Nephrolithiasis remains an important consideration in living kidney donor evaluation, but long-term outcomes in carefully selected donors with asymptomatic stones remain incompletely defined. We evaluated renal functional trajectories and postdonation stone recurrence among donors with incidental nephrolithiasis identified during predonation assessment. In this single-center retrospective cohort study, all living kidney donors who underwent nephrectomy between March 2007 and March 2017 under a standardized age-stratified protocol were analyzed. Donors with asymptomatic nephrolithiasis on predonation computed tomography were compared with stone-free donors. Primary endpoints were postdonation stone recurrence and estimated glomerular filtration rate (eGFR; 2021 Chronic Kidney Disease Epidemiology Collaboration equation) at last follow-up. Multivariable and longitudinal mixed-effects models were used to evaluate renal outcomes. Among 1444 approved donors, 52 (3.6%) had asymptomatic nephrolithiasis; 44 were included in the final analytical cohort. No donor developed radiologic recurrence or symptomatic stone events during extended follow-up. Nephrolithiasis was not independently associated with last follow-up eGFR, ≥30% decline in eGFR, or longitudinal renal functional trajectories. Carefully selected donors with small, asymptomatic stones demonstrated favorable long-term outcomes, supporting a risk-stratified approach to donor selection.

OBJECTIVES:The introduction of direct -acting antivirals has transformed kidney transplantation with hepatitis C virus -positive donors from a high -risk practice to a safe strategy for expanding the donor pool. This study aimed to highlight global research trends, collaborations, and shifts in hepatitis C virus -positive donor kidney transplant before and after the direct -acting antiviral era. MATERIALS AND METHODS:We conducted a thorough search of the Web of Science database, focusing on research output with relevant key words related to the hepatitis C virus and kidney transplant, resulting in 414 pertinent research items. We analyzed these items using bibliometric parameters. RESULTS:Over the past 2 decades, notable shifts have occurred in the research trajectory, with a peak in publications observed in 2018 and 2019 following the introduction of direct -acting antivirals, followed by a decline in subsequent years. The United States generated the highest research output, followed by France and Spain. The journals Transplantation and American Journal of Transplantation dominated in terms of citations. The University of Toulouse, the University of Pennsylvania, and the University of Miami were the leading institutional contributors. CONCLUSIONS:The introduction of direct -acting anti -virals coincided with a rapid rise in research activity and global collaboration, reflecting the transition of hepatitis C virus -positive donor kidney transplant from a high -risk practice to routine clinical adoption.

AIM:This study investigated the risk factors for both high post-void residual (PVR) and the need for urinary re-catheterization (RC) following kidney transplantation (KT). Our objectives were to develop a predictive risk model for high PVR and to outline a management strategy for patients who experience posttransplant elevated PVR. METHODS:This prospective study included 110 adult patients who underwent KT. High PVR was defined as > 150 mL in non-anuric patients and > 50 mL in anuric patients. Logistic regression analysis was conducted to identify predictive factors for high PVR. Urinary RC was evaluated as a secondary outcome. RESULTS:High PVR was observed in 31 (28.2%) patients. On multivariate analysis, DM (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.22-7.94; p = 0.02) and anuria before transplantation (OR, 3.80; 95% CI, 1.34-10.80; p = 0.01) were identified as significant predictors of high PVR. The area under the curve of the receiver operating characteristic for the risk model using these factors was 0.72 (95% CI, 0.61-0.82). Urinary RC was required in 14 (12.7%) patients, and among male recipients, those who required RC due to high PVR had significantly larger prostate volume (p = 0.003). CONCLUSIONS:The present study demonstrated that DM and anuria are predictive factors for high PVR and larger prostate volume in male recipients was associated with an increased likelihood of RC. To prevent the following complications, PVR should be routinely measured especially in patients with a history of diabetes or anuria.

