The long-term impact of SARS-CoV-2 infection on kidney allograft survival remains incompletely understood, particularly regarding the influence of vaccination, acute kidney injury (AKI), and post-infection immunosuppression. We conducted a retrospective analysis of 129 kidney transplant recipients with confirmed SARS-CoV-2 infection between March 2020 and March 2022 with a median follow-up of 50 months. Among 129 recipients, 106 (82%) received vaccination at any time before or after SARS-CoV-2 infection (82%) while 23 (18%) remained unvaccinated. Unvaccinated patients experienced significantly lower long-term graft survival (52% vs. 85%; p = 0.0004) and patient survival (83% vs. 99%; p = 0.0003) compared with vaccinated recipients. AKI occurred in 15% of recipients and independently predicted graft failure (aHR 2.88; p = 0.0341). Post-SARS-CoV-2 serum creatinine and albuminuria were strong prognostic markers of graft loss. Unvaccinated status independently predicted graft failure in both transplantation-anchored (aHR 2.80; p = 0.0342) and SARS-CoV-2-anchored models (aHR 5.31; p = 0.0004). Continuation of mycophenolate mofetil at post-infection assessment was associated with reduced graft-failure risk (aHR 0.99; p = 0.0193). These findings underscore the importance of sustained vaccination in preserving long-term allograft function.

Background Frailty has been identified as an important determinant of adverse transplant-related outcomes; however, its integration into routine kidney transplant practice remains limited.Methods This was a web-based cross-sectional survey assessing current practice patterns and perceptions on frailty assessments among transplant physicians distributed by the DESCaRTES working group of the European Renal Association. The survey consisted of questions about frailty perceptions and practices both pre- and post-transplant.Results A total of 134 responses (response rate 39.2%) were recorded. Although 98.5% recognized frailty as a risk factor for adverse outcomes, only 6.7% reported routinely performing a standardized frailty assessment in pre-transplant evaluations. Nearly 30% never evaluated frailty, and 24.6% did so only in selected high-risk patients, primarily based on age, comorbidities or prolonged dialysis duration. Physical function was recognized as the most important component of frailty assessments; however, no single assessment tool was consistently implemented. The main barriers to integrating frailty assessments into clinical practice were lack of trained staff, absence of standardized guidelines, and uncertainty about clinical usefulness. Post-transplant frailty assessments were rarely conducted routinely, despite 74.6% acknowledging their potential value.Conclusions Despite widespread recognition of frailty as a significant determinant influencing transplant outcomes, its routine assessment in clinical practice remains limited across European centers. Variability in assessment tools, lack of guidelines and insufficient training resources contribute to this gap. Addressing these barriers through targeted education, validation of practical assessment tools, and consensus-driven protocols is essential to support the integration of frailty evaluation into both pre- and post-transplant care.

Background: Glycemic variability (GV) may play an important role in metabolic outcomes after kidney transplantation (KT). This study aimed to evaluate the association between early post-transplant GV, assessed by continuous glucose monitoring (CGM), and the subsequent development of post-transplant dysglycemia. Methods: This prospective exploratory pilot study included adult recipients of primary deceased-donor KT at Martin University Hospital, Slovakia. The Dexcom G6 CGM system was applied immediately before KT and continuously measured interstitial glucose for seven days after KT. Demographic, clinical, and biochemical data were collected on day 0, and 7, and at months 3, 12. Results: Twenty patients completed the 12-month follow-up. PTDM/prediabetes developed in 10 (50%) and had higher HbA1c on day 7 (p = 0.038) and lower postprandial insulin (p = 0.042). At 3 and 12 months, HbA1c (p = 0.006), fasting insulin (p = 0.0219), and HOMA-IR (p = 0.006) were significantly elevated in this group. CGM demonstrated higher mean glucose (p = 0.021), SD (p = 0.001), and estimated HbA1c (p = 0.017), with longer time above range (p = 0.042) and shorter time in range (p = 0.037). In exploratory regression analyses, CV ≥ 36% (aOR 7.31, p = 0.049) and TAR (aOR 1.35, p = 0.045) were associated with subsequent PTDM/prediabetes. Conclusions: In this prospective exploratory pilot study, higher early postoperative GV was associated with subsequent post-transplant dysglycemia. These findings suggest that CGM-derived metrics may help identify patients at higher metabolic risk after KT; however, given the small sample size and exploratory design, the results should be interpreted as hypothesis-generating.

