Organ Transplantation: Current Status, Challenges, and Future Prospects

Organ transplantation has progressed from a life-saving surgical intervention to a multidisciplinary field integrating immunology, bioengineering, and data science. Despite major advances in donor management, perioperative care, and immunosuppression, long-term graft survival remains limited due to chronic rejection, infection, and organ scarcity. Recent breakthroughs in organ preservation, particularly in hypothermic and normothermic machine perfusion, have enabled real-time graft assessment, metabolic reconditioning, and localized therapeutic delivery. Emerging precision immunomodulation strategies, including regulatory T-cell therapy, gene-edited cellular platforms, tolerogenic dendritic cells, and biomarker-guided minimization, are reshaping alloimmune control toward durable tolerance. Innovations in xenotransplantation, multigene-edited donor animals, and tissue biofabrication offer potential solutions to structural organ shortages, although they are accompanied by regulatory and ethical challenges. Artificial intelligence further enhances donor-recipient matching, risk prediction, and personalized immunosuppressive management. This review synthesizes advances in preservation technologies, immune engineering, cellular tolerance induction, artificial intelligence-driven decision support, and xenotransplantation and provides a comprehensive overview of the evolving transplant landscape. By integrating mechanistic insights into translational progress, we outline future pathways for regenerative, immune-educational, and precision organ medicine.