BACKGROUND Machine learning (ML), a major branch of artificial intelligence, has not only demonstrated the potential to significantly improve numerous sectors of healthcare but has also made significant contributions to the field of solid organ transplantation. ML provides revolutionary opportunities in areas such as donor-recipient matching, post-transplant monitoring, and patient care by automatically analyzing large amounts of data, identifying patterns, and forecasting outcomes. AIM To conduct a comprehensive bibliometric analysis of publications on the use of ML in transplantation to understand current research trends and their implications. METHODS On July 18, a thorough search strategy was used with the Web of Science database. ML and transplantation-related keywords were utilized. With the aid of the VOS viewer application, the identified articles were subjected to bibliometric variable analysis in order to determine publication counts, citation counts, contributing countries, and institutions, among other factors. RESULTS Of the 529 articles that were first identified, 427 were deemed relevant for bibliometric analysis. A surge in publications was observed over the last four years, especially after 2018, signifying growing interest in this area. With 209 publications, the United States emerged as the top contributor. Notably, the "Journal of Heart and Lung Transplantation " and the "American Journal of Transplantation " emerged as the leading journals, publishing the highest number of relevant articles. Frequent keyword searches revealed that patient survival, mortality, outcomes, allocation, and risk assessment were significant themes of focus. CONCLUSION The growing body of pertinent publications highlights ML's growing presence in the field of solid organ transplantation. This bibliometric analysis highlights the growing importance of ML in transplant research and highlights its exciting potential to change medical practices and enhance patient outcomes. Encouraging collaboration between significant contributors can potentially fast-track advancements in this interdisciplinary domain.

The integration of artificial intelligence (AI) has profoundly influenced kidney transplantation, enhancing the ability to predict graft survival, diagnose rejection, and improve post-transplant care. This study aims to provide an overview of AI research in kidney transplantation, identifying major contributors, research patterns, and key areas of focus. The data collection and retrieval process involved a systematic search conducted on September 28, 2023, using the Web of Science database. The search resulted in the identification of 269 scholarly articles exclusively focused on AI in kidney transplantation. These articles formed the basis of our comprehensive bibliometric analysis. Analysis reveals a notable increase in publications since 2017, peaking at 87 in 2022. Machine learning (ML) emerged as the predominant AI subtype, with leading institutions including the Medical University of Vienna, Hannover Medical School, and the University of Alberta. The United States led in publications and citations. Primary research areas include graft outcome, survival, immunosuppressive treatments, and rejection. The growing integration of AI, particularly ML, underscores the importance of interdisciplinary collaboration and international cooperation in shaping the field. Further research is needed to address current challenges and fully exploit AI's potential in kidney transplantation.

Pulmonary renal syndrome (PRS) is a constellation of different disorders that cause both rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage. While antineutrophil cytoplasmic antibody associated vasculitis and anti-glomerular basement membrane disease are the predominant causes of PRS, numerous other mechanisms have been shown to cause this syndrome, including thrombotic microangiopathies, drug exposures, and infections, among others. This syndrome has high morbidity and mortality, and early diagnosis and treatment is imperative to improve outcomes. Treatment generally involves glucocorticoids and immunosuppressive agents, but treatment targeted to the underlying disorder can improve outcomes and mitigate side effects. Familiarity with the wide range of possible causes of PRS can aid the clinician in workup, diagnosis and early initiation of treatment. This review provides a summary of the clinical presentation, etiologies, pathophysiology, and treatment of PRS.

