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Transplantology
Special Issues
New Horizons in Transplantation Research: A Review Series
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New Horizons in Transplantation Research: A Review Series

A special issue of Transplantology (ISSN 2673-3943).

Deadline for manuscript submissions: 15 March 2027 | Viewed by 7986

Editors

Prof. Dr. Maurizio Salvadori

E-Mail Website
Guest Editor
Department of Transplantation—Renal Unit, Careggi University Hospital, 50139 Florence, Italy
Interests: immunology; renal transplantation; epidemiology; coronavirus infection; organ transplantation
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Gaetano Ciancio

E-Mail Website
Guest Editor
Department of Urology, Division of Transplant Surgery, Miami Transplant Institute—Jackson Memorial Hospital, Miami, FL, USA
Interests: kidney and pancreas transplantation; living donor kidney transplantation; transplant immunology; xeno-transplantation; new surgical techniques in kidney transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Organ and cell transplantation have revolutionized the treatment of end-stage organ failure and various hematological disorders. As the field continues to evolve, significant advances in immunology, regenerative medicine, precision diagnostics, and immunosuppressive strategies are opening new frontiers and transforming clinical outcomes.

This Special Issue series, New Horizons in Transplantation Research: A Review Series, brings together leading experts to provide comprehensive and insightful overviews of the latest developments, persistent challenges, and emerging opportunities in transplantation science. From innovative approaches to graft tolerance and immune monitoring, to breakthroughs in xenotransplantation, organ preservation, and bioengineering, each review is designed to serve as a valuable resource for researchers, clinicians, and students alike.

By highlighting both the progress made and the pressing questions that remain, this series aims to inspire further innovation and interdisciplinary collaboration, ultimately advancing the future of transplantation medicine.

Prof. Dr. Maurizio Salvadori
Prof. Dr. Gaetano Ciancio
Guest Editors

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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Transplantology is an international peer-reviewed open access quarterly 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 1200 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

  • organ transplantation
  • cell transplantation
  • graft tolerance
  • immune monitoring
  • xenotransplantation
  • organ preservation
  • regenerative medicine
  • immunosuppressive strategies
  • bioengineering
  • precision diagnostics

