Editorial: Renal fibrosis and renal transplantation

The perioperative period is a critical window that often dictates long-term graft survival. Delayed graft function (DGF) is a common manifestation of severe IRI and serves as a precursor to chronic fibrosis. Identifying reliable, non-invasive biomarkers to assess donor organ quality is paramount.Two studies in this collection offer promising clinical tools for DGF prediction. Ma et al. (1) identified donor urinary uridine diphosphate-glucose (UDP-Glc) as a novel damage-associated molecular pattern (DAMP) that independently predicts DGF. Their study demonstrates that elevated UDP-Glc levels correlate with more severe kidney damage and poorer graft recovery, providing surgeons with a stable, easy-to-detect biomarker for evaluating renal quality before implantation.focused on cold-inducible RNA-binding protein (CIRBP) in donor plasma. Their findings reveal that donor CIRBP concentrations in the DGF group are significantly higher than in the immediate graft function group, establishing CIRBP as a potent indicator of the extent of pre-transplant injury and its subsequent impact on long-term plasma creatinine levels.Understanding the transition from acute kidney injury (AKI) to chronic kidney disease (CKD) is essential for preventing fibrosis. The collective findings in this Research Topic underscore that renal fibrosis in transplantation is not a solitary event but the culmination of early donor injury, persistent immune activation, and metabolic maladaptation.As Guest Editors, we hope that this collection inspires further research into the integrated management of renal transplantation. By combining advanced diagnostics with multi-target therapies, we can move closer to the goal of "one transplant for life," ultimately minimizing the burden of fibrosis and maximizing the gift of life for our patients.