Nephrology Dialysis Transplantation最新文献

{"title":"A meta-analysis of graft survival, patient survival and delayed graft function in first-time and repeat kidney transplants.","authors":"Mehmet Kanbay, Sama Mahmoud Abdel-Rahman, Crischentian Brinza, Lasin Ozbek, Elif Yayci, Ozgur Aktas, Candan Genc, Mustafa Guldan, Ezgi N Alper, Alexandru Burlacu, Andreea Covic, Adrian Covic","doi":"10.1093/ndt/gfaf066","DOIUrl":"10.1093/ndt/gfaf066","url":null,"abstract":"<p><strong>Background: </strong>Previous evidence showed that while first-time kidney transplants (KT) typically yield better outcomes, repeat and subsequent transplants were associated with increased risks of graft failure and adverse patient outcomes, yet conflicting findings exist. The aim of this meta-analysis is to compare graft survival and delayed graft function (DGF) outcomes in first-time KT, repeat KT (regrafts) and subsequent KT.</p><p><strong>Methods: </strong>Relevant studies were identified through comprehensive searches in PubMed, Web of Science, Cochrane Library, MEDLINE (Ovid) and Scopus until 8 October 2024. Primary outcomes include graft survival and DGF, compared with repeat and subsequent KT.</p><p><strong>Results: </strong>The meta-analysis included a total of 16 studies. Analysis on long-term graft survival revealed that patients who underwent a first KT had significantly better graft survival compared with those who received a second transplant [86.7% versus 77.6%; odds ratio (OR) 1.40, 95% confidence interval (CI) 1.14-1.71, P = .001]. At 5 years post-transplant, first KT recipients continued to demonstrate superior graft survival (OR 1.41, 95% CI 1.13-1.77, P = .003), although this difference diminished by 10 years, with no significant disparity observed (OR 1.26, 95% CI 0.88-1.81, P = .20). Graft survival at 5 years was also significantly higher in second KT recipients compared with those undergoing a third transplant (OR 2.66, 95% CI 1.86-3.80, P < .00001). Patient survival outcomes were largely comparable between first and second KT groups, with no statistically significant differences in overall survival (OR 1.25, 95% CI 0.87-1.81, P = .23). At specific time points, the 5-year survival rate showed a borderline non-significant trend favoring first KT recipients (OR 1.63, 95% CI 0.97-2.73, P = .06), while the 10-year survival rate showed no difference (OR 0.94, 95% CI 0.67-1.32, P = .71). Survival rates between second and subsequent retransplants (e.g. third or fourth KT) showed no significant variation, including at 5 years (P = .37 and P = .90, respectively). DGF rates did not differ significantly between first and second KT recipients (P = .11).</p><p><strong>Conclusion: </strong>These findings underscore the superior graft survival associated with first and second KT compared with subsequent retransplants, particularly in the early post-transplant period, while highlighting the lack of significant differences in overall patient survival across groups; however, variability in outcomes due to study heterogeneity and patient-specific factors warrants cautious interpretation and tailored clinical approaches.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1906-1918"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide in non-diabetic patients with Fabry disease.","authors":"Eleonora Riccio, Ivana Capuano, Antonio Pisani","doi":"10.1093/ndt/gfaf088","DOIUrl":"10.1093/ndt/gfaf088","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1989-1990"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving spectrum of kidney amyloidosis: advances in diagnosis, typing and treatment.","authors":"Marco Allinovi, Giorgio Trivioli, Costanza Gaudio, Vincenzo L'Imperio, Muhammad U Rauf, Julian D Gillmore","doi":"10.1093/ndt/gfaf042","DOIUrl":"10.1093/ndt/gfaf042","url":null,"abstract":"<p><p>Kidney amyloidosis encompasses a spectrum of heterogeneous conditions in which damage is caused by the deposition of various misfolded proteins that aggregate into fibrils. The main form of renal amyloidosis in Western countries is immunoglobulin light chain (AL) amyloidosis, which is usually secondary to a plasma cell clone or less frequently a B-cell clone, while rarer causes include AA amyloidosis, ALECT2 and hereditary amyloidoses. The main renal manifestations include nephrotic syndrome and kidney dysfunction with modest or absent proteinuria. The course is progressive and renal and overall survival is reduced in many patients. While biopsies are usually positive by Congo Red staining in all types of amyloidosis, precise identification of the amyloid fibril protein is essential and is best achieved with immunohistochemistry or proteomic studies, such as mass spectrometry. This method also allows the discovery of novel amyloidogenic proteins and has contributed to expand the list of amyloid types. The current treatment strategy is based on suppressing new amyloid fibril production through chemotherapy in AL amyloidosis, control of inflammation in AA amyloidosis and 'gene silencing' therapies in hereditary forms, such as the one linked with transthyretin. Novel approaches aim at enhancing natural amyloid clearance in order to reduce the rate of organ failure. Kidney transplantation in patients who achieved response has shown outcomes comparable to the general transplant population. In this review, we present the key aspects of renal amyloidosis and discuss novel concepts in this evolving field.