{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:14Z","timestamp":1788243374243,"version":"build-2803163510"},"reference-count":139,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Historically regarded as competitive modalities, pancreas and islet transplantation are increasingly recognized as complementary approaches to beta-cell replacement therapy. While whole-organ pancreas transplantation remains the established gold standard, islet transplantation has transitioned into an effective clinical alternative for selected cohorts of patients suffering from type 1 diabetes. This review provides a comprehensive evaluation of the clinical evolution characterizing these therapeutic modalities, tracing the shift from static cold storage (SCS) toward innovative dynamic preservation technologies, and exploring potential markers for predicting clinical outcomes. A focus on immunosuppression in islet transplantation is provided, emphasizing precise, tolerance-inducing strategies and investigating costimulation blockade, regulatory T-cell (Treg)-based therapies, and biomaterial-enabled local immunoprotection, with the aim of facilitating long-term graft survival while mitigating the metabolic and renal toxicities secondary to chronic calcineurin inhibitor exposure. Current evidence related to the transition from conventional SCS to advanced perfusion platforms, namely hypothermic machine perfusion (HMP), oxygenated hypothermic perfusion (HOPE), normothermic ex vivo perfusion (NEVP), and normothermic regional perfusion (NRP) is examined: the literature suggests that dynamic pancreas preservation platforms may improve metabolic recovery and some islet isolation outcomes; however, evidence that HOPE specifically reduces ischemia\u2013reperfusion injury and consistently increases islet yield in the pancreas remains limited. Although normothermic perfusion provides significant utility for real-time viability assessment and graft reconditioning, its widespread clinical implementation remains constrained by technical impediments, notably interstitial edema. Ultimately, preservation efficacy is conceptualized not merely as a discrete preservation option, but as a multidimensional construct integrating biological integrity, graft usability, and recipient clinical outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176774","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6774","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Evolution, Outcomes, and Emerging Preservation Technologies in Pancreas and Islet Transplantation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0730-4923","authenticated-orcid":false,"given":"Maria Irene","family":"Bellini","sequence":"first","affiliation":[{"name":"Department of Surgery, Sapienza Universit\u00e0 di Roma, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vassilios","family":"Papalois","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/MED.0b013e32807f2ac8","article-title":"Pancreas and islet cell transplantation in diabetes","volume":"14","author":"Pavlakis","year":"2007","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_2","first-page":"47","article-title":"Current status of clinical islet cell transplantation","volume":"333","author":"Lakey","year":"2006","journal-title":"Methods Mol. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1097\/SLA.0000000000006415","article-title":"Evolution of Pancreas Transplantation At A Single Institution-50+ Years and 2500 Transplants","volume":"280","author":"Finger","year":"2024","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1159\/000439412","article-title":"Beta-Cell Replacement: Pancreas and Islet Cell Transplantation","volume":"31","author":"Niclauss","year":"2016","journal-title":"Endocr. Dev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/ajt.13536","article-title":"A Comparative Analysis of the Safety, Efficacy, and Cost of Islet Versus Pancreas Transplantation in Nonuremic Patients With Type 1 Diabetes","volume":"16","author":"Moassesfar","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/MOT.0000000000000784","article-title":"Pancreas preservation: Clinical practice and future developments","volume":"25","author":"Branchereau","year":"2020","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_7","first-page":"361","article-title":"Organ retrieval and preservation","volume":"38","author":"Nicholson","year":"2020","journal-title":"Surgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/MOT.0b013e3282f63942","article-title":"Pancreas preservation for pancreas and islet transplantation","volume":"13","author":"Iwanaga","year":"2008","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1399-0012.2009.01151.x","article-title":"Preservation of the donor pancreas for whole pancreas and islet transplantation","volume":"24","author":"Ridgway","year":"2010","journal-title":"Clin. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/TP.0000000000004269","article-title":"Abdominal Organ Preservation Solutions in the Age of Machine Perfusion","volume":"107","author":"Ramos","year":"2023","journal-title":"Transplantation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100514","DOI":"10.1016\/j.trre.2019.100514","article-title":"Optimizing organs for transplantation; advancements in perfusion and preservation methods","volume":"34","author":"Soo","year":"2020","journal-title":"Transpl. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.cryobiol.2009.10.006","article-title":"Current state of hypothermic machine perfusion preservation of organs: The clinical perspective","volume":"60","author":"Taylor","year":"2010","journal-title":"Cryobiology"},{"key":"ref_13","unstructured":"(2026, July 15). Oxygenated Hypothermic Machine Perfusion in Pancreas Preservation for Transplantation\u2014NIHR Funding and Awards. Available online: https:\/\/www.fundingawards.nihr.ac.uk\/award\/NIHR204643."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.trre.2011.09.001","article-title":"Protective effects of hypothermic ex vivo perfusion on ischemia\/reperfusion injury and transplant outcomes","volume":"26","author":"Henry","year":"2012","journal-title":"Transpl. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1654","DOI":"10.1097\/TXD.0000000000001654","article-title":"Exploring Preservation Modalities in a Split Human Pancreas Model to Investigate the Effect on the Islet Isolation Outcomes","volume":"10","author":"Buemi","year":"2024","journal-title":"Transplant. Direct"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bellini, M.I., Yiu, J., Nozdrin, M., and Papalois, V. (2019). The Effect of Preservation Temperature on Liver, Kidney, and Pancreas Tissue ATP in Animal and Preclinical Human Models. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091421"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/MOT.0000000000001234","article-title":"Novel techniques of pancreas and islet preservation","volume":"30","author":"Matar","year":"2025","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1586\/1744666X.2015.978291","article-title":"Islet transplantation for Type 1 diabetes: Where are we now?","volume":"11","author":"Ahearn","year":"2014","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_19","first-page":"195","article-title":"Transplantation: Pancreatic and Islet Cells","volume":"1","author":"Gamble","year":"2026","journal-title":"Encycl. Endocr. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/ags3.12214","article-title":"Current state and future evolution of pancreatic islet transplantation","volume":"3","author":"Anazawa","year":"2019","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.domaniend.2013.01.006","article-title":"Evaluation of a high-yield technique for pancreatic islet isolation from deceased canine donors","volume":"47","author":"Vrabelova","year":"2014","journal-title":"Domest. Anim. Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1053\/j.sempedsurg.2014.03.006","article-title":"Islet cell transplantation","volume":"23","author":"McCall","year":"2014","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"413","DOI":"10.2337\/diab.37.4.413","article-title":"Automated method for isolation of human pancreatic islets","volume":"37","author":"Ricordi","year":"1988","journal-title":"Diabetes"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Maillard, E., and Sigrist, S. (2020). From insulin replacement to bioengineered, encapsulated organoids. Biomater. Organ. Tissue Regen., 299\u2013333.","DOI":"10.1016\/B978-0-08-102906-0.00015-5"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/tri.12919","article-title":"Intraportal islet transplantation: The impact of the liver microenvironment","volume":"30","author":"Delaune","year":"2017","journal-title":"Transpl. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1056\/NEJM200007273430401","article-title":"Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen","volume":"343","author":"Shapiro","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.2337\/diabetes.51.7.2148","article-title":"Successful islet transplantation: Continued insulin reserve provides long-term glycemic control","volume":"51","author":"Ryan","year":"2002","journal-title":"Diabetes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/S2213-8587(24)00341-3","article-title":"Long-term outcomes of pancreatic islet transplantation alone in type 1 diabetes: A 20-year single-centre study in Italy","volume":"13","author":"Catarinella","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Duan, K., Liu, J., Zhang, J., Chu, T., Liu, H., Lou, F., Liu, Z., Gao, B., Wei, S., and Wei, F. (2023). Advancements in innate immune regulation strategies in islet transplan tation. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1341314"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.3727\/096368913X670949","article-title":"Current status of islet encapsulation","volume":"23","author":"Robles","year":"2014","journal-title":"Cell Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1038\/nrd.2017.67","article-title":"Advances in islet encapsulation technologies","volume":"16","author":"Desai","year":"2017","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1038\/s41563-018-0099-0","article-title":"Local immunomodulation Fas ligand-engineered biomaterials achieves allogeneic islet graft acceptance","volume":"17","author":"Headen","year":"2018","journal-title":"Nat. Mater."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1038\/s41578-019-0112-5","article-title":"Engineering immunomodulatory biomaterials for type 1 diabetes","volume":"4","author":"Stabler","year":"2019","journal-title":"Nat. Rev. Mater."