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Kidney Transplantation: Innovations in Research and Treatment

Published: February 10, 2023


This methods collection summarizes new findings on the topic of kidney transplantation both in research and in treatment. Important progress has been made on this topic in recent years, leading to improvements in therapeutic measures with reduced acute rejections and improved graft and patient survival rates. In addition, improvements have been made in the field of kidney transplantation from living donors and in extending kidney transplantation to HLA- or ABO-incompatible couples or to elderly patients. Further progress has been made with the utilization of kidneys from so-called marginal donors, including non-heart-beating donors at the time of donation. This progress is illustrated by the persistence of kidney transplantation even during the COVID-19 pandemic.

Overall, five articles were collected1,2,3,4,5, and each describes different aspects of kidney transplantation. Two of the articles describe the importance of telemedicine in kidney transplantation, one article describes the importance of robot assistance in kidney transplantation, and two articles highlight new techniques for transplanting kidneys in rats and mice.

TBase is an electronic health record (EHR) for kidney transplant recipients (KTR) that automatically collects relevant clinical data collected during treatment1. It is a comprehensive database for KTR that is critical for both clinical care and research. The EHR has been used for transplant outpatient care, and its utility is underscored by 20 years of use at Charité Hospital in Berlin. Long-term data are easily recovered by the system and may be used for research. The importance of the EHR is documented by many scientific publications6,7,8,9,10. Overall, 7,595 kidney transplants have been documented with 6,489 sets of donor data. Data on an additional 20,724 renal non-transplanted patients with different conditions have been collected. Several papers have documented the importance of telemedicine as applied to kidney transplantation11,12,13,14.

A system to facilitate bidirectional communication was implemented as fully described in the paper from Duettmann et al.2. Indeed, the use of the MACCS platform for KTR patients allows for video conferences involving the kidney center, the local nephrologist, and the patients, who do not need to move to reach the hospital. In the first 5 months after its implementation, 131 patients actively participated in the project. This telemedicine system is cost-effective and may improve patient care15. A systematic improvement of the system is planned. It is being extended to non-transplanted renal patients and patients transplanted with different organs. The utility of these systems has already been documented during the COVID-19 pandemic16,17 and in countries with long travel distances between medical centers, such as Canada and Australia18.

The paper from Lim et al.3 describes their experience of the important issue of robot-assisted kidney transplantation (RAKT) from living donors. RAKT can reduce postoperative pain and the number of wound infections19. In expert hands, RAKT also allows for kidney transplantation in obese patients20. The authors describe the steps used for RAKT, with the most important being the positioning of the robotic and gel ports. Positioning the kidney allograft, reperfusion, and ureteroneocystostomy are also important steps in this technique. One of the principal advantages of RAKT is the reduction of all the operative times. RAKT is used with regional hypothermia to further reduce post-transplant complications and patient discomfort21. All of these data were validated by an updated analysis from the ERUS-RAKT including almost 300 cases22. Finally, the feasibility and safety of RAKT from deceased donors were documented23 by expert teams, representing a new era for this technique.

The important aspect of the study of You et al.4 is that it modifies the model for rat orthotopic renal transplantation. Clinical trials are always preceded by studies on animals, and rat transplantation is an important model to study renal allograft rejection behavior in preclinical studies. Achieving renal allografts in rat models is essential, and rat transplantation should be free of surgical complications related to the surgical technique. Originally, the techniques used included the anastomosis of the donor rat renal artery and renal vein to the recipient rat aorta and inferior vena cava24,25. However, these techniques can lead to lower body ischemia, which is often associated with thrombosis of the inferior vena cava and death of the recipient rat. Other researchers tried to anastomose the ureter using the cuff method, but the technique did not improve the outcomes26. You et al.4 propose a different technique by which the donor’s kidney vessels are implanted directly into the recipient’s renal vessels. This method increases the survival and avoids obstacles to vascularizing the lower body.

Similar data were provided by Yin et al.5. They describe in detail a further technique for transplanting kidneys in mice. Essentially, they prepare a patch of the abdominal aorta, and the kidneys are taken en bloc, including the ureteral artery, to avoid ureteral necrosis or occlusion. They can also increase or decrease the anastomosis to avoid vessel strictures. In this way, they obtained good results, as documented by a previous study27. In particular, they documented excellent histological results after the sacrifice of the mice28.

In conclusion, the five articles in this methods collection all contribute toward the future of kidney transplantation. The two articles1,2 on telemedicine focus on a topic that is important for facilitating the relationship among transplant centers, renal patients, and local nephrologists. In particular, telemedicine has been shown to be useful during the COVID-19 pandemic and in countries with very long travel distances. RAKT3, when used by skilled teams, is superior to open surgery. The improved surgical techniques developed during mice kidney transplantation4,5 can increase rodent survival and eventually lead to preclinical studies with better operating conditions.