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1826-1837"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authorship trends in nephrology and urology.","authors":"Qihao Leng, Mingzhong Wan, Xu Ou-Yang, Yan Wang, Guochao Zhang, Wei Wang, Pengjie Wu, Yinyan Gao, Xiheng Hu, Hang Yi","doi":"10.1093/ndt/gfaf089","DOIUrl":"10.1093/ndt/gfaf089","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1991-1995"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of estimated glomerular filtration rate equations on prediction of mortality, kidney failure and acute kidney injury.","authors":"Denise M J Veltkamp, Maarten B Rookmaaker, Mark C H de Groot, Marianne C Verhaar, Wouter W van Solinge, Saskia Haitjema, Robin W M Vernooij","doi":"10.1093/ndt/gfaf054","DOIUrl":"10.1093/ndt/gfaf054","url":null,"abstract":"<p><strong>Background: </strong>The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)ASR-NB2009 estimated glomerular filtration rate (eGFR) equation has shown substantial overestimation of GFR in Europeans, hence new equations have been developed. We examined the effect of introducing the European Kidney Function Consortium (EKFC) or Lund-Malmö revised (LMR) eGFR equations on KDIGO eGFR category classification in a large cohort. We compared the EKFC and LMR equations with the CKD-EPIASR-NB2009 formula in view of discriminative ability of all-cause mortality, kidney failure with replacement therapy (KFRT) and acute kidney injury (AKI) risks across eGFR categories.</p><p><strong>Methods: </strong>Individuals aged ≥18 years with a serum creatinine measurement (December 2006-July 2024) at University Medical Center Utrecht, were included. Hazard ratios (HRs) were analysed for all outcomes per eGFR category, per equation. Harrell's Concordance index (C-index) was used to assess the ability of risk discrimination across eGFR categories. Whether reclassification between eGFR categories was justified by the occurrence of events, was assessed with net reclassification improvement analysis.</p><p><strong>Results: </strong>In total, 285 686 individuals were included. Compared with the CKD-EPIASR-NB2009 equation, the EKFC and LMR estimated GFR lower [mean -6.3 (standard deviation, SD 5.3) and -10.7 (SD 6.5) mL/min/1.732, respectively]. The number of individuals with eGFR <60 mL/min/1.73 m2 increased 29.0% (EKFC) and 36.4% (LMR). The EKFC predominantly reclassified older individuals, and the LMR older men, to worse eGFR categories. HRs of reclassified individuals to worse eGFR categories were mainly higher compared with the non-reclassified. The EKFC and LMR equations showed equal/improved C-index for mortality (EKFC 0.584/LMR 0.588/CKD-EPIASR-NB2009 0.570), KFRT (0.895/0.900/0.897) and AKI (0.606/0.609/0.599). The LMR equation reclassified more individuals without an event to worse eGFR categories.</p><p><strong>Conclusion: </strong>eGFR category classification was substantially different when using the EKFC or LMR equation compared with the CKD-EPIASR-NB2009 formula. Both equations showed equal to improved ability of risk stratification across eGFR categories. Shifts in eGFR category classification might significantly impact clinical decisions. Given that we have identified variation between equations, a careful consideration of the advantages and disadvantages of different eGFR equations is essential.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1876-1886"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury in very old patients-incidence, severity, risk factors and short-term outcomes.","authors":"Stefan Herget-Rosenthal, Kolja Stille, Klaus Albrecht, Hajo Findeisen, Martin Scharpenberg, Andreas Kribben","doi":"10.1093/ndt/gfaf074","DOIUrl":"10.1093/ndt/gfaf074","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Although old age is a risk factor for acute kidney injury (AKI), data on AKI in individuals ≥80 years is limited. We aimed to provide data on AKI incidence, severity and outcomes to identify risk factors for AKI and 30-day mortality in those ≥80 years old.</p><p><strong>Methods: </strong>This was a cohort study of 2132 patients admitted to hospital. AKI was defined and classified by extended KDIGO criteria to detect community-acquired AKI, frailty as a clinical frailty score ≥5. Primary endpoints were AKI and its stages, secondary endpoints 30-day mortality and major adverse kidney events (MAKE30), a composite of mortality, new renal replacement therapy or serum creatinine values ≥200% of baseline, all at 30 days.