Tran Ngoc Nguyen, Tam Tran Minh Than, Noor Haj Mohammad, Uyen Thi Phuong Nguyen, Thanh Kien Lam
{"title":"Parathyroid Hormone Threshold Effect and Parathyroid Hormone-to-Vitamin D Ratio as Determinants of Bone Mineral Density in Long-Term Kidney Transplant Recipients: A Cross-Sectional Analytical Study>.","authors":"Tran Ngoc Nguyen, Tam Tran Minh Than, Noor Haj Mohammad, Uyen Thi Phuong Nguyen, Thanh Kien Lam","doi":"10.6002/ect.2026.0203","DOIUrl":"https://doi.org/10.6002/ect.2026.0203","url":null,"abstract":"<p><strong>Objectives: </strong>Persistent hyperparathyroidism and calcitriol deficiency coexist in most long -term kidney transplant recipients, yet the combined skeletal effects of these presentations have not been formally quantified.</p><p><strong>Materials and methods: </strong>In this cross -sectional analytical study at People's Hospital 115 (Ho Chi Minh City, Vietnam ), we studied 135 kidney transplant recipients (mean age 51.0 ± 11.3 years; 66.7 % male; mean time posttransplant 71.4 ± 28.1 months ) who underwent simultaneous measurement of serum intact parathyroid hormone, 1,25 -dihydroxyvitamin D, and dual -energy x -ray absorptiometry at 3 skeletal sites. A prespecified piecewise ordinary least -squares model characterized the relationship between parathyroid hormone and bone mineral density; a confirmatory sensitivity analysis used KDIGO -motivated breakpoint of 65 pg /mL for parathyroid hormone. We evaluated parathyroid hormone -to -vitamin D ratio as a prespecified secondary exposure measure.</p><p><strong>Results: </strong>Bone loss (worst -site T score of < -1.0 ) was present in 103 participants (76.3 % ) and osteoporosis in 27 (20.0 % ). The confirmatory piecewise model at 65 pg /mL demonstrated that above -threshold parathyroid hormone was inversely associated with T -score composite ( β = -0.00367 per pg /mL; bootstrap 95 % CI, -0.0066 to -0.0013; P < .001 ), a 100 pg /mL increment above the threshold corresponded to a -0.37 T -score decrement. Body mass index was the strongest predictor (β = +0.129 per kg /m ²; P < .001 ). The ratio of parathyroid hormone to vitamin D (ρ = -0.262; P = .002 ) provided modestly better model fit than parathyroid hormone alone (R ² = 0.247 vs 0.229; change in Akaike Information Criterion = 3.2 ).</p><p><strong>Conclusions: </strong>Parathyroid hormone exerted a threshold -dependent inverse effect on bone mineral density in long -term kidney transplant recipients, confirmed at the KDIGO lower boundary of 65 pg /mL. The ratio of parathyroid hormone to vitamin D captured the combined mineral burden more efficiently than parathyroid hormone level alone, warranting further prospective evaluation as a monitoring target in posttransplant mineral disease.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"589-599"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehmet C Güneri, Celalettin Usalan, Şeyda Çevik Güneri
{"title":"Red Cell Distribution Width and Its Association With Inflammatory Burden and Proteinuria in Kidney Transplant Recipients.","authors":"Mehmet C Güneri, Celalettin Usalan, Şeyda Çevik Güneri","doi":"10.6002/ect.2025.0272","DOIUrl":"https://doi.org/10.6002/ect.2025.0272","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to investigate whether red cell distribution width can serve as an indicator of subclinical inflammation in kidney transplant recipients by examining its relationship with inflammatory markers, renal functional parameters, bone mineral metabolism, and urinary protein excretion.</p><p><strong>Materials and methods: </strong>We retrospective examined 120 adult kidney transplant recipients followed at our center. We obtained demographic characteristics, immunosuppressive regimens, and laboratory values from hospital records. Biochemical measurements included complete blood count, blood urea nitrogen, serum creatinine, albumin, electrolytes, calcium, phosphorus, parathyroid hormone, 25 -hydroxyvitamin D, glycosylated hemoglobin, high-sensitivity C -reactive protein, and urine protein -to -creatinine ratio. We categorized patients into 2 groups by mean value of red cell distribution width ( <14.5 vs ≥14.5 ). We analyzed correlations between red cell distribution width and laboratory parameters using appropriate statistical methods. P < .05 was considered significant.</p><p><strong>Results: </strong>Mean age of kidney transplant recipients was 40.9 years, and 52 were women. Overall mean red cell distribution width value was 14.5. Red cell distribution width showed significant positive correlations with parathyroid hormone (r = 0.305; P = .001 ), high -sensitivity C -reactive protein (r = 0.189, P = 0.037 ), and glycosylated hemoglobin (r = 0.192, P = .034 ) and a borderline correlation with urine protein -to -creatinine ratio (r = 0.177; P = .052 ). Patients with red cell distribution width ≥14.5 had higher parathyroid hormone, high -sensitivity C -reactive protein, and urine protein -to -creatinine ratio values and lower 25 -hydroxyvitamin D levels compared with those with red cell distribution width <14.5 (all P < .01 ).</p><p><strong>Conclusions: </strong>Increased red cell distribution width values in stable kidney transplant recipients were associated with increased inflammatory markers, greater proteinuria, and alterations in bone mineral metabolism. Red cell distribution width may serve as an accessible indicator of subclinical inflammation and metabolic dysfunction in this population; however, prospective studies are needed to confirm findings.