Background: Early post-transplant albuminuria is associated with adverse graft and cardiovascular outcomes and may reflect ischemia–reperfusion injury-induced damage to the glomerular filtration barrier. However, evidence for safe adjunctive interventions targeting these early pathophysiological processes remains limited. Methods: In this single-center prospective cohort study with historical controls, adult kidney transplant recipients transplanted between January 2020 and September 2022 served as controls, while consecutive recipients transplanted from October 2022 onward received adjunctive silymarin (900 mg/day for 30 days) in addition to standard immunosuppression. The principal renal outcome was UACR assessed during the first 3 months post-transplant. A ≥25% reduction in UACR between Months 1 and 3 was additionally evaluated as an exploratory responder outcome. Secondary outcomes included estimated glomerular filtration rate (eGFR), lipid profile parameters, tacrolimus exposure, and safety. Results: A total of 136 patients (78 silymarin-treated and 58 controls) were included. UACR was consistently lower in the silymarin group at months 1–3. In multivariable analysis, silymarin treatment was independently associated with lower UACR at month 3. In an exploratory responder analysis, a ≥25% reduction in UACR between Months 1 and 3 occurred more frequently in silymarin-treated patients (OR 3.28, 95% CI 1.38–7.79; p = 0.007). eGFR trajectories were similar between groups. No consistent independent effects on lipid parameters were observed after adjustment. Tacrolimus exposure and adverse event rates were comparable between groups. Conclusions: Short-term silymarin exposure initiated early after kidney transplantation was associated with lower UACR during the first three post-transplant months. These findings support a potential targeted effect on early glomerular injury and suggest that silymarin may represent a safe adjunctive strategy to modulate early post-transplant risk.

BackgroundDonor-derived cell-free DNA (dd-cfDNA) is a noninvasive biomarker for allograft injury in kidney transplant recipients. This single-center study aimed to evaluate the clinical indications for dd-cfDNA testing, its association with biopsy findings, and the comparative utility of dd-cfDNA expressed as a percentage versus absolute copy number.MethodsA retrospective analysis was conducted of 571 dd-cfDNA measurements from 313 kidney transplant recipients at the Charité Berlin Transplant Center from May 2020 to May 2025. The clinical indications for testing, biopsy, and rejection predictors were assessed using multivariable logistic regression and linear regression.ResultsElevated creatinine (29%), elevated urine albumin-to-creatinine ratio (UACR, 10%), donor-specific antibody positivity (10%), history of rejection (9%), immunosuppression reduction (5%), and combined reasons (38%) were the most frequent indications for dd-cfDNA testing. Elevated UACR was the only independent predictor of biopsy (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.39–6.58; p = 0.005). In the biopsy cohort, the dd-cfDNA percentage (OR, 5.46; 95% CI, 2.89–13.70; p = 0.0035) and copies/mL (OR, 7.05; 95% CI, 1.01–21.09; p = 0.0062) independently predicted rejection. ROC analysis indicated good discrimination of rejection for both copies/mL (AUC, 0.781) and percentage (AUC, 0.820). DCA revealed that both dd-cfDNA formats offered greater net clinical benefits for rejection prediction than the conventional markers.ConclusionAlthough biopsy decisions primarily rely on conventional clinical parameters, dd-cfDNA can independently identify rejection and improve decision-making when integrated into multimodal post-transplant monitoring strategies.

Thromboembolic and atherosclerotic disorders, necessitating antithrombotic therapies, are prevalent among patients with advanced chronic kidney disease (CKD), as well as in kidney transplant (KT) recipients. However, the optimal management of antithrombotic therapies in these patients remains uncertain due to conflicting evidence and the exclusion of advanced CKD and KT recipients from major randomized controlled trials. Additionally, the perioperative management of antithrombotic therapy in end-stage kidney disease patients undergoing transplantation requires specific attention. This clinical practice document prepared by experts from the Descartes Working Group of the European Renal Association (ERA) and European Kidney Transplant Association (EKITA) from European Society of Organ Transplantation (ESOT) following European Renal Best Practice (ERBP) guidelines, is designed to support clinicians in decision making on antithrombotic therapies in KT candidates and recipients. Following a detailed systematic literature review, it presents current knowledge in epidemiology and pathophysiology and summarizes all relevant studies in this topic.