  1. Schmidt, D., et al. TBase – An integrated electronic health record and research database for kidney transplant recipients. Journal of Visualized Experiments. (170), e61971 (2021).
  2. Duettmann, W., et al. Digital home-monitoring of patients after kidney transplantation: The MACCS platform. Journal of Visualized Experiments. (170), e61899 (2021).
  3. Lim, S. J., et al. Robot-assisted kidney transplantation. Journal of Visualized Experiments. (173), e62220 (2021).
  4. You, H., et al. A rat orthotopic renal transplantation model for renal allograft rejection. Journal of Visualized Experiments. (180), e63464 (2022).
  5. Yin, D., et al. Modified surgical technique for kidney transplantation in mice. Journal of Visualized Experiments. (185), e63434 (2022).
  6. Maier, C., et al. Experiences of transforming a complex nephrologic care and research database into i2b2 using the IDRT tools. Journal of Healthcare Engineering. 2019, 5640685 (2019).
  7. Schmidt, D., et al. A novel tool for the identification of correlations in medical data by faceted search. Computers in Biology and Medicine. 85, 98-105 (2017).
  8. Duettmann, W., et al. eHealth in transplantation. Transplant International. 34 (1), 16-26 (2021).
  9. Schmid, A., et al. Telemedically supported case management of living-donor renal transplant recipients to optimize routine evidence-based aftercare: A single-center randomized controlled trial. American Journal of Transplantation. 17 (6), 1594-1605 (2017).
  10. Massie, A. B., M, L., Segev, D. L. Big data in organ transplantation: Registries and administrative claims. American Journal of Transplantation. 14 (8), 1723-1730 (2014).
  11. Al Ammary, F., Concepcion, B. P., Yadav, A. The scope of telemedicine in kidney transplantation: Access and outreach services. Advances in Chronic Kidney Disease. 28 (6), 527-547 (2021).
  12. Ortiz, F., Giunti, G. Usability assessment of an interactive health technology for kidney living donors: protocol for a prospective cross-sectional survey. BMJ Open. 12 (1), 051166 (2022).
  13. Al Ammary, F., et al. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. American Journal of Transplantation. 22 (8), 2041-2051 (2022).
  14. Holderried, M., et al. Attitude and potential benefits of modern information and communication technology use and telemedicine in cross-sectoral solid organ transplant care. Scientific Reports. 11, 9037 (2021).
  15. Kaier, K., et al. Results of a randomized controlled trial analyzing telemedically supported case management in the first year after living donor kidney transplantation - A budget impact analysis from the healthcare perspective. Health Economics Review. 7 (1), (2017).
  16. Biancone, L., et al. Telemedicine monitoring in the follow-up of kidney transplant recipients: consensus indications from an Italian panel of surgeons and nephrologists after the COVID-19 experience. Journal of Nephrology. 35 (3), 725-733 (2022).
  17. Yadav, A., Singh, P. Telehealth use by living kidney donor transplant programs during the COVID-19 pandemic and beyond: A practical approach. Current Transplantation Reports. 8 (4), 257-262 (2021).
  18. Sidhu, A., Chaparro, C., Chow, C. W., Davies, M., Singer, L. G. Outcomes of telehealth care for lung transplant recipients. Clinical Transplantation. 33 (6), 13580 (2019).
  19. Tzvetanov, I., D'Amico, G., Benedetti, E. Robotic-assisted kidney transplantation: Our experience and literature review. Current Transplantation Reports. 2 (2), 122-126 (2015).
  20. Tzvetanov, I. G., et al. Robotic kidney transplantation in the obese patient: 10-year experience from a single center. American Journal of Transplantation. 20 (2), 430-440 (2020).
  21. Ahlawat, R., et al. Robotic kidney transplantation with regional hypothermia versus open kidney transplantation for patients with end stage renal disease: An ideal stage 2B study. The Journal of Urology. 205 (2), 595-602 (2021).
  22. Musquera, M., et al. Robot-assisted kidney transplantation: Update from the European Robotic Urology Section (ERUS) series. BJU International. 127 (2), 222-228 (2021).
  23. Vignolini, G., et al. Development of a robot-assisted kidney transplantation programme from deceased donors in a referral academic centre: Technical nuances and preliminary results. BJU International. 123 (3), 474-484 (2019).
  24. Fisher, B., Sun, L. Microvascular surgical techniques in research, with special reference to renal transplantation in the rat. Surgery. 58 (5), 904-914 (1965).
  25. Daniller, A., Buchholz, R., Chase, R. A. Renal transplantation in rats with the use of microsurgical techniques: A new method. Surgery. 63 (6), 956-961 (1968).
  26. Ahmadi, A. R., et al. Orthotopic rat kidney transplantation: A novel and simplified surgical approach. Journal of Visualized Experiments. (147), e59403 (2019).
  27. Rong, S., Lewis, A. G., Kunter, U., Haller, H., Gueler, F. A knotless technique for kidney transplantation in the mouse. Journal of Transplantation. 2012, 127215 (2012).
  28. Haas, M. Chronic allograft nephropathy or interstitial fibrosis and tubular atrophy: What is in a name. Current Opinion in Nephrology and Hypertension. 23 (3), 245-250 (2014).

Cite this Article

Maurizio, S. Kidney Transplantation: Innovations in Research and Treatment. J. Vis. Exp. (192), e64906, (2023).More

Maurizio, S. Kidney Transplantation: Innovations in Research and Treatment. J. Vis. Exp. (192), e64906, (2023).

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