Nanomedicine in Organ Transplantation: From Graft Preservation and Repair to Immunomodulation and Monitoring.

Organ transplantation remains a life-saving intervention for end-stage organ failure. However, its long-term success has been constrained by a few critical challenges, including few noninvasive diagnostic technologies for graft assessment, a lack of effective organ preservation and rewarming techniques to mitigate ischemic damage, the issue of ischemia-reperfusion injury (IRI), the risk of immune-mediated rejection and the requirement of advanced postoperative management. Nanomedicine has been explored for overcoming these challenges for organ transplantation. A myriad of polymeric, inorganic and hybrid nanocarriers have been employed for nanomedicine. Targeting and stimuli-responsive nanomedicine has been developed to improve drug distribution and enhance its therapeutic/diagnostic efficacy. Nanomedicine has been applied for rewarming of large-sized organs, IRI mitigation, immunomodulation, and real-time monitoring. This review examines the mechanisms, elaborates design principles, and covers the application of nanomedicine in organ transplantation at stages of pre- to post-transplantation. The challenges in clinical translation of nanomedicine are discussed and future research directions are proposed. This review will provide a consolidated framework for the development and application of nanomedicine for organ transplantation, ultimately improving the quality of life of transplant recipients.