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Transplantology, Volume 6, Issue 3 (September 2025) – 4 articles

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20 pages, 314 KiB  
Review
AI and Machine Learning in Transplantation
by Kavyesh Vivek and Vassilios Papalois
Transplantology 2025, 6(3), 23; https://doi.org/10.3390/transplantology6030023 - 30 Jul 2025
Viewed by 306
Abstract
Artificial Intelligence (AI) and machine learning (ML) are increasingly being applied across the transplantation care pathway, supporting tasks such as donor–recipient matching, immunological risk stratification, early detection of graft dysfunction, and optimisation of immunosuppressive therapy. This review provides a structured synthesis of current [...] Read more.
Artificial Intelligence (AI) and machine learning (ML) are increasingly being applied across the transplantation care pathway, supporting tasks such as donor–recipient matching, immunological risk stratification, early detection of graft dysfunction, and optimisation of immunosuppressive therapy. This review provides a structured synthesis of current AI applications in transplantation, with a focus on underrepresented areas including real-time graft viability assessment, adaptive immunosuppression, and cross-organ immune modelling. The review also examines the translational infrastructure needed for clinical implementation, such as federated learning, explainable AI (XAI), and data governance. Evidence suggests that AI-based models can improve predictive accuracy and clinical decision support when compared to conventional approaches. However, limitations related to data quality, algorithmic bias, model transparency, and integration into clinical workflows remain. Addressing these challenges through rigorous validation, ethical oversight, and interdisciplinary collaboration will be necessary to support the safe and effective use of AI in transplant medicine. Full article
(This article belongs to the Special Issue Artificial Intelligence in Modern Transplantation)
12 pages, 249 KiB  
Article
Mental Health Support for Heart Transplant Recipients and Candidates: Nurturing Well-Being Beyond Surgery
by Lorenzo Giovannico, Valeria Ladisa, Simona De Santis, Giuseppe Fischetti, Domenico Parigino, Luca Savino, Federica Mazzone, Nicola Di Bari, Massimo Padalino and Tomaso Bottio
Transplantology 2025, 6(3), 22; https://doi.org/10.3390/transplantology6030022 - 30 Jul 2025
Viewed by 270
Abstract
Background/Objectives: Heart transplantation is a life-saving procedure for patients with end-stage heart failure, yet it involves significant psychological and emotional challenges throughout its various stages. International guidelines recommend a multi-professional approach to the care of these patients and a psycho-social assessment for listing. [...] Read more.
Background/Objectives: Heart transplantation is a life-saving procedure for patients with end-stage heart failure, yet it involves significant psychological and emotional challenges throughout its various stages. International guidelines recommend a multi-professional approach to the care of these patients and a psycho-social assessment for listing. The recommendations focus on content aspects, but not on the psychometric measure to be administered to patients as part of the assessment. Therefore, the purpose of this study is to provide the preliminary results of administering the protocol used by our center, measuring coping strategies, cognitive functioning, quality of life, and psychological distress in a sample of patients who are candidates for and undergo cardiac transplantation, and to observe any variations after the procedure. Methods: We conducted a comprehensive psychological-clinical assessment involving 40 patients, focusing on psychosocial functioning, cognitive reserves, mental health, and coping strategies. Tools such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Beck Depression Inventory-II (BDI-II), Montreal Cognitive Assessment (MoCA), General Anxiety Disorder 7 (GAD-7), and Medical Outcomes Survey Short Form 36 (SF-36) were employed to evaluate readiness for transplantation and post-transplant adaptation. Results: Results showed high levels of clinical anxiety (52.5%) and low perceived physical health (98%) before the transplant, while post-operative evaluations indicated reduced anxiety (13.51%) and depressive symptoms (10.81%), along with improved psychological well-being and reintegration into daily life. Conclusions: These results show improvement in physical and cognitive levels, accompanied by a state of enhanced psychological well-being after transplantation. A longitudinal psychological approach, from pre-transplant screening to post-discharge follow-up, is needed to address distress, improve coping mechanisms, and promote treatment adherence. This integrative strategy is critical to improving the quality of life and long-term outcomes for heart transplant recipients. Full article
14 pages, 241 KiB  
Article
Outcomes Following Donation After Brain Death and Donation After Circulatory Death Liver Transplantation in Patients with Primary Sclerosing Cholangitis
by Kevin Verhoeff, Uzair Jogiat, Alessandro Parente, Blaire Anderson, Khaled Dajani, David L. Bigam and A. M. James Shapiro
Transplantology 2025, 6(3), 21; https://doi.org/10.3390/transplantology6030021 - 18 Jul 2025
Viewed by 246
Abstract
Background: Primary sclerosing cholangitis (PSC) accounts for 10–15% of liver transplants but is the leading cause of retransplant. This study evaluates whether PSC patients have different survival and graft outcomes when receiving grafts from donors after brain death (DBD) versus circulatory (DCD) [...] Read more.
