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This issue is dominated by metabolic and immunological risk management. Two papers address the metabolic burden of transplantation: a Norwegian randomised protocol testing dapagliflozin in de novo recipients, and a meta-analysis quantifying the incidence and modifiable drivers of post-transplant diabetes. Immunological tailoring features through a risk-stratified low-dose rituximab strategy in ABO-compatible grafts and a real-world audit of preemptive pharmacogenetics for immunosuppressant and comedication dosing, while a small randomised trial probes whether structured education improves adherence. Donor-pool expansion is represented by intermediate-term safety data on HBsAg-positive living donors, and the perioperative and prognostic ends are covered by a meta-analysis of peripheral nerve blocks for opioid sparing and a machine-learning model for long-term allograft survival. Together they reflect a practice increasingly focused on cardiometabolic protection, individualised immunosuppression, and cautious widening of donor eligibility.
1. Can sodium-glucose cotransporter 2 (SGLT2) inhibition preserve renal structure and function in de novo kidney transplant recipients? Protocol for a randomised, double-blind, placebo-controlled trial assessing the efficacy of dapagliflozin on kidney structure, function and safety in kidney transplant recipients in Norway-the DEAK study.
Kongerud IC, Midtvedt K, Solbu MD, Øvrehus MA, Eikrem Ø, Eide IA, Heldal K, Birkeland K, Åsberg A, Jenssen TG. BMJ Open, 2026. PMID: 42315275.
This is the published protocol for the Dapagliflozin Early After Kidney Transplantation (DEAK) study, a nationwide, investigator-initiated, single-centre, double-blind, placebo-controlled randomised trial in Norway. The rationale is that the pivotal SGLT2 inhibitor trials demonstrating slowed chronic kidney disease progression in high cardiovascular-risk populations all excluded transplant recipients, leaving a direct evidence gap. The plan is to enrol 330 de novo adult recipients aged 18–75 with an eGFR of at least 25 mL/min/1.73 m², randomised 1:1 to dapagliflozin 10 mg daily or placebo for three years, with recruitment at 6–8 weeks post-transplant and exclusion of those with recent rejection or active infection. The primary endpoint is the between-group difference in chronic eGFR slope over three years, using the European Kidney Function Consortium equation. Secondary and safety endpoints include measured GFR by iohexol clearance, urinary albumin/creatinine ratio, blood pressure, and infection rates, with embedded protocol biopsies (n=140) scored for inflammation and fibrosis and molecular substudies (n=50). A ten-year registry follow-up of eGFR slope, cardiovascular events, and graft and patient survival is also planned. No results are reported, as this is a design paper (EudraCT 2022-002428-10; NCT05788276). For UK practice, DEAK is the trial most likely to settle whether the cardiorenal gains seen in native CKD extend safely to transplanted kidneys, where infection and volume concerns currently temper enthusiasm.
2. Incidence and risk factors of post-transplant diabetes mellitus after kidney transplantation: a systematic review and meta-analysis.
Chen N, Chen Y, Liu Q, Shu Y. Front Endocrinol (Lausanne), 2026. PMID: 42267307.
This systematic review and meta-analysis pooled observational studies published after 2014 to estimate the incidence of post-transplant diabetes mellitus (PTDM) and identify its risk factors, searching PubMed, EMBASE, the Cochrane Library, and Web of Science up to 24 June 2024. Twenty-six studies from 15 countries, encompassing 8,727 participants, met inclusion criteria, with risk of bias assessed using the Newcastle-Ottawa Scale. The overall pooled incidence of PTDM was approximately 20%. Across the case-control studies, advanced age (OR 1.07, 95% CI 1.04–1.09), high body mass index (OR 1.23, 95% CI 1.08–1.39), and hypertriglyceridaemia (OR 1.01, 95% CI 1.00–1.02) emerged as significant risk factors. Cohort studies additionally identified high fasting plasma glucose, family history of diabetes, and hepatitis C virus infection as contributors, alongside age, BMI, and hypertriglyceridaemia. The authors highlight that BMI, glucose and lipid abnormalities, and HCV infection are modifiable targets. Heterogeneity and reliance on observational data are the principal caveats. The implication for UK transplant clinics is a clear case for systematic pre- and post-transplant metabolic screening and aggressive management of weight, lipids, and glycaemia, particularly in older recipients, given that roughly one in five develops PTDM.
3. Appropriate Risk Classification and Low-Dose Rituximab May Help Prevent Acute Rejection in ABO-Compatible Living Kidney Transplantation.
