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Delayed graft function after renal transplantation

Published/Copyright: February 12, 2025
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Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Background information

Delayed graft function (DGF), defined as the need for dialysis within the first week of a kidney transplant, is a common complication, particularly in extended criteria donor transplants, where its incidence ranges from 21 to 31%.

Objectives

We observed a prolonged case of DGF in a 47-year-old patient with chronic kidney disease (CKD) resulting from diabetic nephropathy. The patient, classified in a moderate immunologic mismatch group, received a marginal deceased donor kidney.

Results

For the first 4 weeks post-transplantation, graft function was impaired. After 29 days of anuria, the transplanted kidney began to recover. The literature review found few clinical cases of DGF extending beyond 1 month. Our patient had several risk factors for DGF, including diabetes mellitus, pre-transplant hemodialysis, and moderate immunologic mismatch. Additionally, the marginal graft increased the risk of ischemia-reperfusion injury and glycocalyx damage. However, it remains unclear how these factors influenced the duration of DGF. The exact cause of the extended DGF in this case remains unknown. Although the literature identifies key risk factors for DGF, data on factors leading to prolonged kidney dysfunction are lacking. Therefore, decisions to remove a non-functioning transplanted kidney should not be made hastily.

Keywords: delayed graft function; kidney transplantation; kidney failure

1 Introduction

Delayed graft function (DGF) is a common term used to describe the initial dysfunction of a transplanted kidney, often due to various perioperative and operative risk factors [1]. These factors can be categorized into donor-related (e.g., organ quality, donor vital signs, age, higher body mass index, acute kidney injury, ethnicity, and shipping distance), recipient-related (e.g., comorbidities, pre-transplant dialysis, HLA mismatch, ABO incompatibility, previous kidney transplants, and higher BMI), and perioperative factors (e.g., hemodynamic instability, calcineurin inhibitors, and nephrotoxic drugs). The primary risk factors contributing to DGF include ischemia-reperfusion injury (IRI), donor kidney origin (deceased or living donation), duration of cold ischemia time (CIT) or warm ischemia time (WIT), and the recipient’s clinical status [2]. DGF is more frequently encountered in recipients of deceased donor kidney transplants, whereas it is relatively rare in living-related renal transplants [3]. The immunological mismatch between the donor and recipient is also a significant contributor to DGF. To mitigate this unfavorable outcome, it is crucial to enhance awareness and conduct comprehensive analyses of renal transplantation procedures globally. Multiple studies have demonstrated that hypothermic machine perfusion (HMP) of deceased donor kidneys, as opposed to cold storage, reduces the incidence of DGF [4]. These findings emphasize the importance of optimizing donor–recipient matching, refining surgical techniques, enhancing postoperative care protocols, and implementing preventive measures to reduce DGF incidence. As DGF is increasingly recognized in contemporary research and clinical settings, further investigation is necessary to gain deeper insights, conserve clinical resources, and fundamentally improve recipients’ quality of life.

2 Case presentation

A 47-year-old patient was admitted to our hospital as a candidate for marginal kidney transplantation. At admission, the patient was asymptomatic. His medical history included over 25 years of type 1 diabetes complicated by diabetic nephropathy (diagnosed 3 years prior), polyneuropathy, and retinopathy. He was diagnosed with stage 5 chronic kidney disease (CKD) in December 2019 and was on hemodialysis via an arteriovenous fistula. In January 2022, he was listed for a kidney transplant. The patient had a BMI of 20.22 kg/m2 and an arterial blood pressure of 170/105 mmHg in both arms. Immunologic compatibility testing revealed four incompatible antigens placing him at moderate risk of immunological mismatch. Pre-transplant imaging showed no significant stenosis in the iliac arteries. Immunosuppression was induced with basiliximab, methylprednisolone, and mycophenolate mofetil. The kidney, preserved using HMP, was transplanted without surgical complications (CIT was 18 h; WIT was 44 min).

On the first postoperative day, the patient was admitted to the ICU for close monitoring. Despite continued immunosuppression, anuria persisted, and DGF was diagnosed, necessitating continued hemodialysis. By postoperative day 7, the patient remained anuric, with Doppler ultrasound indicating a high resistive index, suggestive of renal artery stenosis. However, CT angiography ruled out stenosis (Figure 1). On postoperative day 16, due to continued graft dysfunction, new anti-donor antibodies were detected, cross-reaction flow cytometry was positive, and a biopsy revealed active antibody-mediated rejection (ABMR) with peritubular leukostasis and acute tubular damage. Treatment included methylprednisolone pulse therapy, plasmapheresis, and intravenous immunoglobulin. By postoperative day 29, the kidney function began to improve, with diuresis exceeding 2,000 ml and normalization of creatinine, urea, and electrolyte levels (Figures 2–4). The patient was discharged for outpatient care. Creatinine and GFR levels returned to normal during the outpatient follow-up period.

