{
  "abstract": "Kidney transplantation improves survival and quality of life compared with long-term dialysis, yet many kidney transplant recipients remain characterized by reduced physiological reserve, cardiometabolic vulnerability, and ongoing graft-related risk. Structured exercise is a promising non-pharmacological strategy after transplantation, but its potential immunometabolic and immunomodulatory effects and their relationship with longer-term graft-related trajectories remain insufficiently characterized. The EXercise Training in Kidney TRAnsplant Recipients Trial (EXTRA Trial) is a randomized, assessor-blinded, parallel-group controlled trial that enrolled adult kidney transplant recipients approximately 6 months after transplantation. Participants are allocated 1:1 to usual post-transplant care or a supervised, progressive, combined aerobic and resistance exercise program consisting of a 2-week familiarization period followed by 24 weeks of training. The primary outcomes are the between-group differences in change in peak oxygen uptake (VO2peak) and handgrip strength from baseline to the end of the randomized intervention. VO2peak serves as the principal cardiorespiratory outcome and the basis for the sample-size calculation. Major secondary outcomes include patient-reported physical functioning, habitual physical activity, health-related quality of life, body composition, renal function, blood pressure, and metabolic markers. Exploratory outcomes include rejection-free survival, graft survival, circulating inflammatory cytokines (TNF-α, IL-6, and IL-2), soluble PD-1 and PD-L1, and longer-term trajectories assessed through 24 months after transplantation. The protocol follows SPIRIT 2025 recommendations and integrates exercise physiology, transplant medicine, and immune-related phenotyping to examine whether exercise-induced improvements in physiological reserve are accompanied by measurable inflammatory, immune-checkpoint, and graft-related changesClinical trial registrationClinicalTrials.gov, identifier NCT06216015.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Exercise Sciences and Physiology, Graduate Program in Physical Education, Catholic University of Brasília, Brasília, Distrito Federal, Brazil",
    "Laboratory for Science and Innovation Applied to Pathophysiology and Exercise, Catholic University of Brasília, Brasília, Distrito Federal, Brazil",
    "Department of Genomic Sciences and Biotechnology, Catholic University of Brasília, Brasília, Distrito Federal, Brazil",
    "State University of Northern Paraná, Jacarezinho, Paraná, Brazil",
    "Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil",
    "Nefroclínicas Group, Belo Horizonte, Minas Gerais, Brazil",
    "Clinical Group Home Dialysis Center and RenalClass, São Paulo, Brazil",
    "Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States",
    "Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg",
    "0Division of Transplantation, University Hospital of Brasília, HUBrasil, Brasília, Distrito Federal, Brazil",
    "1Center for Exercise Physiology and Metabolism, Department of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile",
    "2Facultad de Medicina, Universidad Autónoma de Yucatán, Mérida, Yucatan, Mexico"
  ],
  "article_type": null,
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  "author_total": 35,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rafael L. Santos"
    },
    {
      "affs": [
        1
      ],
      "name": "Rafael L. Santos"
    },
    {
      "affs": [
        2
      ],
      "name": "Rafael L. Santos"
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    {
      "affs": [
        0
      ],
      "name": "Thiago S. Rosa"
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    {
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        2
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      "name": "Thiago S. Rosa"
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        3
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      "name": "Thiago S. Rosa"
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    {
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        0
      ],
      "name": "Samara Sezana-Costa"
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    {
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        1
      ],
      "name": "Samara Sezana-Costa"
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    {
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        0
      ],
      "name": "Suyane R. Lisboa"
    },
    {
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        1
      ],
      "name": "Suyane R. Lisboa"
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    {
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        0
      ],
      "name": "Marco Aurélio M. Estivalet"
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    {
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        1
      ],
      "name": "Marco Aurélio M. Estivalet"
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    {
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        0
      ],
      "name": "Carlos Ernesto Santos Ferreira"
    },
    {
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        0
      ],
      "name": "Gislane Ferreira de Melo"
    },
    {
      "affs": [
        0
      ],
      "name": "Lysleine Alves de Deus"
    },
    {
      "affs": [
        4
      ],
      "name": "José Adeirton"
    },
    {
      "affs": [
        4
      ],
      "name": "Michel K. Souza"
    },
    {
      "affs": [
        4
      ],
      "name": "Anderson S. Haro"
    },
    {
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        0
      ],
      "name": "Fernando Costa"
    },
    {
      "affs": [
        3
      ],
      "name": "Mariana Campos A. Mattos"
    },
    {
      "affs": [
        5
      ],
      "name": "José R. B. Neto"
    },
    {
      "affs": [
        6
      ],
      "name": "Carmen Tzanno-Martins"
    },
    {
      "affs": [
        7
      ],
      "name": "Daniel M Mendes"
    },
    {
      "affs": [
        0
      ],
      "name": "Guilherme T. Ribas"
    },
    {
      "affs": [
        1
      ],
      "name": "Guilherme T. Ribas"
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    {
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        8
      ],
      "name": "Guilherme T. Ribas"
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    {
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      "name": "Geraldo R. R. Freitas"
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    {
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      "name": "Mauricio Castro-Sepulveda"
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    {
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      "name": "Adriana Bañares-Cruz"
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    {
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      "name": "Thiago J. Borges"
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    {
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      "name": "Leonardo V. Riella"
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    {
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      "name": "Rodrigo P. Neves"
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    {
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        0
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      "name": "Hugo L. Correa"
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    {
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        1
      ],
      "name": "Hugo L. Correa"
    },
    {
      "affs": [
        2
      ],
      "name": "Hugo L. Correa"
    }
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  "bibtex": "https://research.draconitic.com/paper/cc89pakk8wsv1.bib",
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  "doi": "10.3389/fneph.2026.1972911",
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  "pdf_url": "https://www.frontiersin.org/journals/nephrology/articles/10.3389/fneph.2026.1972911/pdf",
  "pmcid": null,
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  "published": "2026-10-26",
  "publisher": "Frontiers Media S.A.",
  "ris": "https://research.draconitic.com/paper/cc89pakk8wsv1.ris",
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  "title": "Exercise training in kidney transplant recipients (EXTRA Trial): protocol for a randomized controlled trial",
  "title_text": "Exercise training in kidney transplant recipients (EXTRA Trial): protocol for a randomized controlled trial",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:47:20Z",
  "url": "https://research.draconitic.com/paper/cc89pakk8wsv1",
  "venue": "Frontiers in Nephrology",
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