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Biomedicines
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An Update on Transplantation Immunology
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An Update on Transplantation Immunology

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Immunology and Immunotherapy".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 3975

Special Issue Editor

Dr. Hui-Yun Cheng

E-Mail Website
Guest Editor
Center for Vascularized Composite Allotransplantation, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Interests: mesenchymal stem cell; vascularized composite allotransplantation; transplantation immunology; cell therapy

Special Issue Information

Dear Colleagues,

The field of transplantation has made significant progress in terms of immunology, leading to better outcomes in organ and tissue transplants. This Special Issue on “An Update on Transplantation Immunology” calls for submissions showcasing the latest advancements in the field. We invite original research and review articles that explore the roles of various immunological cells and molecules in determining the fate of the transplant, including its rejection and tolerance. We also welcome contributions focusing on innovative strategies such as cell and nucleic acid therapies for immunosuppression and immune modulation. Moreover, studies utilizing advanced technologies in precision medicine and bioinformatics to optimize transplant outcomes are highly encouraged. With this collection of studies, we hope to inspire cross-disciplinary collaboration among researchers, clinicians, and specialists, fostering growth in the field and enhancing the quality of life for transplant patients. We invite authors to share their insights and discoveries to help shape the future of transplantation immunology and improve patient care.

Dr. Hui-Yun Cheng
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • transplantation
  • immunology
  • immunosuppression
  • immunomodulation

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Published Papers (4 papers)

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Research

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12 pages, 968 KiB  
Article
Analysis of Tacrolimus Clearance in Patients with Kidney Transplants from Romania
by Corina Andreea Rotarescu, Ion Maruntelu, Ion Rotarescu, Alexandra-Elena Constantinescu and Ileana Constantinescu
Biomedicines 2025, 13(6), 1501; https://doi.org/10.3390/biomedicines13061501 - 18 Jun 2025
Viewed by 250
Abstract
Background/Objectives: Tacrolimus is a key immunosuppressant in kidney transplantation, but its high interindividual pharmacokinetic variability complicates dosing. This study aimed to develop a population pharmacokinetic model and identify the factors explaining variability to optimize tacrolimus therapy in Romanian kidney transplant recipients. Methods [...] Read more.
Background/Objectives: Tacrolimus is a key immunosuppressant in kidney transplantation, but its high interindividual pharmacokinetic variability complicates dosing. This study aimed to develop a population pharmacokinetic model and identify the factors explaining variability to optimize tacrolimus therapy in Romanian kidney transplant recipients. Methods: The study included 106 kidney transplant recipients treated at Fundeni Clinical Institute (2022–2024). Tacrolimus blood levels were measured using immunoassays, while gene polymorphisms of CYP3A4, CYP3A5, and ABCB1 were identified by real-time polymerase chain reaction. Results: Patients with CYP3A4*1/*1.001 impact clearance (RSE = 11.8%), while hematocrit was a significant covariate for intercompartmental clearance (RSE = 6.14%). Conclusions: Incorporating CYP3A4*1/*1.001 genotype and hematocrit into dosing strategies can improve therapeutic drug monitoring and personalize immunosuppressive therapy. Full article
(This article belongs to the Special Issue An Update on Transplantation Immunology)
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Review

