Curcumin in solid organ transplantation: current evidence, mechanisms, and translational challenges

Solid organ transplantation faces complex pathophysiological challenges, including ischemia-reperfusion injury (IRI), alloimmune rejection, and chronic graft dysfunction. These interconnected processes involve multiple signaling pathways, yet these complex interconnected pathological processes remain a significant clinical challenge. In contrast, natural plant-derived compounds often possess pleiotropic pharmacological activities and may offer a multi-targeted approach to modulate the overall pathological milieu. Curcumin, a representative bioactive natural polyphenol from Curcuma longa, exhibits potent antioxidant, anti-inflammatory, and immunomodulatory properties and has shown therapeutic benefits across a wide range of diseases. In the context of transplantation, preliminary studies have demonstrated encouraging effects in improving graft preservation, attenuating injury, and modulating immune response. However, direct investigation of curcumin in solid organ transplantation remains limited, with fragmented evidence and a weak foundational basis. This review aims to systematically synthesize the current evidence for curcumin's application in kidney, liver, heart, and lung transplantation, to assess the translational hurdles, and to propose a strategic roadmap for future research. We also propose a mechanistic framework for curcumin's potential actions based on established studies in related fields, including IRI, inflammatory diseases, and immunology, intended to generate testable hypotheses for future transplant-focused research. By identifying key knowledge gaps and highlighting promising mechanistic pathways, we hope to stimulate further investigation and accelerate the clinical translation of this pleiotropic natural compound into transplant medicine.