS AND METHODS:We retrospectively reviewed files of kidney transplant recipients in the chest diseases outpatient clinic of our hospital who were diagnosed with pneumonia on thoracic computed tomography scans between April 2020 and April 2025. We exported data (age, sex, laboratory test results at diagnosis, duration of hospitalization, and mortality rate ) to a database spreadsheet file (Excel ) and compared hemoglobin, albumin, lymphocyte, and platelet scores of patients who died versus survived. We analyzed disease severity by classification according to the Pneumonia Severity Index and CURB -65 (ie, confusion, uremia, respiratory rate, blood pressure, and age ≥65 ) scores. RESULTS:Among 178 included patients (100 female, 78 male ), 148 survived (83.1 % ) and 30 died (16.9 % ). Patients who died had lower hemoglobin, albumin, lymphocyte, and platelet scores than patients who survived. Patients with higher Pneumonia Severity Index scores had significantly lower hemoglobin, albumin, lymphocyte, and platelet scores. CONCLUSIONS:The hemoglobin, albumin, lymphocyte, and platelet score is a biomarker based on easily calculable, low -cost, and accessible parameters and may be a potential tool for evaluation of prognosis in the general patient population. Prospective and multicenter studies with larger sample groups are needed to better evaluate the role of the hemoglobin, albumin, lymphocyte, and platelet score for determination of the prognosis related to infections in kidney transplant recipients.
OBJECTIVES:Erectile dysfunction is highly prevalent in men with end -stage renal disease and substantially impairs quality of life. Although kidney transplant can mitigate systemic complications, its effect on erectile dysfunction varies. Here, we evaluated 1 -year changes in erectile function following living donor kidney transplant in Azerbaijani men and identified clinical predictors of postoperative improvement. MATERIALS AND METHODS:This retrospective observational study included 121 male patients undergoing living donor kidney transplant between 2017 and 2024. Erectile function was evaluated with the 5 -item International Index of Erectile Function preoperatively and at 6 and 12 months postoperatively. We used multivariate linear regression to identify independent predictors of improvement. RESULTS:All patients (mean age: 35.9 ± 11.7 y ) had erectile dysfunction at baseline, predominantly mild -to -moderate (42.1 % ) or moderate (28.9 %). Mean 5-item International Index of Erectile Function scores increased significantly from 11.0 ± 3.8 at baseline to 12.2 ± 4.1 at 6 months and to 14.0 ± 4.8 at 12 months (both P < .001 ). At 1 year, 97.5 % of patients demonstrated improvement in score, with a mean increase of 3.0 ± 1.6 points. Univariate analysis linked older age, smoking, regular sexual partnerships, and mild baseline erectile dysfunction with greater increase in score. However, multivariate analysis established the baseline score as the sole independent predictor of 1 -year erectile function improvement (P < .001 ). CONCLUSIONS:Living donor kidney transplant was associated with significant and progressive improvement in erectile function over 1 year in men with end -stage renal disease. Baseline erectile function was the key determinant of recovery, underscoring the importance of early evaluation and management.
OBJECTIVES:Donor pathways (donation after neurological death, ie, brain death; and donation after circulatory death ) are influenced, within each country, by several factors such as social trends and disease prevalence, which profoundly affect the mechanism and age of deaths in a population. An informed perspective on this process requires a rigorous analysis of donor efficiency (number of organs retrieved and transplanted, utilization rate, and organs per donor ) and procurement policies. MATERIALS AND METHODS:We assessed the procurement activity regarding deceased donors in the Tuscany region from the period 2022 -2025. We focused on trends in donation after brain death and donation after circulatory death (both controlled and uncontrolled donation after circulatory death ), and on deceased donor pathway efficiency as assessed by utilization rate and organs per donor. RESULTS:In the Tuscany region, 1517 donors were assessed from the period 2022-2025. Most were donations after brain death (1260 /1517, 83 % ), and the remaining 257 (17 % ) were donations after circulatory death (162 uncontrolled, 63 %; and 95 controlled, 37 % ). The number of uncontrolled donations after circulatory death remained stable, whereas the number of controlled donations after circulatory death showed progressive growth. Utilization rate remained stable in donations after brain death and controlled donations after circulatory death, whereas the rate progressively increased in uncontrolled donations after circulatory death (from 56 % in 2022, to 73 % in 2025 ). During the study period, 1367 transplants were performed, and donations after brain death were the main source for transplants. CONCLUSIONS:Among 1517 deceased donors, the high performance of the donation after brain death pathway, particularly regarding transplant volume and transplant type, underscores the critical need for the systematic identification and optimal management of all potential donations after brain death within the territory.
Distinguishing BK virus nephropathy from T -cell -mediated rejection remains a clinicopathological challenge in kidney transplants, because the 2 entities may share overlapping histological features while requiring opposite therapeutic approaches. We report a kidney transplant recipient with biopsy -proven BK virus nephropathy who later underwent repeat biopsy showing low -level BK virus nephropathy with borderline T -cell -mediated rejection. Despite histological concern for rejection, the broader clinical picture did not support clinically significant T -cell -mediated rejection; specifically, serum creatinine remained stable, BK viral load showed marked improvement, donor -specific antibodies were negative, and there were no vascular or microvascular features of active rejection. A peripheral blood next-generation RNA sequencing gene expression profile yielded a low -risk acute rejection score of 6. Antirejection therapy was deferred, immunosuppression was not escalated, and the patient remained clinically stable. This case highlights the potential adjunctive role of peripheral blood RNA profiling for resolution of histologically ambiguous cases of BK virus nephropathy and borderline T -cell-mediated rejection.
