Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain
the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in
Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles
and JavaScript.
The field of organ transplantation has witnessed significant strides in recent years, offering renewed hope for individuals suffering from organ failure. These advancements address two key challenges: the limited availability of donor organs and the long-term health of transplant recipients. The transplantation of genetically modified porcine organs into brain-dead or severely ill patients, the improvement of organ perfusion and transplantation techniques, the evolution of strategies to achieve longer organ preservation and expansion of donor pools, the advancement of precision immunosuppression approaches, and the development of new automated diagnostic tools for allograft rejection as well as of new predictive and prognostic models, is marking a period of exciting transformation.
This cross-journal Collection welcomes submissions of original research studies focused on addressing unmet needs in organ transplantation. This includes studies focused on new transplantation and xenotransplantation approaches, on strategies aiming at improved organ preservation and expanded availability, and on predicting, monitoring, or ameliorating the health of transplant recipients. We are open to receiving translational and preclinical studies, observational clinical studies, interventional clinical trials, systematic reviews and meta-analyses, biomarker and diagnostic accuracy studies.
In addition to original research, we are open to receiving Reviews, Perspectives, and Comments that offer significant insights into the topic.
Kidney shortages limit treatment options for patients with end-stage kidney disease, prompting exploration of xenotransplantation. Here, the authors show that a genetically modified pig kidney sustained essential functions in a living human for 51 days, informing future clinical strategies.
Normothermic machine perfusion could prolong and/or improve preservation of kidneys in transplantation, but the technology has yet to reach clinical realization. Here, the authors show the hurdles, but also the solutions, for this technology to become a reality in transplantation and beyond.
Current approaches to detect allograft damages non-invasively are limited and do not differentiate between cellular mechanisms. Here, the authors show that the composition of cell-free DNA in blood samples can reveal cellular causes of allograft injury after liver transplant.
Ex vivo normothermic machine perfusion has been proposed to protect donor kidneys. Here, the authors show that red blood cell-based human kidney perfusion and associated hemolysis contribute to iron accumulation, ferroptosis, and kidney injury.
Kidney transplants are at risk of graft failure due to immune system rejection. Here, the authors assess a broad range of clinical and immunological baseline variables in a large, unselected kidney transplant cohort, providing further insights into factors associated with antibody-mediated rejection
Kidney transplantation usually relies on hypothermia to safely preserve the graft. Here, the authors show that keeping kidneys at 37°C, using a machine to supply them with blood, oxygen, and nutrition, is feasible for up to 24 hours, and may be useful for testing and treating them pre-transplant.
Liver transplant recipients are at risk of graft injury, yet diagnosis currently relies on invasive biopsies with associated risks. Here the authors developed and validated a non-invasive AI model, GraftIQ, which integrates clinician expertise with machine learning to accurately predict graft pathology and support clinical decision-making.
Tacrolimus is a critical immunosuppressant for liver transplant recipients, but its dosing is challenging due to individual variability. Here, the authors show that a phenotypic personalized medicine approach improves tacrolimus dosing precision, reducing large deviations from target levels and shortening hospital stays in a Phase 2 randomized trial.
Xenotransplantation is a promising option when allogeneic donors are unavailable but hampered by a more stringent immunological barrier. Here authors show that hypoimmune cells engineered to overcome xenogeneic cytotoxicity of polymorphonuclear cells in addition to averting responses by other immune cell types might improve pig-to-human xenotransplantation.
The complexity of matching ABO blood groups presents a formidable barrier to successful transplantation. Here, the authors show that an enzymatic converted type B kidney was transplanted into a type O brain-dead recipient without hyperacute rejection.
The authors previously reported that normothermic ex vivo kidney perfusion is superior to static cold storage in terms of organ protection, but the detailed mechanism was unclear. Here the authors show that the organ-protective effects of normothermic perfusion are mediated by maintenance of mitochondrial function and enhanced by administration of AP39, a mitochondria-targeted hydrogen sulfide donor.
