What’s new in transplantation in 2025?

The year 2025 confirms the transition of kidney transplantation toward a precision-­medicine paradigm, marked by major advances in pathophysiology, diagnostics, and therapeutics. The study by Sablik et al. redefined the spectrum of antibody-mediated rejection (ABMR) by highlighting the prognostic importance of microvascular inflammation, even in the absence of DSA or C4d deposition. Circulating biomarkers (donor-derived cell-free DNA [dd-cfDNA] and transcriptomic signatures) are now established as key tools for detecting and monitoring rejection, while anti-CD38 antibodies and intravenous immunoglobulins open new therapeutic perspectives in chronic active ABMR. Antiviral immunomonitoring and virus-specific cellular therapies represent a decisive step toward targeted restoration of antiviral immunity, and SGLT2 inhibitors are emerging as cornerstone agents for cardio-renal protection. Advances in quantitative imaging enable non-invasive assessment of graft fibrosis. Finally, xenotransplantation has entered a phase of experimental validation, with the first detailed immunologic characterizations in humans. Together, these developments confirm the convergence of molecular, immunologic, and technological approaches toward truly individualized management of kidney-transplant recipients.