Background: Protein-energy wasting (PEW) is a major predictor of morbidity and mortality in patients with chronic kidney disease (CKD), even before the initiation of dialysis. Its multifactorial pathogenesis includes reduced dietary intake, chronic inflammation, metabolic acidosis, hormonal disturbances, and dysbiosis of the gut microbiota. Early recognition and targeted management are crucial for preventing muscle loss, functional decline, and adverse outcomes. Methods: This narrative review summarises and integrates current evidence from the literature on nutritional and metabolic interventions to prevent and treat protein-energy wasting in patients with nondialysis chronic kidney disease. Relevant clinical trials, meta-analyses, and experimental studies published up to date were evaluated, focusing on dietary strategies, metabolic modulation, physical exercise, and gut microbiome-targeted therapies. Results: Adequate energy and protein intake remain the cornerstone of PEW management, based on available clinical and observational evidence. Individualised diets emphasising high-quality and plant-based proteins, oral nutritional supplements, and ketoanalogues can attenuate muscle wasting. Correction of metabolic acidosis and inflammation enhances protein anabolism and nitrogen balance. Physical exercise acts synergistically with dietary interventions to preserve muscle mass and function. Novel approaches-such as modulating the gut-kidney axis with pre-, pro-, and postbiotics or supplementing with short-chain fatty acids-show promise in improving metabolic and inflammatory profiles. Conclusions: The management of PEW in nondialysis CKD requires a personalised approach that integrates nutrition, physical activity, metabolic correction and microbiome modulation. Early, coordinated intervention may help to slow the progression of CKD and improve patient survival and quality of life.

Background and Clinical Significance: Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis in adults, typically following a chronic course that often leads to end-stage kidney disease. Rapidly progressive glomerulonephritis is a rare and severe variant of IgAN with a poor prognosis. Case Presentation: We present the clinical case of a 68-year-old Caucasian female with a history of systemic lupus erythematosus and untreated chronic hepatitis B, who was admitted to the Transplant-Nephrology Department, University Hospital Martin, with acute kidney injury and nephrotic syndrome accompanied by hematuria. The clinical picture was marked by lower limb oedema and poorly controlled hypertension, both of which responded well to conservative management. Extrarenal causes were excluded through otolaryngologic, stomatologic, and gynecologic assessments, and autoantibody screening was negative. Renal biopsy revealed crescentic glomerulonephritis with endocapillary and mesangial proliferation and IgA deposits. Due to active hepatitis B, initial treatment was limited to corticosteroids. Following a decrease in viral load, pulse therapy with cyclophosphamide was administered, followed by mycophenolic acid; however, renal function did not recover. Conclusions: The rapidly progressive form of IgA nephropathy in the context of active hepatitis B presents a rare and challenging clinical case. Management requires a highly individualised, multidisciplinary approach due to the risk of infectious complications and the need to preserve renal function.

BACKGROUND The recurrence of IgA nephropathy (IgAN) after kidney transplantation (KT) varies between 9% and 51%. Our analysis aimed to identify risk and protective HLA alleles for the development of IgAN and its recurrence after KT. MATERIAL AND METHODS This retrospective single-center analysis included all patients after KT. Patients underwent HLA typing prior to being listed on the waiting list for KT. Comparisons were performed with a cohort of 10 000 healthy donors from the Eurotransplant registry. RESULTS A total of 470 patients were included. Biopsy-proven IgAN, as the underlying cause of renal failure, was found in 7.2% (n=48), of whom 77% were male (n=37). The DRB1*11 allele was present in 47.92% and was identified as a significant risk factor for IgAN (OR 2.09, P=0.0048). The DRB1*03 allele was detected in 4.17%, and we identified it as potentially protective (OR 0.2, P=0.5472). Recurrence of IgAN was detected in 20.8%, 100% of whom were male. The mean time to confirm recurrence was 56.1 months. We identified the DRB1*11 risk allele in 77.8% of patients with confirmed recurrence but did not identify it as an independent risk factor (HR 2.3967; P=0.3956). We found a significant correlation of IgAN recurrence with the development of DSA after KT (r 0.3980, P=0.0218). CONCLUSIONS Our study identified a 20.8% incidence of IgAN recurrence after KT; 77.8% of these patients had the HLA-DRB1*11 allele, which we also identified as a risk allele for the development of IgAN in native kidneys. De novo DSA after KT was correlated with IgAN recurrence.