Background: Primary sclerosing cholangitis (PSC) accounts for 10–15% of liver transplants but is the leading cause of retransplant. This study evaluates whether PSC patients have different survival and graft outcomes when receiving grafts from donors after brain death (DBD) versus circulatory (DCD) death. Methods: Using the SRTR database (2004–2024), we compared PSC patients receiving DCD vs. DBD grafts. Demographics and outcomes including graft loss, mortality, and retransplant were analyzed using multivariable logistic and Cox regression, along with propensity-matched analysis. Results: Among 5762 PSC patients, 391 (6.8%) received DCD grafts. Patients receiving DCD grafts were older but had lower MELD scores (19 vs. 22; p < 0.001) and were less often functionally dependent (11.3% vs. 24.4%; p < 0.001). Multivariable Cox regression demonstrated that receipt of a DCD graft was independently associated with time to graft loss (HR 1.59; CI 1.10–2.31; p = 0.013. Similarly, DCD graft receipt significantly increased the likelihood of requiring retransplant (HR 3.25; CI: 1.93–5.46; p < 0.001) but did not increase the likelihood of mortality. Propensity matched analysis further supported these finding with significantly higher graft loss with DCD grafts at one and two years and higher retransplant rates at all time points including 5-years (+7.9%, CI 4.4 to 11.4%; p < 0.001). Conclusions: DCD grafts in PSC patients are linked to worse graft survival and higher retransplant rates. They may be best suited for older, lower-MELD patients, but further studies on perfusion strategies are needed. Full article
(This article belongs to the Section Organ and Tissue Donation and Preservation)
17 pages, 965 KiB  
Article
Urinary Mitochondrial DNA Is Related to Allograft Function in Living Donor Kidney Transplantation—An Observational Study of the VAPOR-1 Cohort
by Lucas Gartzke, Julia Huisman, Nora Spraakman, Fernanda Lira Chavez, Michel Struys, Henri Leuvenink, Robert Henning and Gertrude Nieuwenhuijs-Moeke
Transplantology 2025, 6(3), 20; https://doi.org/10.3390/transplantology6030020 - 26 Jun 2025
Viewed by 313
Abstract
Background: Ischemia–reperfusion injury (IRI) is a key contributor to graft dysfunction in kidney transplantation. Cell-free mitochondrial DNA (mtDNA) is increasingly recognized as a damage-associated molecular pattern (DAMP) and biomarker in IRI, but its prognostic role in living donor kidney transplantation (LDKT) remains [...] Read more.
Background: Ischemia–reperfusion injury (IRI) is a key contributor to graft dysfunction in kidney transplantation. Cell-free mitochondrial DNA (mtDNA) is increasingly recognized as a damage-associated molecular pattern (DAMP) and biomarker in IRI, but its prognostic role in living donor kidney transplantation (LDKT) remains unclear. Methods: This post hoc analysis of the VAPOR-1 study evaluated urinary mtDNA (UmtDNA) in 57 LDKT recipients. MtDNA levels (ND1, ND6, and D-loop) were measured at five early timepoints post-transplantation using qPCR. Associations between early UmtDNA and long-term graft function, defined by estimated glomerular filtration rate (eGFR) at 1, 12, and 24 months, were analyzed. Results: Higher UmtDNA levels in the first urine after reperfusion were significantly associated with improved eGFR at 12 months and a positive change in eGFR between month 1 and 24. These associations were not attributable to urine creatinine levels or mitochondrial copy number. Conclusions: In this LDKT cohort, elevated early UmtDNA may reflect a well-functioning graft capable of clearing systemic mtDNA rather than ongoing tubular injury. These findings suggest that the biological interpretation of mtDNA as a biomarker is context-dependent and call for careful reconsideration of its role in early transplant monitoring. Full article
(This article belongs to the Section Organ and Tissue Donation and Preservation)
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