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"eadg5794","DOI":"10.1126\/scitranslmed.adg5794","article-title":"Human hypoimmune primary pancreatic islets avoid rejection and autoimmunity and alleviate diabetes in allogeneic humanized mice","volume":"15","author":"Hu","year":"2023","journal-title":"Sci. Transl. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"100879","DOI":"10.1016\/j.xcrm.2022.100879","article-title":"Engineering human stem cell-derived islets to evade immune rejection and promote localized immune tolerance","volume":"4","author":"Gerace","year":"2023","journal-title":"Cell Rep. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Eisenson, D.L., Iwase, H., Chen, W., Hisadome, Y., Cui, W., Santillan, M.R., Schulick, A.C., Gu, D., Maxwell, A., and Koenig, K. (2024). Combined islet and kidney xenotransplantation for diabetic nephropathy: An update in ongoing research for a clinically relevant application of porcine islet transplantation. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1351717"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e70016","DOI":"10.1002\/wnan.70016","article-title":"Islet Transplantation: Microencapsulation, Nanoencapsulation, and Hypoimmune Engineering","volume":"17","author":"Lee","year":"2025","journal-title":"Wiley Interdiscip. Rev. Nanomed. Nanobiotechnol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ho, B.X., Teo, A.K.K., and Ng, N.H.J. (2024). Innovations in bio-engineering and cell-based approaches to address immunological challenges in islet transplantation. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1375177"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Yue, L., Li, J., Yao, M., Song, S., Zhang, X., and Wang, Y. (2024). Cutting edge of immune response and immunosuppressants in allogeneic and xenogeneic islet transplantation. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1455691"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"16845","DOI":"10.3389\/ti.2026.16845","article-title":"Hypoimmune platforms: From rejection to immune evasion and regulatory implications","volume":"39","author":"Campo","year":"2026","journal-title":"Transpl. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/MOT.0000000000000670","article-title":"Current state of organ transplant tolerance","volume":"24","author":"Rickert","year":"2019","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2816","DOI":"10.1111\/tri.14163","article-title":"Autologous regulatory T cells in clinical intraportal allogenic pancre atic islet transplantation","volume":"34","author":"Yao","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/TP.0000000000001559","article-title":"Effect of Ex Vivo-Expanded Recipient Regulatory T Cells on Hematopoietic Chimerism and Kidney Allograft Tolerance Across MHC Barriers in Cynomolgus Macaques","volume":"101","author":"Sondermeijer","year":"2017","journal-title":"Transplantation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.biomaterials.2015.07.009","article-title":"Engineering an \u201cinfectious\u201d T(reg) biomimetic through chemoselective tethering of TGF-\u03b21 to PEG brush surfaces","volume":"67","author":"Yang","year":"2015","journal-title":"Biomaterials"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.actbio.2023.06.038","article-title":"Enhancing longevity of immunoisolated pancreatic islet grafts by modifying both the intracapsular and extracapsular environment","volume":"167","author":"Qin","year":"2023","journal-title":"Acta Biomater."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1016\/j.ajt.2023.07.023","article-title":"Delayed graft rejection in autoimmune islet transplantation via biomaterial immunotherapy","volume":"23","author":"Coronel","year":"2023","journal-title":"Am. J. Transplant."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Burrack, A.L., Martinov, T., and Fife, B.T. (2017). T Cell-Mediated Beta Cell Destruction: Autoimmunity and Alloimmunity in the Context of Type 1 Diabetes. Front. Endocrinol., 8.","DOI":"10.3389\/fendo.2017.00343"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/01.mot.0000186082.47623.76","article-title":"Enhanced immunosuppression induced by targeted mutation of cytotoxic T lymphocyte antigen 4-immunoglobulin","volume":"10","author":"Kokko","year":"2005","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/MOT.0000000000000656","article-title":"The past, present, and future of costimulation blockade in organ trans plantation","volume":"24","author":"Schroder","year":"2019","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/1744666X.2018.1485489","article-title":"Belatacept\/CTLA4Ig: An update and critical appraisal of preclinical an d clinical results","volume":"14","author":"Schwarz","year":"2018","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1111\/j.1600-6143.2005.00749.x","article-title":"Rational development of LEA29Y (belatacept), a high-affinity variant o f CTLA4-Ig with potent immunosuppressive properties","volume":"5","author":"Larsen","year":"2005","journal-title":"Am. J. Transplant."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"100913","DOI":"10.1016\/j.trre.2025.100913","article-title":"Transition from preclinical to clinical application of CTLA4-Ig co-sti mulation blockage in beta-cell replacement therapy","volume":"39","author":"Perrier","year":"2025","journal-title":"Transplant. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"120232","DOI":"10.1016\/j.biomaterials.2020.120232","article-title":"Neovascularized implantable cell homing encapsulation platform with tu nable local immunosuppressant delivery for allogeneic cell transplanta tion","volume":"257","author":"Capuani","year":"2020","journal-title":"Biomaterials"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.phrs.2014.06.016","article-title":"Novel immunological strategies for islet transplantation","volume":"98","author":"Tezza","year":"2015","journal-title":"Pharmacol. Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s11892-013-0414-8","article-title":"Biologic agents in islet transplantation","volume":"13","author":"Pepper","year":"2013","journal-title":"Curr. Diabetes Rep."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1056\/NEJMoa061267","article-title":"International trial of the Edmonton protocol for islet transplantation","volume":"355","author":"Shapiro","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00125-020-05184-7","article-title":"Transplant strategies for type 1 diabetes: Whole pancreas, islet and p orcine beta cell therapies","volume":"63","author":"Bellin","year":"2020","journal-title":"Diabetologia"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1097\/TP.0b013e31819025e5","article-title":"Islet transplantation with alemtuzumab induction and calcineurin-free maintenance immunosuppression results in improved short- and long-term outcomes","volume":"86","author":"Froud","year":"2008","journal-title":"Transplantation"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1097\/TP.0000000000001276","article-title":"IL-7 mediated homeostatic expansion of human CD4+CD25+FOXP3+ regulator y T cells after depletion with anti-CD25 monoclonal antibody","volume":"100","author":"Vignali","year":"2016","journal-title":"Transplantation"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e12640","DOI":"10.1111\/xen.12640","article-title":"Immunosuppressive and metabolic agents that influence allo- and xenogr aft survival by in vivo expansion of T regulatory cells","volume":"27","author":"Zhao","year":"2020","journal-title":"Xenotransplantation"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Singer, B.D., King, L.S., and D\u2019Alessio, F.R. (2014). Regulatory T cells as immunotherapy. Front. Immunol., 5.","DOI":"10.3389\/fimmu.2014.00046"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1089\/ten.tea.2012.0643","article-title":"PLG scaffold delivered antigen-specific regulatory t cells induce syst emic tolerance in autoimmune diabetes","volume":"19","author":"Graham","year":"2013","journal-title":"Tissue Eng.-Part A"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1097\/MOT.0000000000000130","article-title":"Islet cell transplant and the incorporation of Tregs","volume":"19","author":"Krzystyniak","year":"2014","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1002\/eji.201747316","article-title":"Tr1 cell immunotherapy promotes transplant tolerance via de novo Tr1 c ell induction in mice and is safe and effective during acute viral inf ection","volume":"48","author":"Jofra","year":"2018","journal-title":"Eur. J. Immunol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Petrosyan, A., Montali, F., Peloso, A., Citro, A., Byers, L.N., La Pointe, C., Suleiman, M., Marchetti, A., McNeill, E.P., and Speer, A.L. (2022). Regenerative medicine technologies applied to transplant medicine. An update. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.1015628"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.addr.2017.05.012","article-title":"Bio-synthetic materials for immunomodulation of islet transplants","volume":"114","author":"Foster","year":"2017","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.mehy.2015.04.005","article-title":"Engineering \u03b2-cell islets or islet-like structures for type 1 diabetes treatment","volume":"85","author":"Liu","year":"2015","journal-title":"Med. Hypotheses"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1111\/ajt.15168","article-title":"Synthetic poly(ethylene glycol)-based microfluidic islet encapsulation reduces graft volume for delivery to highly vascularized and retrieva ble transplant site","volume":"19","author":"Weaver","year":"2019","journal-title":"Am. J. Transplant."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"115205","DOI":"10.1016\/j.addr.2024.115205","article-title":"Encapsulation and immune protection for type 1 diabetes cell therapy","volume":"207","author":"Kioulaphides","year":"2024","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jdiacomp.2015.03.017","article-title":"Current status of encapsulated islet transplantation","volume":"29","author":"Yang","year":"2015","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1089\/ten.teb.2017.0311","article-title":"Selection of Implantation Sites for Transplantation of Encapsulated Pa ncreatic Islets","volume":"24","author":"Zhu","year":"2018","journal-title":"Tissue Eng.