Background:Biopsy-based transcriptomics (BBT) was implemented in Central Europe in 2022 to improve kidney transplant diagnostics. Differences in diagnostic practices across transplant centers remain underexplored. Methods:This retrospective multicenter study analyzed 474 kidney graft biopsies from 10 transplant centers between August 2022 and May 2024, where, besides routine histology, BBT using the Molecular Microscope Diagnostic System (MMDx) was performed. Differences in BBT indications and discrepancies between histology assessment by Banff 2022 and MMDx sign-outs among transplant centers were evaluated. Results:Most centers used BBT in only 12%-31% of all performed biopsies, relying on histology alone for most diagnostic decisions. BBT indications varied across centers: 3 focused on histological no-rejection with clinical discrepancy (44%, 45%, and 70%), 2 on chronic or chronic-active antibody-mediated rejection (AMR; clinical discrepancy 44% and 48%), and 2 on borderline changes (clinical discrepancy 30% and 33%). BBT showed moderate agreement with histology (κ = 0.49), with similar discrepancy rates between high- and low-volume centers. Molecular AMR was found in 44% of probable AMR, 63% of active AMR, 63% of microvascular inflammation, C4d- and donor-specific antibody (DSA)-, 77% of chronic-active AMR, and 21% chronic AMR. Molecular T cell-mediated rejection (TCMR) was confirmed in 26% of histologically active TCMR, in 9% of chronic TCMR, and in 16% of borderline changes. In histologic no-rejection cases, molecular AMR was present in 10% of DSA- and 34% of DSA+ biopsies. Conclusions:A moderate discrepancy between histology and MMDx sign-outs was found regardless of the center volume. BBT indications notably varied among centers. Standardized indications should be defined to improve the integration of molecular diagnostics into routine care.

Sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized by the formation of noncaseating epithelioid granulomas. Clinically significant renal involvement is rare in sarcoidosis. It most commonly manifests as chronic tubulointerstitial nephritis and nephrocalcinosis with nephrolithiasis. Further, glomerular involvement is observed sporadically, mainly membranous glomerulopathy or focal segmental glomerulosclerosis. We describe the clinical case of a 49-year-old patient of Caucasian ethnicity with a history of sarcoidosis of the lungs and intrathoracic lymph nodes who was hospitalized for acute kidney injury, hypercalcemia, hypoxemic respiratory insufficiency, general weakness, weight loss, and fever. Conservative treatment was not successful, and therefore early initiation of renal function replacement in the form of intermittent hemodialysis was necessary. During differential diagnosis process, we found nephrotic range proteinuria with microscopic hematuria; autoantibody panel was completely negative. Histologically, a unique constellation of renal lesions in the form of severe chronic tubulointerstitial nephritis combined with diffuse sclerosing crescentic glomerulonephritis was confirmed. Computed tomography scan of the lungs revealed recurrence of sarcoidosis, and a secondary finding was subpleurally localized primary calcified tuberculous infection. Treatment with corticosteroids was initiated in collaboration with a pulmonologist, with rapid improvement in the patient’s extrarenal clinical condition. Sarcoidosis needs to be considered in the differential diagnosis of rapidly progressive glomerulonephritis even though it is a very rare type of renal involvement.