Figure 1 Urgent CT angiography.
Figure 1

Urgent CT angiography.

Figure 2 Serum creatinine concentration during the course of treatment.
Figure 2

Serum creatinine concentration during the course of treatment.

Figure 3 Serum potassium levels during the course of treatment.
Figure 3

Serum potassium levels during the course of treatment.

Figure 4 Change in GFR during the course of treatment.
Figure 4

Change in GFR during the course of treatment.

  1. Informed consent: Written informed consent was obtained from the participant/patient(s) for the publication of this report.

3 Discussion

DGF is often described in the literature as the need for dialysis during the first week of kidney transplantation [5]. However, in rare cases, the graft function can remain diminished for extended periods [6]. According to the literature review, we found that prolonged DGF lasting more than 14 days [7] or 28 days [8] negatively affected graft survival during the follow-up period. Reports of DGF lasting more than 1 month are rare. For example, Thye et al. [3] described a case of DGF lasting 132 days in a 47-year-old patient with a living-related kidney transplant. Similarly, Schulz et al. [9] reported a 148-day anuric episode in a 59-year-old recipient of a living-unrelated kidney transplant. In both cases, the kidney function fully recovered. In our case, the kidney function began to improve after 29 days, which is a shorter but still atypical timeframe for DGF. Two days after the initial improvement, the graft regained full function. Several factors could explain this. The age of the donor is a fixed risk factor that elevates the likelihood of DGF and graft failure [10]. This is because the mechanism of cell renewal is reduced, or tolerance to the ischemic state is poor, which may lead to irreversible cell necrosis due to IRI syndrome.

Additionally, Smudla et al. found that DGF was related to lower residual diuresis, higher intradialytic weight gain, and higher fluid balance during the first postoperative day [11]. Unfortunately, we did not analyze this patient’s body hydration status. According to an analysis by Bura et al. at Kaunas University of Health Sciences Hospital in Lithuania, recipients after kidney transplantation in the early pre- and post-transplant period are usually hyperhydrated [12]. Systematic venous congestion and volume overload can decrease kidney perfusion and prolong the ischemic period [13].

IRI is the most critical process occurring during the explantation and transplantation of the kidney graft. It involves complex pathophysiology, including cell death, endothelial dysfunction, transcriptional reprogramming, and activation of the innate and adaptive immune systems. Due to the decrease in oxygen supply, cells switch to anaerobic metabolism, destabilizing lysosomal membranes with leakage of lysosomal enzymes, breakdown of the cytoskeleton, and inhibition of membrane-bound Na+/K ± ATPase activity. This process initiates intracellular accumulation of Na+ ions and water due to cellular edema [14]. After reperfusion, all processes return to normal, but intracellular hypercalcemia, which is elevated during the ischemic stage, activates calpains, causing injury to the cell structure and cell death. This leads to an uncontrolled release of cellular fragments into the extracellular space [15]. At the vascular level, IRI leads to swelling of endothelial cells, loss of glycocalyx, and degradation of the cytoskeleton. Consequently, intercellular contact between endothelial cells is lost, increasing vascular permeability and fluid loss to the interstitial space. In expanded criteria brain dead donors, pronounced IRI is always present, and the results of early kidney function depend on the severity of IRI and the recipient’s status before kidney transplantation. Therefore, older donors have less intracellular ability to repair after IRI [16].

The second reason could be glycocalyx damage to the transplanted kidney endothelium. A study by Hui Liew aimed to examine the longitudinal effects of kidney transplantation on the glycocalyx by measuring biochemical markers of glycocalyx, endothelial dysfunction, and the perfused boundary region (PBR) through direct visualization of cortical peritubular capillaries in transplanted kidneys. The study found that PBR improved and syndecan-1 levels (a marker of endothelial glycocalyx degradation) decreased after living donor kidney transplantation compared with cadaveric donor kidneys, which suffer from prolonged ischemic time. These findings demonstrate that damage to the endothelial glycocalyx develops early in the course of renal IRI. The combination of reduced PBR and syndecan-1 following transplant suggests that transplantation may improve glycocalyx stability (at 3 months post-transplant) [17]. This study demonstrates that ischemically injured marginal donors’ kidneys are characterized by reduced microvascular blood flow and loss of glycocalyx integrity compared with kidneys from living donors. Unfortunately, we did not find publications comparing changes in glycocalyx biomarkers in patients with different early and DGF. In our case, several factors could have led to DGF. DGF increases the immunogenicity of post-transplant grafts and the risk of rejection and mortality in post-transplant patients. The ABMR was previously loosely correlated with the presence of acute glomerulitis, which is the infiltration of the glomerulus by numerous mononuclear cells [18]. In our case, we detected the donor’s antibody and performed a transplanted kidney biopsy. The relative hazard for biopsy-proven acute rejection in DGF (vs no DGF) was 1.55 [19].