Fukuda M, Yokoyama T, Miki K, Tanaka K, Kamiyama M, Nakamura Y, Ishii Y. Transplant Proc, 2026. PMID: 42315390.
This single-centre retrospective study examined whether a risk-stratified, single low-dose of rituximab could prevent rejection in ABO-compatible (ABOc) living-donor kidney transplantation, a setting usually considered low-risk but where rejection still occurs. From 264 living-donor transplants performed between January 2015 and July 2024, the authors analysed 158 ABOc recipients after excluding ABO-incompatible cases and those receiving plasmapheresis or intravenous immunoglobulin. Twenty-eight recipients received a single 200 mg dose of rituximab 14 days before transplant and 130 received none, with the rituximab group carrying higher immunological risk—fewer related donors (32.1% vs 66.2%; p=0.002), more sensitised patients (67.9% vs 39.2%; p=0.011), and more donor-specific antibody (DSA) positivity (17.9% vs 1.5%; p=0.001). Despite this adverse risk profile, one-year acute rejection was numerically lower in the rituximab group (0% vs 10.8%; p=0.133), with a trend toward better rejection-free survival (log-rank p=0.075) and comparable one-year infection rates (21.4% vs 23.1%). In the small DSA-positive subgroup, all five treated patients remained rejection-free whereas both untreated patients rejected. The findings are limited by small numbers, retrospective design, and non-significant primary comparisons. For UK units, this supports exploring individualised desensitisation in selected immunologically higher-risk ABOc recipients rather than blanket dosing, pending prospective confirmation.
4. Preemptive Pharmacogenetics in Renal Transplantation: A Real-World Assessment of Pharmacogenetic Actionability.
Chastagner D, Arnion H, Monchaud C, Rérolle JP, Danthu C, Touré F, Picard N. Ther Drug Monit, 2026. PMID: 42307594.
This single-centre retrospective study assessed the real-world actionability of preemptive pharmacogenetic (PGx) testing performed during pretransplant evaluation, on the premise that immunosuppressants and their comedications have narrow therapeutic indices. The cohort comprised 110 adults who underwent pretransplant PGx assessment between 1 January 2022 and 30 June 2023, analysed across 16 pharmacogenes shared between the local panel and the ClinPGx guideline interface. Medication lists were captured pretransplant and post-transplant (or at last follow-up for waitlisted patients), with theoretical actionability defined as any actionable genotype and effective actionability as any actionable gene-drug pair under international guidelines. Theoretical actionability was near-universal at 109 of 110 patients (99%), while effective actionability applied to 29 of 110 (26%) at the pretransplant stage and rose to 19 of 41 (46%) post-transplant. The most frequent actionable pairs after transplant were CYP2C19–proton pump inhibitors (38%), CYP3A5–tacrolimus (25%), SLCO1B1–statins (13%), CYP2D6–tramadol (8%), and ABCG2–allopurinol (8%). Limitations include the single-centre retrospective design and hotspot-only coverage for some genes. The practical message for UK services is that embedding a PGx panel before listing could complement therapeutic drug monitoring—most obviously for CYP3A5-guided tacrolimus initiation—and flag relevant interactions across commonly co-prescribed drugs.
5. Improving Medication Adherence in Kidney Transplant Recipients Through Educational Intervention and Monitoring: A Randomized Clinical Trial.
Heinrich de Oliveira C, Schweig A, Gonçalves BP, Bissani CA, Saldanha MAP, Santini ADR, Riva E, Maestri HDP, Behr RV, Kroth LV. Transplant Proc, 2026. PMID: 42315392.
This randomised clinical trial tested whether a standardised educational intervention improves knowledge, immunosuppressant adherence, and clinical outcomes after kidney transplantation, given that non-adherence is a recognised driver of graft loss. Fifty-nine recipients were randomised, with the intervention group (n=31) receiving two structured health-education sessions using video, a booklet, and oral explanations, while the control group (n=28) received only routine discharge guidance. Knowledge was measured by questionnaire before and after the intervention, adherence by the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS), and clinical outcomes were followed for 12 months. The intervention markedly improved knowledge: one week after discharge the intervention group scored higher than controls (7.5 vs 5.1; p<0.001). However, BAASIS-measured adherence at six months did not differ significantly (45.2% vs 39.3%; p=0.697), and there were no significant between-group differences in rejection, infection, or survival over the first year. The trial is small and single-centre, limiting power for clinical endpoints. The takeaway for UK transplant follow-up is that education reliably raises understanding but, on its own, may not translate into measurable adherence or outcome gains—reinforcing the case for sustained, multimodal adherence support rather than one-off teaching.