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Review

21 pages, 1255 KB  
Review
A Review of Risk Assessment in the Evolving Heart Transplant Landscape
by Lyana Labrada, Mihir Shah, Pooja Saiganesh, Maha Inam and Eman Hamad
Transplantology 2026, 7(2), 14; https://doi.org/10.3390/transplantology7020014 - 4 Jun 2026
Viewed by 417
Abstract
Heart transplantation remains a vital therapy for patients with end-stage heart failure, yet organ scarcity and evolving allocation policies necessitate robust risk prediction models to optimize outcomes and equity. This narrative review explores the current landscape of risk assessment in heart transplantation, contextualized [...] Read more.
Heart transplantation remains a vital therapy for patients with end-stage heart failure, yet organ scarcity and evolving allocation policies necessitate robust risk prediction models to optimize outcomes and equity. This narrative review explores the current landscape of risk assessment in heart transplantation, contextualized within the broader framework of solid organ allocation and the emerging continuous distribution (CD) model. While kidney, liver, and lung transplantation have integrated validated risk scores into allocation systems, heart transplantation continues to rely on therapy-based criteria without a unified, benefit-based approach. We examine existing pre- and post-transplant predictive models and highlight their strengths and limitations. Additionally, we discuss the multidimensional factors influencing transplant success, ranging from donor and recipient characteristics to psychosocial and system-level variables. As CD expands across organ types, the development and integration of validated heart-specific risk scores will be essential to ensure equitable and effective organ allocation. Full article
(This article belongs to the Special Issue New Horizons in Transplantation Research: A Review Series)
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24 pages, 852 KB  
Review
Inflammatory and Immune Pathways in Kidney Transplant Rejection: Current Evidence and Future Perspectives
by Petar Todorović, Anita Racetin, Azer Rizikalo, Ivona Letica, Fila Raguž, Katarina Vukojević and Nela Kelam
Transplantology 2026, 7(2), 13; https://doi.org/10.3390/transplantology7020013 - 27 May 2026
Viewed by 467
Abstract
Kidney transplantation remains the optimal treatment for end-stage renal disease, yet long-term allograft survival has plateaued due to persistent rejection. This review provides a comprehensive overview of the inflammatory and immune pathways implicated in kidney allograft rejection, integrating current evidence from basic and [...] Read more.
Kidney transplantation remains the optimal treatment for end-stage renal disease, yet long-term allograft survival has plateaued due to persistent rejection. This review provides a comprehensive overview of the inflammatory and immune pathways implicated in kidney allograft rejection, integrating current evidence from basic and translational research. Ischemia–reperfusion injury initiates an inflammatory cascade through the release of damage-associated molecular patterns, activating Toll-like receptors and the complement system, thereby priming the alloimmune response. Innate immune cells, including macrophages, dendritic cells, and natural killer cells, bridge sterile tissue injury to adaptive alloimmunity, while the emerging concept of trained immunity reveals long-lasting epigenetic reprogramming of monocytes with direct implications for graft longevity. The adaptive response encompasses T cell-mediated rejection, driven by Th1, Th17, and CD8+ cytotoxic lymphocytes, and antibody-mediated rejection, mediated by donor-specific antibodies through complement activation and antibody-dependent cellular cytotoxicity. Key signalling pathways, including JAK-STAT, NF-κB, NLRP3 inflammasome, and mTOR, amplify allograft inflammation and promote progression toward chronic injury. Macrophage polarisation and macrophage-to-myofibroblast transition have been identified as major drivers of interstitial fibrosis and late graft failure. Recent advances in non-invasive biomarkers, such as donor-derived cell-free DNA and molecular phenotyping, are transforming rejection diagnostics. Emerging therapies, including costimulation blockade, anti-CD38 antibodies, complement inhibitors, and regulatory T cell-based approaches, offer the potential to shift transplant medicine toward precision-guided, tolerance-inducing strategies. This review synthesises these developments and discusses future perspectives for improving long-term allograft outcomes. Full article
(This article belongs to the Special Issue New Horizons in Transplantation Research: A Review Series)
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13 pages, 463 KB  
Review
Update on Kidney Tranplantation in Regard to ABO-Incompatible Blood Groups
by Maurizio Salvadori and Giuseppina Rosso
Transplantology 2026, 7(2), 12; https://doi.org/10.3390/transplantology7020012 - 25 May 2026
Viewed by 500
Abstract
Kidney transplantation is considered the best therapeutic option for patients affected by end-stage renal failure, but this possibility is limited by a shortage of donors. Living-donor kidney transplantation (LDKD) is a valuable option, frequently limited by immunological incompatibility between donor and recipient. This [...] Read more.