In photodynamic therapy (PDT), 5-aminiolevulinic acid (5-ALA) applied topically is converted, via the heme cycle, into protoporphyrin IX (PpIX), a photosensitizing agent, which upon excitation with light can induce tumor destruction. Due to its hydrophilic and zwitterionic characteristics, 5-ALA has limited penetration into the skin. More lipophilic 5-ALA ester derivatives are expected to cross stratum corneum more easily than 5-ALA. According to the determination of the partition coefficients of 5-ALA methyl, n-butyl, n-hexyl and n-octyl esters, these compounds showed an increased affinity to the SC, with 5-ALA hexyl ester and 5-ALA-octyl ester having the highest partition coefficients. Our in vitro skin permeation studies demonstrated an increased permeated amount for hexyl-ALA after 6 h of incubation, compared to other esters and 5-ALA. After 6 h, more 5-ALA-hexyl ester and -octyl ester were retained at viable epidermis and dermis than 5-ALA. According to these results, and considering that the conversion of 5-ALA into PpIX occurs preferentially in epidermis, it can be supposed that topical use of ester derivatives with longer chains (C6 or C8) is an interesting proposal to optimize topical 5-ALA-PDT

It is well known that evaluation of parameters for any mathematical model is always very important and often a very difficult problem. This is especially true for agents-based models because as a rule the evaluation of an agent's parameters can be made only based on available information from the higher levels of a complex system. Such problems can be ill-posed or even have a non-unique solution. That is why there is no general algorithm for solving these problems and a researcher has to search for it for every specific model type.In this paper the problem of evaluating transmission probabilities for different age groups during an influenza epidemic/pandemic in a city will be considered. In order to solve this problem a regularization procedure based on illness attack rates for several age groups (cumulated numbers of infected residents as functions of time) is proposed and validated. It can be used for past epidemics to estimate the efficiency or inefficiency of undertaken interventions, to propose new ones and to reveal its advantages and shortcomings. Under some conditions it can be used to model the possible dynamics of a coming epidemic.

BACKGROUND:Cytomegalovirus (CMV) is a significant cause of morbidity and mortality after solid organ transplantation. While guidelines suggest using highly sensitive QNAT assays for CMV detection, there is no defined viral load to guide initiation of preemptive therapy. This study evaluates the progression to quantifiable CMV (DNAemia) following a CMV "blip" in high-risk (D+/R) kidney/kidney-pancreas (KP) transplant recipients.METHODS:This is a single center, retrospective study. A CMV "blip" was defined as the first positive QNAT assay below the level of quantification (<1.37 × 102 IU/ml or <200 viral copies). Subsequent CMV QNAT assays were followed to assess the progression from blip to CMV DNAemia for 1 year following transplant.RESULTS:A total of 134 patients were included in the study. Fifty-three (39.6%) patients had their first positive CMV QNAT value below the level of quantification, a "CMV blip." Of these 53 patients, 69.8% (n = 37) progressed to DNAemia while 30.2% (n = 16) did not. The median time from transplant to the first CMV blip was 68 (46-97) days and most patients with viral blips (71.1%) were on prophylaxis. No differences in patient characteristics were found among those who progressed from blip to DNAemia and those who only had a blip.CONCLUSIONS:In CMV high-risk kidney/KP transplant recipients, CMV blips progressed to CMV DNAemia in the majority of cases. This progression typically occurred 2-3 weeks following the initial blip. CMV blips are common early posttransplant despite prophylaxis and likely represent an early marker of CMV infection.

It is a well-known fact that the demand for kidneys far outpaces our society’s supply. The kidney allocation system (KAS) was created to ensure a fair distribution of a scarce societal resource. In 2014, the KAS was revised to help balance the equity and utility. Here we examine the many inequalities the KAS 2014 overcame, discuss the barriers that still exist, and evaluate the future implications of the new version of the KAS that is set to begin March 14, 2021. With the implementation of KAS 2014, longevity matching was much improved with decrease in number of recipient and donor age mismatch >15 years. There was an increase in highly sensitized transplants, especially those with calculated panel reactive antibody (cPRA) >98% due to a sliding scale of points and local/regional/national priority. Some groups even reported that it may have advantaged the very highly sensitized patients too much and suggested a more gradual sliding scale of points. The racial/ethnic disparities were much improved with allowance of wait time to start at time of dialysis initiation to capture those who did not have adequate and early access to a transplant center. Despite these improvements, there remains a geographic disparity which was not addressed with KAS 2014. KAS 2021 (set to begin March 14, 2021) was created to lessen the geographic barriers without compromising the utility of the organs. By eliminating donor service area (DSA) and instead using 250 nautical mile (nm) concentric circles around donor hospitals, this new system is intended to broaden the sharing. This change to the allocation is another step toward the goal of improving equality, but how this change will affect the utility remains to be seen.

