Kidney transplantation is the gold-standard therapy for end-stage renal disease. However, in the early postoperative period following allograft kidney transplantation, insufficient graft function presents a diagnostic challenge to clinicians. Ischemic damage to the graft and/or an early autoimmune rejection may cause a decrease in function. Ischemic damage is a benign and transient condition, while acute immune rejection requires immediate therapy. A kidney graft ultrasound may produce a false negative result, and graft biopsy is invasive and slow to return results. Serum lactate dehydrogenase (LDH) is under examination as a possible tool for differential diagnosis between ischemic damage and immune rejection. Herein, we analyze the continuous lab results of four patients in the early post-transplantation period, showing patterns correlating with different clinical outcomes and prognoses. In our experience, a persistent elevated LDH accompanies ischemic damage. Immune rejection was, however, associated with a decrease in LDH. Hemodialysis was not a confounding factor, while packed red blood cell transfusion caused severe diagnostic problems.

Introduction: Indocyanine green is a fluorescent dye, the use of which is becoming more and more widespread in different areas of surgery. Several international studies deal with the dye’s usefulness in intraoperative angiography, the localization of tumors, the more precise identification of anatomical structures, the detection of lymph nodes and lymph ducts, etc. The application of the dye is safe, but a suitable equipment park is required for its use, which entails relatively high costs.Objectives: The aim of our research is to create a detector system on a low budget, to be used safely in everyday practice and to illustrate its operation with practical examples at our own institute.Methods: By modifying a web camera, using filter lenses and special LEDs, we created a device suitable for exciting and detecting indocyanine green fluorescence. We prove its excellent versatility during the following procedures at our institute: breast tumor surgery, kidney transplantation, bowel resection, parathyroid surgery and liver tumor resection.Results: The finished camera has an LED light source with a peak wavelength of 780 nm, and the incoming light is filtered by a bandpass filter with a center wavelength of 832 nm. A low budget ($112), easy-to-use tool was created, which is suitable for taking advantage of the opportunities provided by indocyanine green.

Introduction: Post-transplant malignancies are a major cause of long-term morbidity and mortality in kidney transplant recipients. Reliable non-invasive biomarkers may improve post-transplant oncological surveillance. Circulating microRNAs have emerged as promising candidate biomarkers in several malignancies, but their role in kidney transplant recipients remains poorly characterized. Objective: To compare circulating serum microRNA concentrations between kidney transplant recipients with and without post-transplant malignancies and to identify candidate microRNAs associated with the presence of malignancy. Methods: This exploratory pilot study included 40 kidney transplant recipients (27 with post-transplant malignancies and 13 cancer-free controls). Serum concentrations of five preselected microRNAs (miR-21, miR-146a, miR-196a, miR-203a, and miR-221) were quantified using droplet digital PCR. Group comparisons were performed using the Mann–Whitney U test, and receiver operating characteristic (ROC) curve analysis was used to evaluate discriminatory performance. Results: Serum concentrations of miR-21 and miR-196a were significantly higher in recipients with post-transplant malignancies than in cancer-free controls (both p = 0.003). Serum miR-221 concentrations were also significantly elevated ( p = 0.020), whereas no significant differences were observed for miR-146a or miR-203a. ROC analysis demonstrated acceptable discriminatory performance for miR-21 (AUC 0.742, 95%CI 0.601–0.883) and miR-196a (AUC 0.771, 95%CI 0.619–0.922). Conclusions: Circulating serum miR-21 and miR-196a were significantly associated with the presence of post-transplant malignancy in kidney transplant recipients, while miR-221 showed an additional exploratory association. These findings support further investigation of circulating microRNAs as candidate non-invasive biomarkers in transplant oncology. Larger prospective studies are required to validate these observations.