As mentioned previously, DGF is becoming a more common complication among kidney transplant recipients due to the critical shortage of organs and the use of marginal kidneys [20].

It has been proven that kidney function is diminished due to IRI and potential glycocalyx damage in these cases. Kidney transplantation is a complex medical procedure that also depends on various recipient and perioperative factors [21]. One of the risk factors can be immunologic mismatch and sensitization, which has a clinically significant impact on early and long-term graft function [22]. In our case, the patient was evaluated as having a moderate immunologic mismatch risk. However, the literature states that it is not uncommon to transplant a kidney in such a patient group while using adequate immunosuppression therapy [23]. For immunologic induction therapies in moderate-risk kidney transplant patients, there are several options. The first-choice agent for early acute rejection prophylaxis has long been basiliximab, which inhibits IL-2 receptors. Recent studies show that rabbit-derived anti-thymocyte globulin has a greater effect on preventing acute graft rejection in higher-risk patients [24]. Our patient received basiliximab-based induction therapy, along with intravenous methylprednisolone and mycophenolate mofetil.

Another significant risk factor associated with DGF is pre-transplant dialysis. Both the procedure and the duration of kidney replacement therapy have a significant impact on short- and long-term graft functions. A few decades ago, pre-transplant dialysis was certainly perceived as a clear risk factor. However, recent literature calls for a reconsideration of this view. Some articles state that hemodialysis has no negative effect on graft survival and function, while peritoneal dialysis results in an even better post-transplant survival rate [25]. Our patient had been treated with hemodialysis for 2.5 years prior to transplantation, which should not place him at additional risk for DGF. Finally, diabetes mellitus has recently been identified as a risk factor for DGF [26]. The precise mechanism of this effect is not yet fully understood, but poor blood glucose control leads to a greater chance of transplanted kidney tissue damage.

Apart from analyzing factors that could have caused this extended DGF condition, clinical management of these patients is equally challenging. Since the expanded criteria donors’ kidney cells have significantly low repair and recovery mechanisms, this is an unshakable factor for DGF. Fortunately, there are new methods to avoid DGF from expanded criteria donors.

The function of the allograft also depends on the conditions of preservation after explantation. Static cold storage (SCS) and HMP are two primary options for renal allograft preservation. Compared with SCS, HMP decreases the incidence of DGF and protects the graft function. However, more evidence is still needed to prove the advantages of HMP. In our case, we used HMP with normal perfusion parameters. Randomized controlled trials comparing the effect of HMP and SCS in deceased donor kidney transplantation were identified through searches of the MEDLINE, EMBASE, and Cochrane databases between January 1, 1980 and December 30, 2017. The results indicated that compared with SCS, HMP decreased the incidence of DGF (RR: 0.78, 95% CI: 0.69–0.87, P < 0.0001) and improved graft survival at 3 years (RR: 1.06, 95% CI: 1.02–1.11, P = 0.009) [27]. Despite our clinical case study, the use of HMP resulted in DGF. We believe that impaired allograft function had several etiological and pathophysiological factors that contributed to the clinical status.

One promising tool in kidney transplantation is normothermic machine perfusion (NMP), which could potentially improve the outcome of expanded criteria donor kidney transplantation and reduce the DGF ratio [28,29]. Future double-blinded, randomized, large clinical trials will be required to evaluate the benefits of NMP technology [30].

Choosing adequate immunosuppressive therapy to prevent graft rejection while maintaining a certain immunity status to avoid opportunistic infections is also important. Another dilemma that physicians face in these types of cases is deciding whether to remove a transplanted kidney. Over time, a non-functioning graft can become a source of infection and a stimulus for a systemic immune response, thus becoming more of a problem than a solution. In our case, the patient did not experience graft infection or develop a systemic immune response; therefore, despite not functioning, the kidney was not removed. In our opinion, there is no need to rush to perform a transplantectomy unless there are absolute indications for DGF and a high risk of infection.