Despite being recommended, day-zero biopsies are often not performed, due to the cost and time. Here, the authors show that machine learning and donor’s basic parameters can predict the biopsy, offering a reliable virtual estimation of the day-zero biopsy findings.
Ex vivo perfusion is a unique platform to study isolated human lungs. Here, authors show that a machine learning model, InsighTx, derived from data generated during ex vivo lung perfusion can accurately predict transplant outcomes and increase organ utilization rates.
Long-term machine perfusion of human livers outside the body is an emerging field with tremendous potential for the assessment, recovery, and modification of organs prior to transplantation. Here, the authors report the long-term ex situ perfusion of human livers and demonstrate the ability to split and perfuse these organs using a standardised protocol.
The possibility of banking cryopreserved organs could make transplantation medicine much more accessible. Here, the authors show that vitrification and nanowarming—cooling organs to an ice-free state followed by rapid rewarming using nanoparticles and magnetic fields—enables organ cryopreservation, long-term banking, and recovery of full function in a rat kidney transplant model.
Acute graft versus host disease is a rare but deadly complication following liver transplantation. Author show here, upon screening a large cohort of liver transplanted patients and detailed immune phenotyping of samples from the 7 affected individuals and appropriate controls, that human T cell lymphotropic virus type I infection of donor immune cells appear to correlate with the occurrence of acute graft versus host disease.
In this study, authors use combinatory bacteriophage-antibiotic therapy, as treatment for extensively drug-resistant Pseudomonas aeruginosa infection in a toddler post liver transplantation. They report on the clinical and microbiological improvement, and present their investigation on how bacterial phage resistance did not result in therapeutic failure.
Lung transplantation is hindered by the scarcity of organs and by mortality following primary graft dysfunction. Here, the authors show that cytokine absorption can be used in donor lungs during ex vivo lung perfusion and post-transplant, and leads to restored lung function and reduced primary graft dysfunction in animal models.
Roehrich, Hinkov et al. report a case series on treating aortic valve dysfunction after heart transplantation, which may cause recurrent heart failure. Authors find that transcatheter aortic valve replacement is preferred in these complex, high-risk cases, while surgery remains an option for patients who are ineligible for catheter-based treatment.
Hisadome et al. compare the impact of static cold storage or hypothermic machine perfusion of kidneys that are xenotransplanted from pig to primate. Hypothermic machine perfusion reduces ischemia-reperfusion injury, so may help prevent early xenograft failure.
Li et al. aims to externally validate the TRIUMPH model, a machine learning model previously established to predict post-transplant HCC recurrence. It demonstrates good accuracy and clinical utility, superior to pre-existing models including MORAL, AFP, and HALT-HCC.
Burrello et al. combine extracellular vesicle profiling with adaptive artificial intelligence to monitor cell rejection after heart transplant. Heart transplant rejection is detected with high accuracy, outperforming biopsy and anticipating rejection before histological signs, offering a promising noninvasive tool for timely intervention and personalized monitoring.
Singh, Goerlich et al. transplant 10 gene modified pig hearts into non-human primates. Life-supporting function occurred for up to 225 days but there was evidence of adipose deposition, chronic vasculopathy, micro and macro thrombosis, and acute cellular rejection.
Clarke et al. present a reproducible protocol for the extended normothermic machine perfusion of human livers. Function and are preserved in five human livers perfused between 121–184 h.
Chisholm-Burns et al. discuss the substantial shortage of organs available for transplantation, with disparities in access amongst some racial and ethnic groups. The authors suggest that while xenotransplantation can potentially increase organ availability, it also has the potential to further embed inequities in transplant care.
Divard, Raynaud et al. compare artificial intelligence (AI)-based predictions of kidney allograft failure based on electronic health records with those made by transplant physicians of varying levels of experience. The ability of physicians to predict allograft failure is limited, with superior performance seen for the AI system.
Minor et al. present and evaluate a quantitative approach to measuring metabolic turnover of 13C-acetate during isolated perfusion to ascertain the quality of porcine donor kidneys. This approach effectively discriminates varying degrees of organ graft quality, where conventional renal function tests are ineffective.