6. Renal Outcomes in HBsAg-Positive Living Kidney Donors: A Retrospective Cohort Study.
Huang X, Yin S, Lin T. Transplant Proc, 2026. PMID: 42315391.
This retrospective cohort study evaluated the intermediate-term renal safety of using hepatitis B surface antigen-positive (HBsAg+) living kidney donors, a potential strategy to expand the donor pool. Among 415 living donors, 31 (7.5%) were HBsAg+, followed for a mean of 46.81 months versus 42.10 months for HBsAg- donors, with the primary outcome being change in renal function by serum creatinine and the incidence of eGFR below 45 mL/min/1.73 m². Baseline characteristics were comparable between groups. At last follow-up, serum creatinine was essentially identical (81.65 vs 81.64 µmol/L; p=0.996), and although the creatinine rise from baseline was marginally greater in HBsAg+ donors (12.53 vs 11.08 µmol/L), this was not statistically significant (p=0.060). Low eGFR was uncommon in both groups (3.2% vs 0.5%; p=0.543) with no cases of end-stage kidney disease, and multivariable analysis confirmed HBsAg+ status was not an independent predictor of creatinine increase (estimate 1.42, 95% CI −0.16 to 3.01; p=0.078), whereas hypertension and diabetes were. The retrospective design and small HBsAg+ subgroup limit firm conclusions. For UK practice, where donor scarcity is acute, these data offer cautious reassurance that carefully selected HBsAg+ living donors may be considered, with attention to comorbid hypertension and diabetes.
7. Opioid-Sparing Effects of Peripheral Nerve Blocks in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.
Yun HJ, Kim DH, Chung MY, Min JY. Ann Transplant, 2026. PMID: 42298791.
This systematic review and meta-analysis evaluated whether peripheral nerve blocks (PNBs) reduce postoperative opioid requirements in adult kidney transplant recipients, who face heightened opioid-related risks. Following PRISMA methodology, the authors searched PubMed, EMBASE, the Cochrane Library, and Web of Science through April 2025, with the primary outcome being cumulative opioid use within 24 hours after surgery, expressed as intravenous morphine equivalents. Twelve studies met inclusion criteria and ten contributed to the quantitative synthesis. Pooled analysis showed PNBs significantly reduced 24-hour morphine consumption versus control analgesia, with a mean difference of −16.20 mg intravenous morphine equivalents (95% CI −24.66 to −7.74; p=0.0002). Heterogeneity was very high (I²=99%), reflecting variability in block techniques and perioperative regimens, but no study reported higher opioid use or increased adverse events in the PNB groups. The authors conclude PNBs are an effective opioid-sparing adjunct while calling for better-designed comparative trials. The substantial heterogeneity tempers the precision of the estimate. For UK practice, this strengthens the case for incorporating regional analgesia into multimodal, opioid-sparing enhanced-recovery pathways for transplant surgery.
8. Predicting long-term allograft outcomes in kidney transplant recipients using a machine learning approach: a 5-year retrospective cohort study.
Gao X, Chen J, Wang M, Li Z, Lou X, Chen J. Ren Fail, 2026. PMID: 42272126.
This retrospective cohort study developed and internally validated machine-learning models to predict five-year allograft survival in deceased-donor kidney transplant recipients, addressing the scarcity of prediction tools that integrate comprehensive pre- and post-transplant data with extended follow-up. The cohort comprised 940 adult deceased-donor recipients followed beyond five years. Two models were built: a pre-transplant model (KAPTOR-pre) using donor-recipient matching data, and a one-year landmark conditional model (KAPTOR-full) incorporating pre- and post-transplant parameters, pathology, and first-year laboratory markers. KAPTOR-full achieved excellent discrimination with an area under the receiver operating characteristic curve of 0.904, while KAPTOR-pre reached 0.813. In internal validation, both models showed higher C-index and improved risk stratification than established tools, including the Kidney Donor Profile Index (KDPI). The addition of first-year post-transplant data notably enhanced predictive accuracy over the pre-transplant model alone. The key limitation is that validation was internal only, so generalisability awaits independent multicentre testing. For UK practice, such models could eventually support more personalised surveillance and counselling, but they should be regarded as promising rather than deployable until externally validated against UK registry data.
Generated 2026-06-20 from PubMed search results for kidney transplantation published 2026-06-06 to 2026-06-20. Articles already recorded in prior issues were excluded. PubMed is the source of all metadata and abstracts.