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13 pages, 612 KiB  
Review
JAK2 Inhibitors and Emerging Therapies in Graft-Versus-Host Disease: Current Perspectives and Future Directions
by Behzad Amoozgar, Ayrton Bangolo, Abdifitah Mohamed, Charlene Mansour, Daniel Elias, Christina Cho and Siddhartha Reddy
Biomedicines 2025, 13(7), 1527; https://doi.org/10.3390/biomedicines13071527 - 23 Jun 2025
Viewed by 304
Abstract
Graft-versus-host disease (GVHD) remains a significant barrier to the success of allogeneic hematopoietic stem cell transplantation (allo-HSCT), contributing to long-term morbidity and non-relapse mortality in both pediatric and adult populations. Central to GVHD pathophysiology is the Janus kinase (JAK)-signal transducer and activator of [...] Read more.
Graft-versus-host disease (GVHD) remains a significant barrier to the success of allogeneic hematopoietic stem cell transplantation (allo-HSCT), contributing to long-term morbidity and non-relapse mortality in both pediatric and adult populations. Central to GVHD pathophysiology is the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway, where JAK2 mediates key pro-inflammatory cytokines, including IL-6, IFN-γ, and GM-CSF. These cytokines promote donor T cell activation, effector differentiation, and target organ damage. The introduction of ruxolitinib, a selective JAK1/2 inhibitor, has transformed the treatment landscape for steroid-refractory acute and chronic GVHD, leading to improved response rates and durable symptom control. However, its limitations—such as cytopenias, infectious complications, and incomplete responses—have catalyzed the development of next-generation agents. In 2024, the FDA approved axatilimab, a CSF-1R inhibitor that targets monocyte-derived macrophages in fibrotic chronic GVHD, and remestemcel-L, an allogeneic mesenchymal stromal cell therapy, for pediatric steroid-refractory acute GVHD. Both agents offer mechanistically distinct and clinically meaningful additions to the therapeutic armamentarium. In parallel, emerging combination strategies involving JAK2 inhibitors and novel biologics show promise in enhancing immune tolerance while preserving graft-versus-leukemia (GvL) effects. Recent advances in biomarker development, such as the MAGIC Algorithm Probability (MAP), are enabling early risk stratification and response prediction. The integration of these tools with organ-specific and personalized approaches marks a shift toward more precise, durable, and tolerable GVHD therapy. This review highlights the current state and future direction of JAK2 inhibition and complementary therapies in the evolving GVHD treatment paradigm. Full article
(This article belongs to the Special Issue An Update on Transplantation Immunology)
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19 pages, 880 KiB  
Review
Unraveling the Roles of Macrophages in Vascularized Composite Allotransplantation
by Hui-Yun Cheng, Madonna Rica Anggelia and Cheng-Hung Lin
Biomedicines 2025, 13(6), 1425; https://doi.org/10.3390/biomedicines13061425 - 10 Jun 2025
Viewed by 329
Abstract
The phenotypic heterogeneity and functional diversity of macrophages have been increasingly appreciated, particularly regarding their roles as innate immune cells in shaping transplantation outcomes. However, their functions in vascularized composite allotransplantation (VCA) remain underexplored. In this review, we first describe the development of [...] Read more.
The phenotypic heterogeneity and functional diversity of macrophages have been increasingly appreciated, particularly regarding their roles as innate immune cells in shaping transplantation outcomes. However, their functions in vascularized composite allotransplantation (VCA) remain underexplored. In this review, we first describe the development of macrophages and the heterogeneity of macrophage differentiation, then present current insights into macrophages’ involvement across key stages of VCA, including ischemia–reperfusion injury at the peri-transplantation stage, and the outcomes following transplantation, including acute rejection, chronic rejection, and development of transplantation tolerance. The existing evidence supports that macrophages significantly influence both short- and long-term VCA graft survival. The presence of vascularized bone marrow within some VCA grafts further suggests the involvement of donor bone marrow-derived macrophage population and adds another layer of complexity to immune dynamics. Collectively, current understanding highlights the macrophage as a promising target for therapeutic intervention and warrants continued investigation into their diverse functions and potential for improving VCA outcomes. Full article
(This article belongs to the Special Issue An Update on Transplantation Immunology)
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17 pages, 853 KiB  
Review
Heart Transplant Rejection: From the Endomyocardial Biopsy to Gene Expression Profiling
by Anca Otilia Farcas, Mihai Ciprian Stoica, Ioana Maria Maier, Adrian Cornel Maier and Anca Ileana Sin
Biomedicines 2024, 12(8), 1926; https://doi.org/10.3390/biomedicines12081926 - 22 Aug 2024
Cited by 2 | Viewed by 2190
Abstract
Heart transplant prolongs life for patients with end-stage heart failure but rejection remains a complication that reduces long-term survival. The aim is to provide a comprehensive overview of the current status in HT rejection. EMB is an invasive diagnostic tool, consisting in the [...] Read more.
Heart transplant prolongs life for patients with end-stage heart failure but rejection remains a complication that reduces long-term survival. The aim is to provide a comprehensive overview of the current status in HT rejection. EMB is an invasive diagnostic tool, consisting in the sampling of a fragment of myocardial tissue from the right ventricular septum using fluoroscopic guidance. This tissue can later be subjected to histopathological, immunohistochemical or molecular analysis, providing valuable information for cardiac allograft rejection, but this procedure is not without complications. To increase the accuracy of the rejection diagnosis, EMB requires a systematic evaluation of endocardium, myocardium, interstitium and intramural vessels. There are three types of rejection: hyperacute, acute or chronic, diagnosed by the histopathological evaluation of EMB as well as by new diagnostic methods such as DSA, ddcfDNA and gene expression profiling, the last having a high negative predictive value. More than 50 years after the introduction of EMB in medical practice, it still remains the “gold standard” in monitoring rejection in HT recipients but other new, less invasive diagnostic methods reduce the number of EMBs required. Full article
(This article belongs to the Special Issue An Update on Transplantation Immunology)
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