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"619-625"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Early Persistent Proteinuria After Kidney Transplant as a Predictor of Long-Term Graft Outcomes: A Retrospective Cohort Study.","authors":"Mihriban Gungor, Gizem Kumru, Rezzan Eren Sadioglu, Merve Aktar, Sayeste Akkan Eren, Sule Sengul, Kenan Keven","doi":"10.6002/ect.2025.0149","DOIUrl":"10.6002/ect.2025.0149","url":null,"abstract":"<p><strong>Objectives: </strong>The source and clinical significance of early proteinuria following kidney transplantation are complex, as proteinuria may be transient or may derive from native kidneys. This study evaluated the effects of early persistent proteinuria on long -term kidney allograft outcomes.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of 312 kidney transplant recipients who received transplants between 2009 and 2020. Persistent proteinuria was defined as a spot urine protein -to -creatinine ratio ≥500 mg /g documented in at least 2 consecutive assessments within the first 24 months posttransplant. We compared graft survival according to proteinuria status.</p><p><strong>Results: </strong>Among 312 study patients, proteinuria was detected in 46.3 % of patients at a single visit and 16.0 % met criteria for persistent proteinuria. Nineteen patients (6.1 % ) experienced graft loss. Single -visit proteinuria was associated with a 2 -fold increased risk of graft loss, whereas persistent proteinuria demonstrated a stronger independent association (hazard ratio 4.68; 95 % CI, 1.56 -14.07; P = .006 ). Proteinuria documented at least twice at the 6 -, 12 -, and 24 -month visits was related to an approximately 9 -fold higher probability of graft loss (hazard ratio 8.63; 95 % CI, 2.06-36.22; P = .003 ). Graft survival progressively declined with increasing levels of proteinuria.</p><p><strong>Conclusions: </strong>Early persistent proteinuria is strongly and independently associated with adverse long -term graft outcomes. Frequent assessment of proteinuria can yield important prognostic insights and can help identify recipients who require enhanced monitoring and additional diagnostic evaluation.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"600-607"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Mongi Bacha, Aziz El Matri, Ezzedine Abderrahim
{"title":"ABO-Incompatible Kidney Transplantation as a Strategic Expansion Tool in Low- and Middle-Income Countries.","authors":"Mohamed Mongi Bacha, Aziz El Matri, Ezzedine Abderrahim","doi":"10.6002/ect.MESOT2025.L16","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.L16","url":null,"abstract":"<p><p>The persistent disparity between organ supply and demand remains the principal limitation to kidney transplantation worldwide. ABO-incompatible kidney transplant has progressively evolved from an experimental procedure to an established strategy for expanding the living donor pool. This review critically evaluated whether ABO-incompatible kidney transplant represents a justified, effective, and feasible solution in low- and middle-income countries. We conducted a structured review of international registry data, meta-analyses, and major cohort studies to assess epidemiology, historical evolution, immunologic principles, clinical outcomes, desensitization protocols, economic implications, and complication profiles associated with ABO-incompatible kidney transplant. Our results showed that global transplant activity fulfills <10% of estimated needs. ABO-incompatible kidney transplant procedures have increased living donor availability by approximately 25% to 33% in countries adopting this strategy. Contemporary data showed that graft and patient survival rates approached rates of compatible transplant, although early risks of antibody-mediated rejection, infection, and bleeding remain higher. Advances in B-cell depletion therapy, immunoadsorption techniques, and modern immunosuppressive regimens have markedly improved outcomes. The primary limitation in low- and middle-income settings is financial cost, particularly related to antibody removal technologies; however, validated cost-reduction strategies exist. ABO-incompatible kidney transplantation is no longer experimental and should be considered a mature, evidence-supported strategy. When implemented in experienced centers with appropriate protocols and cost-adaptation measures, this method constitutes a reasonable and potentially transformative approach to mitigating organ shortages in selected low- and middle-income countries.