Intestinal obstruction (IO) is an important but underexplored complication following simultaneous pancreas‐kidney transplantation (SPKT) and is associated with considerable morbidity and both clinical and economic burdens. This study aimed to quantify the incidence of IO, identify significant predictors, and evaluate its impact on graft outcomes and patient survival.

This single‐center cohort study (January 2016 and February 2025) was conducted at The Second Affiliated Hospital, Guangzhou Medical University. Perioperative parameters, including demographic characteristics, surgical variables, and laboratory findings over time, were analyzed. Univariate and multivariable logistic regression with Firth's penalization (in view of the number of events being limited to 20) were performed to identify significant predictors of clinical outcomes. Survival was evaluated using the Kaplan‐Meier method, with intergroup comparisons using the log‐rank test.

There were 264 SPKT recipients during the study period. The overall incidence of postoperative IO was 7.6% (20/264). Multivariable Firth's penalized logistic regression identified preoperative diabetic gastroenteropathy (odds ratio [OR] = 4.04, 95% confidence interval [CI]: 1.46–11.19, p = 0.007), operation time > 8 h (OR = 4.24, 95% CI: 1.46–12.26, p = 0.008), and postoperative hypoalbuminemia (OR = 3.25, 95% CI: 1.13–9.32, p = 0.028) as significant independent predictors of risk. Conservative management (e.g., bowel rest, decompression, laxatives) was successful in 90% (18/20) of cases, with only 10% requiring surgical intervention. Kaplan–Meier analysis revealed no significant difference in long‐term survival between patients with and without IO (p = 0.370), with comparable 1‐year, 3‐year, and 5‐year survival rates.

The findings of this observational cohort study underscore the importance of preoperative optimization and vigilant postoperative monitoring in high‐risk SPKT recipients. IO occurred in a subset of SPKT recipients and was significantly associated with diabetic gastroenteropathy, a prolonged operation time, and postoperative hypoalbuminemia. However, IO was amenable to nonoperative management and showed no significant association with long‐term mortality or graft loss. These findings should be interpreted as hypothesis‐generating, given the limited number of events, and warrant validation in larger cohorts.

The aim of this study is to evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) for cryptococcal infection after kidney transplantation by comparing its positivity rate, turnaround time, and impact on clinical decision-making with those of conventional diagnostic methods, including India ink staining, culture, and capsular antigen testing.

This retrospective study included 16 kidney transplant recipients diagnosed with cryptococcal infection between January 2017 and July 2025. Among them, 11 had isolated pulmonary infection, 1 had isolated central nervous system (CNS) infection, and 4 had combined pulmonary and CNS involvement. Cerebrospinal fluid and bronchoalveolar lavage fluid samples were analyzed using mNGS and conventional assays. Positivity rates, sensitivity, specificity, and turnaround times were compared using McNemar's exact test for paired data. Confidence intervals (CIs) at 95% were calculated using the Clopper‐Pearson method.

The overall mNGS positivity rate was 93.8% (15/16, 95% CI: 69.8%–99.8%), exceeding the 62.5% (10/16, 95% CI: 35.4%–84.8%) achieved using conventional methods (paired difference, 31.3%; 95% CI: 4.1%–54.6%; McNemar's exact test, p = 0.031). The median turnaround time was significantly shorter for mNGS than for fungal culture (24 vs. 120 h, p < 0.001). In the CNS infection subgroup, mNGS was positive in 4 of 5 cases (80.0%), compared with four of five cases (80.0%) using conventional testing. In the pulmonary infection subgroup, mNGS detected all 15 cases (100%), whereas conventional methods identified 9 of 15 (60.0%). Six patients who tested negative using all conventional methods were diagnosed using mNGS, and all patients received targeted antifungal therapy guided by mNGS results.

In this small exploratory study, mNGS was associated with a higher early detection rate than conventional methods. In six patients with negative results across all conventional tests, mNGS results directly guided antifungal therapy. These findings suggest that mNGS plays an important role in diagnosing cryptococcal infection after kidney transplantation, particularly when conventional tests are negative.

Simultaneous pancreas‐kidney (SPK) transplantation has become a standard therapy for end‐stage diabetic nephropathy patients. This study aims to investigate serum microRNA (miRNA) profiles in patients with type 2 diabetic nephropathy after SPK and explored the mechanism of insulin resistance induced by relevant miRNAs.

Patients with type 2 diabetic nephropathy were recruited at our organ transplantation center from June 2018 to March 2019. Six patients were randomly selected, and miRNA microarray analysis was performed to assess serum miRNA expression levels. Target genes were predicted, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis was conducted.

The gene chip results revealed significant upregulation of miR‐320d, miR‐4701‐3p, and miR‐940 and significant downregulation of miR‐1229‐5p, miR‐125a‐3p, miR‐3614‐5p, miR‐6090, and miR‐6893‐5p. Target gene prediction and pathway analysis revealed that four miRNAs (miR‐125a‐3p, miR‐320d, miR‐940, and miR‐1229‐5p) form distinct signal regulatory networks.

Specific miRNA expression profiles are present in the serum of patients with diabetic nephropathy after simultaneous pancreas‐kidney transplantation. These specific miRNAs may be involved in the regulatory mechanism of restoring normoglycemia in diabetic nephropathy patients.