IgA nephropathy (IgAN) is the leading cause of primary glomerulopathy globally, presenting a high lifetime risk of kidney failure, with up to 50% of patients requiring kidney function replacement by age 51. Kidney transplantation (KT) is the preferred treatment method. The recurrence of IgAN post-transplantation is a significant factor leading to graft failure, occurring in 9%–61% of cases based on various studies. Younger age and aggressive disease are associated with higher recurrence risk. The predisposition to IgAN may be linked to specific HLA-DR and -DQ alleles. This analysis sought to identify risk and protective HLA alleles. This retrospective monocentric analysis included patients with biopsy-verified IgAN who underwent KT at the Transplant-Nephrology Department of the University Hospital Martin. Patients were monitored for IgAN recurrence through histological confirmation in graft biopsies. HLA typing was conducted before placing patients on the KT waiting list. The analysis included a comparison to a control group of 10,000 healthy donors from the Eurotransplant registry, capturing demographic and clinical characteristics of the patients. Out of 470 patients screened post-KT, 7.2% (n = 48) were found to have biopsy-verified IgAN, primarily affecting men (77%). The allele DRB111 was found in 47.92% of IgAN patients, indicating a significant risk for IgAN (OR 2.09), while DRB103 appeared in 4.17% and was protective against IgAN (OR 0.2). Recurrence of IgAN post-KT was confirmed histologically in 10% of patients (n = 5), all of whom were men, with an average time of 51.4 months to recurrence. All patients with confirmed recurrence had the risky allele DRB111, and 80% also had DRB103. Notably, one patient exhibited early recurrence after a secondary KT and carried both risk alleles. The study found a 7.2% incidence of biopsy-confirmed IgAN and a 10% recurrence rate in grafts following KT. The allele DRB111 was identified as a risk factor, while DRB103 was protective against the development of IgAN and recurrent disease post-transplantation.

End-stage kidney disease is optimally managed through kidney transplantation. However, the suboptimal function of the transplanted kidney can lead to imbalances in processes controlled by the kidneys, necessitating long-term monitoring of the graft's function and viability. Given the kidneys' high metabolic activity, a metabolomics approach is well-suited for tracking systematic changes in post-transplant patients and holds significant potential for monitoring graft function. In this study, which follows the study on blood plasma, we analyzed morning and 24-hour urine samples from 55 patients who underwent primary kidney transplantation and were uniformly treated with immunosuppressants with a minimal follow-up of 50 months post-surgery. We assessed the relative levels of urinary metabolites detectable by NMR spectroscopy and investigated correlations between these metabolite levels and renal function. We observed rather unexpected independence of levels of urinary creatinine on serum creatinine as well as on allograft function expressed by eGFR. This observation allowed a very good agreement of outcomes from raw and creatinine-normalized data, consistent for both morning urine samples and 24-hour urine collections. The urinary levels of citrate and acetone were detected to be sensitive to allograft function, and the urinary levels of metabolites in combination showed promising prediction for kidney function, on the level of p-value: for 24 h pooled urine: 4.6 × 10−12 and morning urine: 5.36 × 10−9. Based on the results, we support the opinion of critical assessment of creatinine clearance when judging the filtration function of the allograft, where surely factors such as alterations in the tubular secretion of creatinine may play a particular role. As the next, urinary metabolomics can serve as an easily available supplement to prediction for allograft function in patients after kidney transplantation.

We assume that cardiac involvement in patients with glomerulopathy due to granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) is an underdiagnosed entity, mainly due to the absence of standardized screening and the relatively common subclinical course. The aim of our study was to determine risk factors for renal involvement and to find out the prevalence of cardiac involvement, its types and the phenotype of patients who are most commonly affected, in this group of patients. A retrospective study enrolled adult patients who had confirmed new diagnosis or relapse of GPA or MPA between January 2022 and August 2024 at the Renal Department and Vasculitis Clinic of Addenbrooke's Hospital in Cambridge. We recorded all patients’ demographic and clinical characteristics, including all cardiac laboratory and imaging studies. A total of 274 patients were included in our analysis. We found some type of renal involvement in 47.45% (n = 130). Both groups of patients did not show significant differences in age, sex, type of disease and antibodies. Patients with renal involvement had significantly more often new presentation of the disease (P < 0.0001), were diagnosed as an inpatient (P < 0.0001), had significantly higher mean BVAS (P < 0.0001), higher CRP (P < 0.0001), lower eGFR (P < 0.0001) and more often associated pulmonary involvement (P = 0.0300). In multivariate analysis, we identified BVAS > 16 (HR 1.0849; P < 0.0001), CRP > 100 mg/l (HR 4,1582; P < 0.0001), CRP 5–100 mg/l (HR 2.2385; P = 0.0066), inpatient diagnosis (HR 3.3531; P < 0.0001) and pulmonary involvement (HR 1.5294; P = 0.0156) as an independent risk factor for renal involvement. On the contrary, we identified BVAS ≤ 3 (HR 0.0527; P < 0.0001) and relapse presentation (compared to new diagnosis) as an independent protective factor for renal involvement. We found cardiac involvement in 38.5% of patients with renal involvement, while up to 23.9% had significant cardiac involvement. Using Pearson's correlation, we found that significant cardiac involvement was positively correlated with the occurrence of renal involvement (PCC 0.3962; P < 0.0001). Myocarditis (PCC 0.2197; P = 0.0287), cardiomyopathy (PCC 0.2777; P = 0.0054), left ventricle dysfunction (PCC 0.2944; P = 0.0031) and, interestingly, even elevated serum levels of troponin I (PCC 0.1629; P = 0.0464) and NT-proBNP (PCC 0.3703; P < 0.0001) were also positively correlated with renal involvement. On the contrary, in subgroup of patients with significant cardiac involvement, we detected higher occurrence of renal involvement, but not in whole cardiac group. Association of renal and cardiac involvement in GPA and MPA is more common than expected, as cardiac involvement is often asymptomatic and therefore underdiagnosed. Our findings confirm the importance of cardiac screening in asymptomatic patients, at least in the identified risk group.

