{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:27:01Z","timestamp":1780637221561,"version":"3.54.1"},"reference-count":126,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T00:00:00Z","timestamp":1591920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>\u03b1-Klotho is a known anti-aging protein that exerts diverse physiological effects, including phosphate homeostasis. Klotho expression occurs predominantly in the kidney and is significantly decreased in patients with chronic kidney disease. However, changes in serum klotho levels and impacts of klotho on outcomes among kidney transplant (KTx) recipients and kidney donors remain unclear. A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through October 2019 to identify studies evaluating serum klotho levels and impacts of klotho on outcomes among KTx recipients and kidney donors. Study results were pooled and analyzed utilizing a random-effects model. Ten cohort studies with a total of 431 KTx recipients and 5 cohort studies with a total of 108 living kidney donors and were identified. After KTx, recipients had a significant increase in serum klotho levels (at 4 to 13 months post-KTx) with a mean difference (MD) of 243.11 pg\/mL (three studies; 95% CI 67.41 to 418.81 pg\/mL). Although KTx recipients had a lower serum klotho level with a MD of = \u2212234.50 pg\/mL (five studies; 95% CI \u2212444.84 to \u221224.16 pg\/mL) compared to healthy unmatched volunteers, one study demonstrated comparable klotho levels between KTx recipients and eGFR-matched controls. Among kidney donors, there was a significant decrease in serum klotho levels post-nephrectomy (day 3 to day 5) with a mean difference (MD) of \u2212232.24 pg\/mL (three studies; 95% CI \u2013299.41 to \u2212165.07 pg\/mL). At one year following kidney donation, serum klotho levels remained lower than baseline before nephrectomy with a MD of = \u2212110.80 pg\/mL (two studies; 95% CI 166.35 to 55.24 pg\/mL). Compared to healthy volunteers, living kidney donors had lower serum klotho levels with a MD of = \u221292.41 pg\/mL (two studies; 95% CI \u2212180.53 to \u22124.29 pg\/mL). There is a significant reduction in serum klotho levels after living kidney donation and an increase in serum klotho levels after KTx. Future prospective studies are needed to assess the impact of changes in klotho on clinical outcomes in KTx recipients and living kidney donors.<\/jats:p>","DOI":"10.3390\/jcm9061834","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:50:49Z","timestamp":1592268649000},"page":"1834","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Serum Klotho in Living Kidney Donors and Kidney Transplant Recipients: A Meta-Analysis"],"prefix":"10.3390","volume":"9","author":[{"given":"Charat","family":"Thongprayoon","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier A.","family":"Neyra","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Bone and Mineral Metabolism, Department of Internal Medicine, University of Kentucky, Lexington, KY 40506, USA"},{"name":"Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, Dallas, TX 75390, USA"},{"name":"Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5041-4290","authenticated-orcid":false,"given":"Panupong","family":"Hansrivijit","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Medaura","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Napat","family":"Leeaphorn","sequence":"additional","affiliation":[{"name":"Renal Transplant Program, University of Missouri-Kansas City School of Medicine\/Saint Luke\u2019s Health System, Kansas City, MO 64110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Davis","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2920-7235","authenticated-orcid":false,"given":"Wisit","family":"Kaewput","sequence":"additional","affiliation":[{"name":"Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Bathini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohail Abdul","family":"Salim","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Api","family":"Chewcharat","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-668X","authenticated-orcid":false,"given":"Narothama Reddy","family":"Aeddula","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-8238","authenticated-orcid":false,"given":"Saraschandra","family":"Vallabhajosyula","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1814-7003","authenticated-orcid":false,"given":"Michael A.","family":"Mao","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-9711","authenticated-orcid":false,"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3438","DOI":"10.1096\/fj.10-154765","article-title":"Klotho: A novel phosphaturic substance acting as an autocrine enzyme in the renal proximal tubule","volume":"24","author":"Hu","year":"2010","journal-title":"FASEB J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.bbagen.2009.02.005","article-title":"Klotho and aging","volume":"1790","year":"2009","journal-title":"Biochim. 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