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"10-13"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nanotechnology in Transplantation: Emerging Mechanisms, Clinical Applications, and Future Directions.","authors":"Hassan Argani","doi":"10.6002/ect.MESOT2025.L36","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.L36","url":null,"abstract":"<p><p>Nanotechnology has rapidly evolved into a transformative platform in transplant medicine, offering sophisticated tools for targeted drug delivery, organ preservation, precision diagnostics, and tolerance induction. Engineered nanoparticles enable localized and sustained delivery of immunosuppressive agents while minimizing systemic toxicity, thus allowing long-standing limitations of conventional immunosuppression to be addressed. Diverse nanomedicine platforms, including liposomes, polymeric nanoparticles, dendrimers, magnetic nanoparticles, and inorganic systems, enhance drug bioavailability, reduce off-target effects, and allow integration of imaging and therapeutic functions. This review synthesized current progress in nanoparticle-enabled therapeutics, diagnostics, machine-perfusion-based delivery, gene editing, and personalized nano-immunotherapy, highlighting their potential to reduce rejection, ischemia-reperfusion injury, and chronic graft dysfunction. Insights from recent advances.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"26-31"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farhod A Khadjibaev, Pulat K Sultanov, Dmitriy L Kim, Dilshod N Ergashev, Mirkamol A Hashimov, Nurbek B Iskhakov, Ruslan K Sadikov, Jur'at A Djuraev, Aziz A Ismatov
{"title":"Characteristics of the Management of Gastric and Duodenal Ulcers in Individuals With Advanced Chronic Kidney Disease.","authors":"Farhod A Khadjibaev, Pulat K Sultanov, Dmitriy L Kim, Dilshod N Ergashev, Mirkamol A Hashimov, Nurbek B Iskhakov, Ruslan K Sadikov, Jur'at A Djuraev, Aziz A Ismatov","doi":"10.6002/ect.MESOT2025.P52","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.P52","url":null,"abstract":"<p><p>Peptic ulcer disease in patients with end -stage chronic kidney disease presents a complex clinical problem due to metabolic disturbances, impaired mucosal regeneration, polypharmacy, and limitations in the use of standard medications. In this study, we conducted a comparative analysis of conservative and surgical (kidney transplant ) management of gastric and duodenal ulcers in patients with end -stage renal disease versus patients without renal dysfunction. Among the 34 patients who were examined, findings showed that kidney transplant contributed to rapid ulcer healing, normalization of biochemical parameters, and reduction in recurrence rates. The study highlighted the necessity of individualized treatment strategies for patients with end -stage renal disease and emphasized the importance of restoring renal function to improve gastrointestinal outcomes.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"287-290"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association of 25-Hydroxyvitamin D and Bone Turnover Markers Levels With Bone Mineral Density Measurement in Renal Transplant Patients.","authors":"Melike Beyin, Gülşah Sasak","doi":"10.6002/ect.MESOT2025.O78","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.O78","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic kidney disease is associated with mineral and bone disorders, including abnormalities in calcium, phosphorus, parathyroid hormone, and vitamin D metabolism, as well as bone diseases like renal osteodystrophy. Although renal transplant can improve some bone mineral disorders, osteoporosis and altered bone metabolism remain important issues due to factors like corticosteroid use and persistent hyperparathyroidism. Bone biopsies are the gold standard for diagnosing bone disorders but are invasive, leading to the exploration of noninvasive methods such as bone turnover markers and bone mineral density measurements. In this study, we aimed to investigate whether there is a relationship between bone turnover markers and bone mineral densities measured by dual -energy X -ray absorptiometry.</p><p><strong>Materials and methods: </strong>This study evaluated 121 renal transplant patients categorized as normal, with osteopenia, or with osteoporosis based on dual -energy X -ray absorptiometry measurements. Biochemical markers (parathyroid hormone, alkaline phosphatase, calcium, phosphorus, vitamin D, beta -CrossLaps, and osteocalcin ) were analyzed for their relationship with bone mineral density.</p><p><strong>Results: </strong>Osteoporosis was more common in women (34.09 % ) than in men (9.09 % ), likely because of postmenopausal hormonal changes. No significant correlation between bone mineral density and bone turnover markers was observed, and none of the biochemical markers demonstrated strong predictive value for osteoporosis.</p><p><strong>Conclusions: </strong>Findings suggested that bone mineral density alone is insufficient to fully evaluate bone health, as bone turnover can vary significantly among individuals. A more comprehensive assessment combining bone mineral density, bone turnover markers, and clinical findings is necessary for a better understanding of bone health in renal transplant patients. However, the study's limitations, including a relatively small sample size, single -point measurements, and lack of follow -up, underscore the need for larger, longitudinal studies. Such studies are essential to better understand bone turnover dynamics and to develop optimized screening and treatment strategies for this patient population.