Kidney transplantation is considered the best therapeutic option for patients affected by end-stage renal failure, but this possibility is limited by a shortage of donors. Living-donor kidney transplantation (LDKD) is a valuable option, frequently limited by immunological incompatibility between donor and recipient. This review will consider the possibility of performing living-donor kidney donation in the case of AB0 blood group incompatibility and the progress that has been made in this field. Kidney-paired donation is one possibility. This technique is the best option if there are numerous available pairs. This approach is possible because of national and international registries. The more diffuse technique is the desensitization of the recipients. Desensitization may be achieved in several ways, which are extensively discussed in this review. Recently, some published studies documented the possibility of enzymatically converting the A or B groups from the cells of the donor to the O group. This approach is only in a nascent stage but may represent the future, eventually associated with mild desensitization. Full article
(This article belongs to the Special Issue New Horizons in Transplantation Research: A Review Series)
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18 pages, 297 KB  
Review
Dual, Split and Multi-Graft Liver Transplantation: Surgical Strategies to Maximize Liver Utilization
by Josip Basić, Ivan Romić, Juraj Kolak, Goran Pavlek and Hrvoje Silovski
Transplantology 2026, 7(1), 2; https://doi.org/10.3390/transplantology7010002 - 7 Jan 2026
Viewed by 1888
Abstract
Liver graft shortage remains a major limiting factor in contemporary liver transplantation, particularly in the setting of increasing waiting list pressure and constrained donor availability. While the biological quality of donor organs cannot be modified surgically, several operative strategies have been developed to [...] Read more.
Liver graft shortage remains a major limiting factor in contemporary liver transplantation, particularly in the setting of increasing waiting list pressure and constrained donor availability. While the biological quality of donor organs cannot be modified surgically, several operative strategies have been developed to optimize liver utilization and compensate for insufficient graft volume. These include split liver transplantation (SLT), dual-graft living donor liver transplantation (DGLT), auxiliary procedures, and selected multi-graft or hybrid configurations. This review provides an updated and structured overview of surgical concepts aimed at maximizing effective liver mass for transplantation. We discuss indications, technical considerations, and reported outcomes of split, dual, and combined graft approaches, with particular emphasis on graft-to-recipient weight ratio (GRWR), portal inflow modulation, and prevention of small-for-size syndrome. The role of machine perfusion technologies—including normothermic and hypothermic approaches—as enabling tools for graft assessment and safer utilization of partial grafts is also examined. Finally, we address ethical and logistical challenges associated with complex graft strategies and outline future directions in which advances in perfusion, graft assessment, and staged transplantation concepts may further refine patient selection and procedural safety. Collectively, these strategies represent complementary solutions for extending liver transplantation beyond conventional single-graft paradigms in highly selected settings. Full article
(This article belongs to the Special Issue New Horizons in Transplantation Research: A Review Series)
34 pages, 1585 KB  
Review
Liver Transplantation in the Era of Metabolic Dysfunction–Associated Fatty Liver Disease: Challenges, Ethical Dilemmas, and Future Directions
by Said A. Al-Busafi and Mohammed Eslam
Transplantology 2025, 6(4), 35; https://doi.org/10.3390/transplantology6040035 - 21 Nov 2025
Cited by 1 | Viewed by 3651
Abstract
Metabolic dysfunction–associated fatty liver disease (MAFLD) is now the leading indication for liver transplantation (LT), reshaping the landscape of transplant hepatology. Its close association with obesity, type 2 diabetes, cardiovascular disease, and extrahepatic malignancies poses unique challenges throughout the transplant continuum. This narrative [...] Read more.
Metabolic dysfunction–associated fatty liver disease (MAFLD) is now the leading indication for liver transplantation (LT), reshaping the landscape of transplant hepatology. Its close association with obesity, type 2 diabetes, cardiovascular disease, and extrahepatic malignancies poses unique challenges throughout the transplant continuum. This narrative review synthesizes current evidence across the pre-, peri-, and post-transplant spectrum, with a focus on practical implications for clinical management. We explore pre-transplant evaluation, focusing on how metabolic comorbidities, frailty, and organ allocation disparities intersect with emerging interventions such as GLP-1 receptor agonists, bariatric surgery, and structured weight loss programs. The increase in pediatric MAFLD, especially its early-onset aggressive form, indicates an evolving and concerning future burden on transplant programs. In the peri-operative and post-transplant periods, we address MAFLD recurrence, cardiometabolic complications, and the rising incidence of new cancers, particularly in relation to calcineurin inhibitor (CNI) exposure. Customized immunosuppression strategies, using mTOR inhibitors and mycophenolate mofetil, are discussed for their role in balancing graft protection with reducing cancer risk. We also review the application of machine perfusion technologies to optimize and expand the pool of steatotic donor livers. Future directions include the development of non-invasive diagnostic biomarkers, precision immunosuppression, and genomics-based risk stratification. Collectively, these insights emphasize the urgent need for multidisciplinary, patient-specific approaches and prospective, multicenter studies to optimize outcomes and equity in the era of MAFLD-driven liver transplantation. Full article
(This article belongs to the Special Issue New Horizons in Transplantation Research: A Review Series)
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