Background and Clinical Significance: Kidney transplantation remains the most effective method of renal replacement therapy. Living donor transplantation offers several advantages—reduced cardiovascular risk, better graft survival, and preemptive intervention. However, donor obesity is a growing concern, as it is usually associated with perioperative and long-term complications, which can affect donor eligibility. Bariatric surgery is a standard recommendation for patients with a BMI over 35 kg/m2. There are limited data on the use of pharmacological agents for weight reduction in kidney donors. This case presents a successful conservative treatment with GLP-1 receptor agonist in an obese woman wishing to donate a kidney to her son. Case Presentation: We are presenting the case of a 63-year-old woman with grade II obesity who was initially denied being a kidney donor to her son because of her weight. Under these circumstances, she underwent comprehensive lifestyle modification in the cardio-obesitology clinic (caloric restriction, physical activity, and pharmacological treatment with liraglutide). During the 3-month follow-up, she decreased her BMI to 33.4 kg/m2, and subsequent examinations confirmed no surgical contraindications to donating a kidney. Despite hematuria, biopsy and genetic testing revealed a benign carrier condition of Alport syndrome, which, without proteinuria or renal impairment, allowed successful kidney donation. Conclusions: This case demonstrates that conservative pharmacological treatment for body weight reduction with GLP-1 receptor agonists may be an alternative to bariatric surgery for selected obese kidney donor candidates. The presented case highlights the importance of a multidisciplinary and personalized approach.

It is well known that hyperglycaemia occurs very often after kidney transplantation (KT), but previous findings suggest that glycaemic variability (GV) may have a major impact on the development of later complications and patient's outcome. The aim of our study was to identify the impact of GV in the early post-transplant period on the development of metabolic complications using continuous glycaemic monitoring (GCM). This prospective study was performed in patients after primary KT at the Transplant-nephrology department of University hospital Martin, Slovakia. Adult patients with excluded diabetes and prediabetes were given a Dexcom G6 CGM before KT. This system was paired with a smartphone and continuously recorded blood glucose over a period of 7 days after KT. We recorded all patients' demographic and clinical characteristics on day 0, 5 and on the third and twelfth month, including findings in protocol biopsy, or donor specific antibodies. Oral glucose tolerance test was performed in the third and twelfth month. The total length of follow-up was 12 months, and all patients were set on the same immunosuppression. Currently, 20 patients (mean age 47.5 ± 14.6; 65% males) have completed the total length of follow up and were therefore included in the data analysis. The study group consisted of a total of 10 patients who were diagnosed with post-transplant diabetes mellitus—PTDM (n = 7) and prediabetes (n = 3). At baseline, we found no significant differences in basic characteristics between the control and the study group. On the 5th day after KT, we found significantly higher glycated haemoglobin—HbA1c (P = 0.0382) and lower insulin 2 hours post load (P = 0.0417) in the study group. In the study group, we identified significantly higher HbA1c (P = 0.0420), homeostatic model assessment index for insulin resistance, HOMA-IR (P = 0.0420) at month 3 and fasting insulin (P = 0.0219), HbA1c (P = 0.0059), HOMA-IR (P = 0.0060) at month 12 compared to the control group. By analysing the 7-day data from the CGM, we found a significantly higher average glucose (P = 0.0208), standard deviation - SD (P = 0.0006), estimated A1c (P = 0.0169), time in hyperglycaemia (TIH)—high (P = 0.0423), TIH—very high (P = 0.0194) and lower time in normal range (P = 0.0365) in the study group. We determined a criterion of >2.1 for SD as a predictor of PTDM/prediabetes occurrence using CGM models based on ROC curve analysis with a sensitivity of 70 and specificity of 80. The first results of our study demonstrate the impact of GV in the early post-transplant period on the development of glucose metabolism disorders in the third and twelfth months after KT. CGM is an ideal tool for measuring GV in the early period after KT.

