World Transplant Congress 2025 Highlights: Immunosuppression

Kidney transplantation outcomes have advanced significantly with modern immunosuppression, yet indefinite graft survival and general-population-comparable patient outcomes remain elusive. At the World Transplant Congress 2025 in San Francisco, immunosuppression emerged as a central theme spanning from bench to bedside, including regulatory processes, innovative trial design, and patient-centered approaches. Key sessions addressed the slowing pace of new drug approvals since the 1990s "golden era" of transplantation and highlighted expedited regulatory pathways, patient advocacy, and the use of surrogate endpoints as accelerators of future drug development. Patient-reported outcomes emphasized the burden of immunosuppression side effects and the need to improve adherence through education, health literacy, and financial support. Optimization of tacrolimus use and refinements of adherence management underscored optimization of currently used immunosuppressive standard regimens, whereas steroid-sparing strategies and induction agent selection were revisited. Belatacept-based regimens demonstrated promise across diverse patient groups, with novel approaches of costimulation blockade (eg, CD154, CD28) advancing toward clinical translation. Biomarkers such as donor-derived cell-free DNA may enable personalized immunosuppression and safe drug minimization. Strategies for desensitization and rejection treatment, including CD38 targeting, show potential for highly sensitized patients or patients with antibody-mediated rejection. Finally, tolerance induction through chimerism, regulatory T cells, and engineered cellular therapies highlighted pathways toward immunosuppression withdrawal. Collectively, these innovations presented at the Congress signal a transition toward safer, more personalized, and durable transplant outcomes.