Despite DGF being a common complication of kidney transplantation, in our case, it lasted up to 29 days, which is highly unusual for this condition. The patient did have several risk factors for DGF that could have impacted the transplanted kidney’s function, but there are no data in the current literature indicating that these aspects could affect the duration of the post-transplant anuric period. It is still not clear whether the listed risk factors manifested the condition independently or if an interplay between certain conditions led to this type of reaction. Furthermore, this case could serve as a valuable example for further analyzing the use of immunosuppressive medications in moderate-to-high immunologic risk kidney transplant patients, as well as treatment modalities for acute rejection reactions.

4 Conclusions

We report a highly extended DGF in a 47-year-old patient with diabetes mellitus and CKD, with kidney function fully recovering after 29 days of anuria. The case highlights the complexity of DGF, which may result from an interplay of donor, recipient, and perioperative factors. Our findings suggest that extended DGF, while rare, is possible, and further research is needed to understand its etiology and management. This case underscores the importance of individualized treatment strategies in kidney transplantation, particularly in patients with moderate-to-high immunologic risk.

Acknowledgements

We would like to thank the staff from departments of Nephrology and Urology.

  1. Funding information: This research received no external funding.

  2. Author contributions: D. S. and A. S. contributed equally to this work. They participated in the study design, data collection, imaging data analysis, and drafting of the manuscript. P. L. and A. B. provided valuable assistance in critically revising the manuscript for important intellectual content. All authors contributed to the article and approved the submitted version.

  3. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

  4. Data availability statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

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Received: 2024-09-05
Revised: 2025-01-08
Accepted: 2025-01-10
Published Online: 2025-02-12

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. Review Articles
  126. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  127. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  128. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  129. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  130. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  131. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  132. The application of augmented reality in robotic general surgery: A mini-review
  133. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  134. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  135. Plant polyphenols, terpenes, and terpenoids in oral health
  136. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  137. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  138. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  139. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  140. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  141. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  142. Giant borderline ovarian tumours – review of the literature
  143. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  144. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  145. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  146. Case Reports
  147. Delayed graft function after renal transplantation
  148. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  149. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  150. Giant right atrial hemangioma presenting with ascites: A case report
  151. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  152. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  153. Rapid Communication
  154. Biological properties of valve materials using RGD and EC
  155. Letter to the Editor
  156. Role of enhanced external counterpulsation in long COVID
  157. Expression of Concern
  158. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  159. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  160. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  161. Corrigendum
  162. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  163. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  164. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  165. Retraction
  166. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  167. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  168. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  169. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  170. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  171. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  172. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  173. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  174. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  175. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  176. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  177. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  178. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  179. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  180. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  181. Special Issue Diabetes
  182. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  183. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  184. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  185. A review of brain research on T2DM-related cognitive dysfunction
  186. Special Issue Biomarker Discovery and Precision Medicine
  187. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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https://doi.org/10.1515/med-2025-1140
Keywords for this article
delayed graft function; kidney transplantation; kidney failure
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BY 4.0

Articles in the same Issue

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  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
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  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
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  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
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  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
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  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
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  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
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  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
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  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
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  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
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  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
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  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
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  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. Review Articles
  126. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  127. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  128. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  129. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  130. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  131. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  132. The application of augmented reality in robotic general surgery: A mini-review
  133. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  134. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  135. Plant polyphenols, terpenes, and terpenoids in oral health
  136. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  137. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  138. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  139. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  140. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  141. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  142. Giant borderline ovarian tumours – review of the literature
  143. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  144. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  145. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  146. Case Reports
  147. Delayed graft function after renal transplantation
  148. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  149. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  150. Giant right atrial hemangioma presenting with ascites: A case report
  151. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  152. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  153. Rapid Communication
  154. Biological properties of valve materials using RGD and EC
  155. Letter to the Editor
  156. Role of enhanced external counterpulsation in long COVID
  157. Expression of Concern
  158. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  159. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  160. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  161. Corrigendum
  162. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  163. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  164. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  165. Retraction
  166. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  167. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  168. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  169. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  170. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  171. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  172. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  173. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  174. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  175. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  176. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  177. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  178. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  179. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  180. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  181. Special Issue Diabetes
  182. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  183. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  184. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  185. A review of brain research on T2DM-related cognitive dysfunction
  186. Special Issue Biomarker Discovery and Precision Medicine
  187. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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