Raman spectroscopy and surface-enhanced Raman scattering (SERS) are analytical techniques for non-invasive assessment of kidney transplant health. By producing molecular fingerprints through inelastic light scattering, they’re able to detect biochemical changes associated with graft injury, immune activation, and other relevant pathophysiological changes. This review synthesizes current evidence of Raman-based techniques across three key domains in kidney transplantation: transplant monitoring, donor organ assessment, and evaluation of alloreactive immune activation. Recent studies demonstrate that SERS can be applied to biofluids and can accurately distinguish between transplant states. Additionally, Raman-based analyses of donor-derived samples show potential for predicting transplant outcomes and identifying viable organs despite high-risk features. It has also been shown to differentiate between activated and non-activated T lymphocytes. Raman spectroscopy and SERS represent powerful, non-invasive approaches that have the potential to reduce the reliance on invasive biopsy.
Over the past two decades, pancreas transplantation in the United States has experienced a marked and persistent decrease in activity at the national and programmatic levels. Recently, significant increases in donation after circulatory death cases and the use of perfusion technologies have culminated in a major threat to training the future pancreas transplant workforce. Although pancreas transplantation remains the only established surgical therapy providing long-term insulin independence for people managing insulin dependent diabetes, declining procedure numbers have undermined surgical and medical training opportunities in this technically complex field. The effect of less training is evident in both the recovery and transplant settings. This paper examines national trends in pancreas transplant activity, the workforce in place, and fellowship training exposure. Through this lens we explore the systemic drivers and implications for the future pancreas transplant workforce and future patient access to pancreas transplantation.
To evaluate and summarize the current landscape of peripheral blood monitoring and immunophenotyping of patients following heart and lung transplantation, highlighting recent advances in monitoring which may help to predict and improve clinical outcomes. Immunological contributions to primary graft dysfunction, acute allograft dysfunction, and chronic allograft dysfunction are reviewed. In heart transplantation, novel diagnostic approaches like donor-derived cell-free DNA (dd-cfDNA) and gene expression profiling (GEP) show promise as alternatives to invasive biopsies for detecting rejection. Following lung transplantation, various immune cell populations—including NK cells, T cells, B cells, and regulatory T cells—demonstrate distinct dynamics between peripheral blood and the allograft compartment. Key findings include associations between circulating immune cell phenotypes and chronic lung allograft dysfunction (CLAD), donor-specific antibodies correlating with graft survival, and telomere length serving as a potential biomarker. Immune cells in circulation do not always phenotypically reflect immune cells in the allograft. While some promising markers for allograft dysfunction exist, further studies are needed to correlate them with disease severity and/or progression.
Kidney machine perfusion has moved from a niche preservation tool to a central strategy for using higher-risk deceased donor kidneys. This narrative review examines how contemporary perfusion platforms are reshaping preservation, viability assessment and the emerging concept of organ rehabilitation in kidney transplantation. Continuous hypothermic machine perfusion now has the strongest clinical evidence and reduces delayed graft function in selected deceased-donor grafts. Oxygenated hypothermic perfusion and controlled oxygenated rewarming show increasingly supportive mechanistic and clinical signals, particularly in kidneys at greater ischaemic risk. Normothermic machine perfusion offers direct functional assessment and a platform for ex situ therapy, but the benefits of outcome remain less settled than early enthusiasm suggested. Across platforms, composite assessment models appear more defensible than single perfusion markers. Ex situ perfusion is no longer simply a method of storage. It is becoming a platform for preservation, assessment, rescue of declining kidneys and targeted biological intervention. The next phase of the field will depend on standardised trial design, validated composite viability tools and service models that improve both organ utilisation and post-transplant outcomes.
Lung transplantation is a definitive therapeutic option for selected patients with advanced pulmonary diseases. However, long-term outcomes remain suboptimal, largely driven by immunologically mediated complications, including acute rejection and chronic lung allograft dysfunction, as well as the cumulative toxicity of lifelong immunosuppression. This study was conducted as a systematic review and meta-analysis in accordance with PRISMA recommendations. A comprehensive search of PubMed, Embase, and the Cochrane Library was performed from inception. Randomized controlled trials evaluating maintenance immunosuppressive regimens in adult lung transplant recipients were included. When appropriate, treatment effects were pooled using random-effects models and are reported as risk ratios (RR) with 95
