Prabhahar A, Batta A, Hatwal J, Kumar V, Ramachandran R, Batta A. Endothelial dysfunction in the kidney transplant population: Current evidence and management strategies. World J Transplant 2025; 15(1): 97458 [DOI: 10.5500/wjt.v15.i1.97458]
Corresponding Author of This Article
Akash Batta, DM, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Arun Prabhahar, Department of Telemedicine (Internal Medicine and Nephrology), Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Akshey Batta, Department of Urology and Renal Transplant, Neelam Hospital, Rajpura 140401, Punjab, India
Juniali Hatwal, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Vivek Kumar, Raja Ramachandran, Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Author contributions: Prabhahar A, Batta Ak, and Batta A designed the review, analyzed the data, wrote the manuscript, and subsequently revised it; Prabhahar A, Batta Ak, Hatwal J performed the literature review and data collection; Kumar V and Ramachandran R supervised the study and provided key feedback and suggestions; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akash Batta, DM, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Received: May 30, 2024 Revised: September 4, 2024 Accepted: November 4, 2024 Published online: March 18, 2025 Processing time: 180 Days and 17.6 Hours
Abstract
The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators. Endothelial dysfunction (ED), characterized by impaired vasodilation, inflammation, and thrombosis, triggers future cardiovascular (CV) diseases. Chronic kidney disease, a state of chronic inflammation caused by oxidative stress, metabolic abnormalities, infection, and uremic toxins damages the endothelium. ED is also associated with a decline in estimated glomerular filtration rate. After kidney transplantation, endothelial functions undergo immediate but partial restoration, promising graft longevity and enhanced CV health. However, the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED, culminating in poor CV health and graft survival. ED in kidney transplant recipients is an under-recognized and poorly studied entity. CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts. ED contributes to the pathogenesis of many of the CV diseases. Various biomarkers and vasoreactivity tests are available to study endothelial functions. With an increasing number of transplants happening every year, and improved graft rejection rates due to the availability of effective immunosuppressants, the focus has now shifted to endothelial protection for the prevention, early recognition, and treatment of CV diseases.
Core Tip: Endothelium promotes vascular homeostasis by regulating vascular permeability, leucocyte diapedesis, hemostatic response, and vascular tone. Endothelial dysfunction (ED) plays a key role in the genesis of cardiovascular (CV) and kidney outcomes seen in the chronic kidney disease and kidney transplant population. There is increased CV morbidity and mortality imparted due to ED in transplant recipients. Among various biomarkers and diagnostic tests available to detect endothelial function, flow-mediated dilation is a widely recognized and reproducible test available in clinical settings. Though overlooked in kidney transplant settings, promoting CV and graft health by monitoring endothelial functions and mitigating risk factors of ED can improve overall outcomes.