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"204-212"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bibliometric Review of Türkiye-Based Publications on Organ Donation and Transplantation Between 2000 and 2025: A Thematic and Network-Based Approach.","authors":"Ayse Meydanlıoğlu, Büşra Nur Temür, Nilgün Aksoy","doi":"10.6002/ect.MESOT2025.P26","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.P26","url":null,"abstract":"<p><strong>Objectives: </strong>A systematic analysis of organ donation -related publications can enable assessment of the existing knowledge base and can help inform future policy development Here, we analyzed scientific publications addressing public awareness on organ donation and transplantation between 2000 and 2025 by bibliometric method.</p><p><strong>Materials and method: </strong>We conducted a descriptive study based on bibliometric analysis. We obtained data using EkşiVeri 1.0.5 R -Shiny Integrated Smart Data Analysis and Analytics Application. We obtained sources from an open access database known as (TR Index, a national database developed by TÜBİTAK ULAKBİM in accordance with international standards to provide researchers with access to national and scientific content in electronic environment ). We searched publications using the key words \"organ donation\" and \"transplantation.\" We evaluated relationships between concepts using network metrics such as modularity, centrality and average path length.</p><p><strong>Results: </strong>Data were obtained from 63 research articles published by Turkish authors. Word networks with 23 nodes and 54 links at the title level and 20 nodes and 59 links at the subject level were created. Analysis of the title word network showed that the terms organ, donation, and transplantation were positioned as thematic centers with high degree and betweenness centrality values. In addition, broader and interdisciplinary concepts such as \"medicine,\" \"services,\" \"ethics,\" and \"policy\" characterized the subject area. Publications often focused on students, health care professionals, and patient groups and revolved around themes of knowledge, attitudes, and behaviors.</p><p><strong>Conclusions: </strong>Title searches for \"organ\" and \"transplantation\" showed publications originating from Türkiye that not only focused on organ donation and transplantation but also encompassed a broader and systemic context. Future studies should focus on different groups and increase initiatives aimed at raising public awareness of organ transplantation.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"268-274"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Early and Late Reperfusion Injury in Liver Transplant: A Case Series and Anesthetic Management Strategies.","authors":"Mark William Noble, Rathnavelu Kanganavelu","doi":"10.6002/ect.MESOT2025.P102","DOIUrl":"10.6002/ect.MESOT2025.P102","url":null,"abstract":"<p><p>Postreperfusion syndrome is a recognized complication of liver transplant, characterized by acute cardiovascular instability following graft reperfusion . We present a case series of 2 deceased-donor liver transplant recipients who developed distinct patterns of reperfusion injury: a patient with early reperfusion syndrome and another patient with delayed (late) reperfusion instability. Both cases manifested significant hypotension and bradycardia or low cardiac output, requiring prompt anesthetic intervention with vasopressors and inotropes. Timely recognition, vigilant intraoperative monitoring, and tailored anesthetic management resulted in hemodynamic stabilization and favorable graft outcomes. This series highlights the importance of proactive anesthetic strategies for management of ischemia-reperfusion injury during liver transplant.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"428-429"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajeev Sharma, Siarhei Dzedzik, Nasir Khan, Abhinav Seth, Vishy Chaudhary
{"title":"Peripheral Blood Next-Generation RNA Sequencing as an Adjunctive Tool in the Evaluation of Borderline T-Cell-Mediated Rejection in BK Virus Nephropathy.","authors":"Rajeev Sharma, Siarhei Dzedzik, Nasir Khan, Abhinav Seth, Vishy Chaudhary","doi":"10.6002/ect.2026.0075","DOIUrl":"10.6002/ect.2026.0075","url":null,"abstract":"<p><p>Distinguishing BK virus nephropathy from T -cell -mediated rejection remains a clinicopathological challenge in kidney transplants, because the 2 entities may share overlapping histological features while requiring opposite therapeutic approaches. We report a kidney transplant recipient with biopsy -proven BK virus nephropathy who later underwent repeat biopsy showing low -level BK virus nephropathy with borderline T -cell -mediated rejection. Despite histological concern for rejection, the broader clinical picture did not support clinically significant T -cell -mediated rejection; specifically, serum creatinine remained stable, BK viral load showed marked improvement, donor -specific antibodies were negative, and there were no vascular or microvascular features of active rejection. A peripheral blood next-generation RNA sequencing gene expression profile yielded a low -risk acute rejection score of 6. Antirejection therapy was deferred, immunosuppression was not escalated, and the patient remained clinically stable. This case highlights the potential adjunctive role of peripheral blood RNA profiling for resolution of histologically ambiguous cases of BK virus nephropathy and borderline T -cell-mediated rejection.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 7","pages":"569-574"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}