</p><p><strong>Results: </strong>Median age was 86 years. AKI was frequent (35.3%) and predominately community-acquired (80.2%). The incidence rate of AKI rose with increasing age, reaching the maximum in patients 95 years old. Some 48.9% of AKI patients developed stage 1, while 27.0% and 24.1% reached stages 2 and 3, respectively. Frailty was identified as an independent AKI risk factor {adjusted odds ratio (aOR) 2.42 [95% confidence interval (CI) 1.93-3.03]}. The 30-day mortality rate was significantly higher in AKI compared with non-AKI patients (25.4% vs 7.6%), 44.4% of AKI patients developed MAKE30. Among others, AKI and frailty were risk factors for 30-day mortality [aOR 3.02 (95% CI 2.25-4.07) and 1.53 (95% CI 1.16-2.02)], with frailty exceeding AKI in patients ≥90 years.</p><p><strong>Conclusions: </strong>AKI occurs frequently, increases with age, is severe and is predominately community-acquired in individuals ≥80 years admitted to hospital. Frailty is a risk factor for AKI besides established factors. Very old patients with AKI more frequently died or developed a high rate of the composite endpoint MAKE30. AKI and frailty are risk factors for 30-day mortality. The effect of frailty on mortality exceeded that of AKI in nonagenarians.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1949-1960"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active glomerular inflammation versus chronicity and fibrosis: the role of targeted therapies in IgA nephropathy.","authors":"Jai Radhakrishnan, Richard A Lafayette","doi":"10.1093/ndt/gfaf059","DOIUrl":"10.1093/ndt/gfaf059","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1811-1814"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends in the treatment of relapsing minimal change podocytopathy-a binational cohort study.","authors":"Tilde Kristensen, Rutger Maas, Henrik Birn, Per Ivarsen","doi":"10.1093/ndt/gfaf072","DOIUrl":"10.1093/ndt/gfaf072","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>While the primary treatment for minimal change disease (MCD) is prednisolone, the immunosuppressive treatment at relapse is less well defined. More treatment options for MCD have become available and concerns about the adverse effects of prednisolone have been raised. It is unclear to what extent this has influenced the treatment of relapsing disease. Thus, the objective of this study is to characterize the changes in the immunosuppressive treatment of relapse in MCD over the past 35 years.</p><p><strong>Methods: </strong>A multicentre, retrospective cohort including adult patients with biopsy-proven MCD from 13 hospitals in Denmark and the Netherlands between 1985 and 2022. Patients were identified from pathology registers. Information on treatment and clinical outcomes was retrieved from health records. Treatment before and after 2010 was compared.</p><p><strong>Results: </strong>The study included 239 patients with a median age of 46 years, 55% female and 64% being diagnosed before 2010. A first relapse was identified in 50% and a second relapse in 28%. The most frequently prescribed treatment at first relapse was prednisolone monotherapy before and after 2010 (67% and 44% of patients, respectively), while the use of calcineurin inhibitors (CNI) increased 3-fold after 2010 compared with before 2010. At second relapse CNI was the most frequently prescribed treatment after 2010, while the use of both cyclophosphamide and prednisolone decreased when compared with before 2010. A similar trend was observed at the 3rd to 14th relapse with CNI (44% of patients) and rituximab (35% of patients) being the most frequently prescribed treatments after 2010 while the use of cyclophosphamide and prednisolone decreased (0% and 21% of patients, respectively). Regardless of treatment, remission rates remained high.</p><p><strong>Conclusion: </strong>The treatment of relapses in MCD has changed since 2010 with reduced use of prednisolone monotherapy and cyclophosphamide, and increased use of CNI and rituximab.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1941-1948"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional outcomes in pediatric patients on renal replacement therapy in a worldwide registry.","authors":"Kristin J Dolan, Katja M Gist, Abby Basalely, Gabriella Bottari, Abhishek Chakraborty, Mihaela Damian, Dana Fuhrman, Denise C Hasson, Catherine Joseph, Dave Kwiatkowski, Susan Martin, Jenn Nhan, Nicolas Ollberding, David T Selewski, Danielle Soranno, Michelle C Starr, Amy Strong, Sameer Thadani, Huaiyu Zang, Ayse Akcan Arikan","doi":"10.1093/ndt/gfaf067","DOIUrl":"10.1093/ndt/gfaf067","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Mortality rates of children supported with continuous renal replacement therapy (CRRT) have improved, yet morbidity remains high. We aimed to evaluate the functional outcomes of children receiving CRRT using Functional Status Scale (FSS). We hypothesized that children receiving CRRT will have worse FSS compared with their baseline and acquire new morbidity at hospital discharge and 6 and 12 months post-discharge, and that lack of renal recovery will contribute to worsening functional status.