Silymarin is an extract of the plant Silybum marianum, which is used as a complementary treatment for liver diseases. However, it significantly interferes with lipid metabolism, and also affects glucose metabolism—in animal models, its administration led to a significant rise in plasma glutathione, while in in vivo models it decreased podocyte damage with nephroprotection in diabetic nephropathy. We performed a pilot, monocentric, analysis of patients transplanted at the Transplantation-Nephrology Department of UNM in patients with insulin resistance defined by HOMA-IR index > 2 with subsequent supplementation of 450 mg of silymarin per day for 180 days with monitoring of metabolic parameters, graft function and level immunosuppressants. Our study was a prospective study including 28 patients after primary kidney transplantation, 71.4

The suboptimal function of transplanted kidney can lead to imbalances in processes controlled by the kidneys, necessitating long-term monitoring of the graft’s function and viability. Given the kidneys’ high metabolic activity, a metabolomics approach is well-suited for tracking changes in post-transplant patients and holds significant potential for monitoring graft function. Examination of the response of urinary creatinine levels to (i) serum creatinine levels and (ii) allograft function during periods of impaired kidney function in post-transplant patients. We analyzed morning and 24-h urine samples from 55 patients who underwent primary kidney transplantation and were uniformly treated with immunosuppressants, with an average follow-up of 50 months post-surgery. We assessed the relative levels of urinary metabolites detectable by NMR spectroscopy and investigated correlations between these metabolite levels and renal function. We observed rather unexpected independence of urinary creatinine levels on levels of serum creatinine as well as on allograft function expressed by eGFR (estimated glomerular filtration rate). This observation allowed a very good agreement of outcomes from raw and creatinine-normalized data, consistent for both morning urine samples and 24-h urine collections. The urinary levels of citrate and acetone were detected to be sensitive to allograft function, and the urinary levels of metabolites in combination showed promising prediction for kidney function, on the level of p-value: for 24 h pooled urine: 4.6 × 10−12 and morning urine: 5.36 × 10−9. We discussed the data also in the light of metabolic changes in blood plasma. We support the opinion of critical assessment of renal creatinine clearance when judging the filtration function of the allograft. As the next, urinary metabolomics can serve as an easily available supplement to prediction for allograft function in patients after kidney transplantation.

BACKGROUND Kidney transplantation is the best therapeutic option for patients with end-stage kidney disease. Despite advances in surgical techniques, the surgical procedure itself is associated with a risk of postoperative complications, with an incidence rate of 5-25%. The aim of this retrospective analysis was to identify risk factors for surgical complications after kidney transplantation. MATERIAL AND METHODS The study included 283 patients who underwent kidney transplantation at our center over an 11-year period (2013-2023). Baseline characteristics of the recipients (age, sex, and type of donor) and factors influencing the development of surgical complications (type of induction therapy, diabetes mellitus, BK positivity) were recorded. Patients who developed a surgical complication (bleeding, lymphocele, ureteral stenosis) were identified and analyzed in relation to potential independent risk factors. RESULTS Surgical complications occurred in 15.8% of patients (n=45), with ureteral stenosis comprising 60% of all surgical complications. The average time to surgical complication onset ranged from 5.4 to 8.6 months. By using Cox proportional-hazard regression multivariate analysis, none of the parameters that were looked at were found to be independent risk factors for the development of surgical complications (endpoints: surgical complications itself, bleeding, ureteral stenosis, lymphocele/lymphorrhea). CONCLUSIONS Kidney transplantation significantly improves quality of life and survival in patients with end-stage kidney disease. Surgical complications remain a significant post-transplant challenge, with urological, vascular, and parietal complications being most common. While we found no independent risk factors among the parameters studied, minimizing these complications is essential to reduce the need for reinterventions and to improve outcomes.