Fluid management after kidney transplantation requires balancing adequate graft perfusion against fluid overload. We compared central venous pressure (CVP)-guided and point-of-care ultrasound (POCUS)-guided postoperative management and explored whether longitudinal changes in inferior vena cava (IVC) diameter relative to an individual postoperative reference provided information beyond absolute IVC diameter. This single-center retrospective comparative study included 60 adult kidney transplant recipients (30 per group) with standardized assessments on postoperative days 1–5 and 10. POCUS-guided management was associated with more active therapeutic adjustments during days 1–5 (48.0% vs. 25.3%; OR 2.80, 95% CI 1.45–5.42; p = 0.002), without a significant difference in cumulative fluid balance. Reference IVC diameter ranged from 7 to 21 mm and showed substantial interindividual variability. Within-patient IVC variation was associated with daily fluid balance (p = 0.002) and weight change (p = 0.003). In a post hoc exploratory ROC analysis, peak baseline-referenced ΔIVC showed an AUC of 0.749 (95% CI 0.574–0.924) for >1 kg postoperative weight gain, compared with 0.518 (95% CI 0.300–0.737) for peak absolute IVC; the two AUCs were not formally compared. No statistically significant between-group differences in early graft outcomes were observed, although the study was not powered for these outcomes. POCUS-guided monitoring was associated with greater treatment actionability; whether this translates into clinical benefit requires prospective evaluation.

Background and Objective Tacrolimus is a cornerstone of immunosuppression after kidney transplantation; however, its narrow therapeutic window and substantial inter- and intra-individual pharmacokinetic variability complicate dose optimization. Extended-release tacrolimus (ER-Tac) and MeltDose^® prolonged-release tacrolimus (LCP-Tac) formulations have been developed to improve bioavailability and stabilize drug exposure. The concentration-to-dose (C/D) ratio has emerged as a clinically relevant surrogate marker of tacrolimus metabolism and apparent clearance. We aimed to evaluate long-term differences in C/D ratio dynamics between once-daily tacrolimus formulations. Methods In this single-center retrospective study, 100 de novo kidney transplant recipients (2015–2018) received either ER-Tac (n = 50) or LCP-Tac (n = 50). Tacrolimus trough concentrations, daily doses, and laboratory parameters were collected up to 60 months post-transplantation. Longitudinal pharmacokinetic assessment was performed using repeated C/D ratio measurements. Linear mixed-effects models adjusted for recipient age and time post-transplantation were used for analysis. Clinical outcomes included delayed graft function (DGF), biopsy-proven acute rejection (BPAR), new-onset diabetes after transplantation (NODAT), and mortality. Results LCP-Tac-treated patients required significantly lower daily doses from month 3 onward (p < 0.001) while maintaining comparable trough concentrations. The C/D ratio was consistently higher in the LCP-Tac group, reaching statistical significance from month 12 (p = 0.015) and increasing further over time (p < 0.001), suggesting lower apparent tacrolimus clearance and/or greater dose-normalized exposure. A higher proportion of LCP-Tac measurements remained within the predefined therapeutic range throughout follow-up. No significant differences were observed in DGF, BPAR, NODAT, or mortality between groups. Conclusion LCP-Tac was associated with lower dose requirements and higher, more stable C/D ratios compared with ER-Tac, suggesting formulation-dependent differences in tacrolimus pharmacokinetics. The C/D ratio may serve as a simple, clinically applicable surrogate marker for long-term pharmacokinetic monitoring in kidney transplant recipients.

Introduction: Indocyanine green is a fluorescent dye, the use of which is becoming more and more widespread in many areas of surgery. Several international studies deal with the dye’s effectiveness in intraoperative angiography, the search for tumors, the more precise identification of anatomical structures, the detection of lymph nodes and lymph ducts, etc. The application of the dye is safe, but a suitable equipment park is required for its use, which entails relatively high costs. Objectives: The aim of our research is to create a detector system on a low budget, able to be used safely in everyday practice and to illustrate its operation with practical examples in our own institute. Methods: By modifying a web camera and using filter lenses and special LEDs, we created a device suitable for exciting and detecting indocyanine green fluorescence. We prove its excellent usability during the following surgeries at our institute: breast tumor surgery, kidney transplantation, bowel resection, parathyroid surgery and liver tumor resection. Results: A low budget, easy-to-use tool was created, which is suitable for taking advantage of the opportunities provided by indocyanine green.