</p><p><strong>Methods: </strong>This is a retrospective chart review from The Worldwide Exploration of Renal Replacement Outcomes Collaborate in Kidney Disease (WE-ROCK), an international multi-center registry. Twenty-eight centers across five countries participated in this analysis. Children from birth to 25 years, on CRRT for acute kidney injury (AKI) or fluid overload, were included. Patients with underlying kidney disease, on extracorporeal membrane oxygenation and non-survivors were excluded. FSS was collected at discharge (n = 527), 6 months (n = 387) and 12 months post-discharge (n = 344). The primary outcome was FSS at discharge and 6 months. Secondary outcomes included: new morbidity at discharge and 6 months; FSS at 12 months; and the impact of renal recovery on functional outcomes.</p><p><strong>Results: </strong>A total of 527 patients had median FSS of 7 (6, 90) at hospital discharge. Thirty-nine percent (n = 204) had worse FSS. Eighteen percent (95/527) acquired a new morbidity at discharge. Predictors of FSS at discharge were baseline FSS {odds ratio (OR) 1.30 [95% confidence interval (CI) 1.11-1.52]}, weight [OR 0.99 (95% CI 0.98-0.9997)], comorbidities [OR 1.88 (95% CI 1.16-3.04)], mechanical ventilation [OR 1.72 (95% CI 1.04-2.85)] and sepsis on intensive care unit admission [OR 1.46 (95% CI 1.01-2.21)]. A total of 387 patients had median FSS score of 6 (6, 8) at 6 months. Ten percent (n = 39/387) acquired new morbidity at 6 months. The significant predictors of FSS at 6 months were FSS at discharge [OR 2.36 (95% CI 1.95-2.84)] and presence of comorbidities [OR 1.77 (95% CI 1.03-3.06)].</p><p><strong>Conclusion: </strong>This is the first large, multi-center study evaluating functional outcomes of children on CRRT. Persistent morbidity following discharge emphasizes the importance of comprehensive identification and multidisciplinary follow-up to optimize patient outcomes.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1919-1930"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma trimethylamine N-oxide concentration and all-cause mortality in kidney transplant recipients.","authors":"Manuela Yepes-Calderón, Fernando Martín Del Campo Sanchez, Daan Kremer, Tim J Knobbe, Antonio W Gomes Neto, Margery A Connelley, Robin P F Dullaart, Eva Corpeleijn, Martin H de Borst, Stephan J L Bakker","doi":"10.1093/ndt/gfaf071","DOIUrl":"10.1093/ndt/gfaf071","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Trimethylamine N-oxide (TMAO) is a pro-atherosclerotic molecule produced by intestinal microbiome. TMAO has been linked to increased mortality risk in chronic kidney disease, but its effect in kidney transplant recipients (KTR) is unclear. We investigated the pre-post-transplantation plasma TMAO change, and the association of post-transplantation plasma TMAO with all-cause mortality in KTR.</p><p><strong>Methods: </strong>This prospective study included two cohorts. Cohort A comprised 623 KTR from the TransplantLines Cohort and Biobank Study (ClinicalTrials.gov: NCT03272841), and assessed pre-transplantation and at 3, 6, 12 and 24 months post-transplantation. Cohort B included 544 KTR with a functioning graft for ≥1 year [median 7.4 (3.9-13.0) years post-transplantation] to study late associations. Potential kidney donors (n = 315) served as healthy controls. Plasma TMAO was measured by proton nuclear magnetic resonance. Time-dependent coefficient Cox regression analyses were performed to assess TMAO association with all-cause mortality.</p><p><strong>Results: </strong>Plasma TMAO concentration significantly declined after transplantation {from 29.0 [interquartile range (IQR) 20.6-48.5] µmol/L to 4.5 (IQR 2.7-8.6) mol/L at 3-months post-transplantation, P < .001}. Afterwards it remained stable [β -0.4 (95% confidence interval -2.2 to 1.34) µmol/L per post-transplantation year, P = .63], remaining consistently higher than that of healthy control [2.6 (IQR 1.8-4.3) µmol/L]. In Cohort A, during a median follow-up of 2.2 years, 41 KTR (7%) died. In Cohort B, over a median follow-up of 4.1 years, 78 KTR (14%) died. A 1-SD higher plasma TMAO concentration was independently associated with an increased risk of all-cause mortality in both cohorts [hazard ratio (95% confidence interval) 1.35 (1.19‒1.53); P < .001, and 1.34 (1.23‒1.47); P < .001; respectively].</p><p><strong>Conclusion: </strong>Plasma TMAO decreases sharply after kidney transplantation, without reaching healthy controls levels. A higher plasma TMAO concentration was independently associated with an increased mortality risk in KTR. Further research is warranted to assess whether accounting for gut dysbiosis and TMAO could improve clinical outcomes in KTR.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1931-1940"},"PeriodicalIF":5.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}