Hepatitis C virus (HCV) is associated with increased mortality and morbidity in patients with chronic kidney disease (CKD). The early detection and treatment of Hepatitis C associated with kidney disease is paramount to preventing the progressive loss of kidney function. HCV treatment until the advent of direct acting anti-viral agents (DAAs) was limited to interferon and ribavirin. Interferon and ribavirin treatment resulted in only modest success but with frequent adverse events and poor tolerability. Furthermore, interferon and ribavirin could not be used in certain patient populations including those with advanced CKD, were on dialysis, or those who have received a kidney transplant. DAAs have now made treatment possible in these sub-groups with a sustained viral response (SVR) of 90–100% and minimal side effects. DAAs have helped increase transplant rates by allowing for the use of HCV positive kidneys in recipients who are HCV negative. Although the choice of DAAs should be carefully considered and based on patient characteristics, concomitant medications, and HCV genotype.

Background Elderly patients are the fastest growing population requiring renal replacement therapy. As previous studies have shown a survival benefit of kidney transplantation compared to dialysis for end-stage renal disease, we sought to evaluate if this survival benefit extends to octogenarians. Methods This was a single-center retrospective cohort study of renal allograft recipients >= 80 years transplanted from 1999 to 2014 who were compared to patients listed during the same period that did not proceed to transplantation. A secondary matched group was selected from the UNOS transplant waitlist database. The primary outcome was patient survival. Secondary outcomes included graft survival and rejection incidence. Results Thirty-three transplanted patients were compared to 71 patients waitlisted at our center and 66 patients from the UNOS database. Patients in the study group were transplanted 20.8 +/- 16.1 months after listing. Patient survival was 87.8% at 6 months and 1 year and 71.4% at 3 years. Kidney transplantation was associated with a significant decrease in the risk of death after listing (HR: 0.22, CI: 0.11-0.45,P < .001). Conclusion With escalating life expectancy, kidney transplantation is a suitable treatment option in eligible octogenarians.

Coronavirus disease-2019 (COVID-19) has caused a pandemic that has affected millions of people worldwide. COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and is spread by close contact and by respiratory droplets. It has also impacted different aspects of caring for people with kidney disease, including those with acute kidney injury (AKI), chronic kidney disease (CKD), those requiring kidney replacement therapy (KRT), and those with a kidney transplant. All of these patients are considered high risk. The lessons learned from the COVID-19 pandemic will hopefully serve to protect patients with kidney disease in a similar situation in the future.

Purpose Kidney dysfunction causes significant morbidity and mortality after lung transplantation. Historically there is a 30-40% incidence of creatinine doubling after lung transplantation. We report our experience using sirolimus for lung transplant recipients with renal insufficiency. Methods We hypothesized that the addition of sirolimus would have a renal function sparing effect by reducing calcineurin inhibitor (CNI) exposure and analyzed data from lung transplant patients who initiated sirolimus between June 2011 and September 2017 at the University of Maryland Medical Center. Results Forty-seven patients received sirolimus because of renal insufficiency (median) creatinine (Cr) 1.58 mg/dL (IQR 1.19 - 1.83). Cr remained stable at 1, 3, and 6 months after sirolimus initiation 1.50 (1.13-1.73); 1.49 (1.2-1.7) and 1.57 (1.21-1.86). CNI exposure was reduced by 34% after sirolimus initiation. FEV1 also remained stable over the six-month study interval; baseline median 2.17 L/sec (1.77-2.66); six month 2.13 (1.67-2.57). Conclusion Sirolimus treatment is associated with stability of lung and renal function in lung transplant recipients with progressive renal insufficiency.