-Part B Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"115179","DOI":"10.1016\/j.addr.2024.115179","article-title":"Immunoprotection of cellular transplants for autoimmune type 1 diabete s through local drug delivery","volume":"206","author":"Lansberry","year":"2024","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"121804","DOI":"10.1016\/j.biomaterials.2022.121804","article-title":"Prolongation of graft survival via layer-by-layer assembly of collagen and immunosuppressive particles on pancreatic islets","volume":"290","author":"Tran","year":"2022","journal-title":"Biomaterials"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.biomaterials.2015.11.065","article-title":"Transforming growth factor-beta 1 delivery from microporous scaffolds decreases inflammation post-implant and enhances function of transplan ted islets","volume":"80","author":"Liu","year":"2016","journal-title":"Biomaterials"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e20914","DOI":"10.1002\/advs.202520914","article-title":"Profiling Localized Immunomodulation and Drug Biodistribution within a Subcutaneous Vascularized Niche for Cell Transplantation","volume":"13","author":"Capuani","year":"2026","journal-title":"Adv. Sci."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"7951","DOI":"10.1038\/s41467-022-35629-z","article-title":"Implantable niche with local immunosuppression for islet allotransplan tation achieves type 1 diabetes reversal in rats","volume":"13","author":"Capuani","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.cej.2025.168418","article-title":"Hypothermia-induced on-demand drug delivery at a subcutaneous islet tr ansplantation site","volume":"523","author":"Waduthanthri","year":"2025","journal-title":"Chem. Eng. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/tri.12603","article-title":"Immunosuppressive minimization with mTOR inhibitors and belatacept","volume":"28","author":"Diekmann","year":"2015","journal-title":"Transpl. Int."},{"key":"ref_79","unstructured":"Posselt, A.M., Szot, G.L., Frassetto, L.A., Masharani, U.B., and Stock, P.G. (2010). Clinical islet transplantation at the University of California, San Fr ancisco. Clin. Transpl., 235\u2013243."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"S362","DOI":"10.1016\/j.transproceed.2003.12.035","article-title":"Immunosuppression for pancreatic islet transplantation","volume":"36","author":"Berney","year":"2004","journal-title":"Transplant. Proc."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Tahbaz, M., and Yoshihara, E. (2021). Immune Protection of Stem Cell-Derived Islet Cell Therapy for Treating Diabetes. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.716625"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1432-2277.2008.00761.x","article-title":"Minimization and withdrawal of steroids in pancreas and islet transpla ntation","volume":"22","author":"Mineo","year":"2009","journal-title":"Transpl. Int."},{"key":"ref_83","unstructured":"(2026, August 27). Organ Procurement & Transplantation Network (OPTN), Available online: https:\/\/www.hrsa.gov\/optn."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1111\/tri.13876","article-title":"Pancreas utilization rates in the UK\u2014An 11-year analysis","volume":"34","author":"Cornateanu","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Kervella, D., Mesnard, B., Prud\u2019homme, T., Blancho, G.J., and Branchereau, J. (2023). Sterile Pancreas Inflammation during Preservation and after Transplant ation. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054636"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Bellini, M.I., Tortorici, F., Amabile, M.I., and D\u2019Andrea, V. (2021). Assessing Kidney Graft Viability and Its Cells Metabolism during Machine Perfusion. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22031121"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1111\/ajt.16401","article-title":"Preservation of pancreas in the University of Wisconsin solution suppl emented with AP39 reduces reactive oxygen species production and impro ves islet graft function","volume":"21","author":"Nishime","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/cbin.12114","article-title":"Lipid droplets, autophagy, and ER stress as key (survival) pathways du ring ischemia-reperfusion of transplanted grafts","volume":"48","author":"Skrzycki","year":"2024","journal-title":"Cell Biol. Int."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/MOT.0000000000001224","article-title":"New methods for improving pancreas preservation","volume":"30","author":"Elzawahry","year":"2025","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e1743","DOI":"10.1097\/TXD.0000000000001743","article-title":"Impact of Hypothermic Perfusion on Immune Responses and Sterile Inflammation in a Preclinical Model of Pancreatic Transplantation","volume":"11","author":"Mesnard","year":"2025","journal-title":"Transplant. Direct"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"7435248","DOI":"10.1155\/2019\/7435248","article-title":"Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidney Transplantation: A Single Centre Experience","volume":"2019","author":"Bellini","year":"2019","journal-title":"BioMed Res. Int."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Bellini, M.I., Nozdrin, M., Yiu, J., and Papalois, V. (2019). Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts. J. Clin. Med., 8.","DOI":"10.3390\/jcm8081221"},{"key":"ref_93","first-page":"55","article-title":"An ex-vivo model for hypothermic pulsatile perfusion of porcine pancreata: Hemodynamic and morphologic characteristics","volume":"8","author":"Karcz","year":"2010","journal-title":"Exp. Clin. Transplant."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"613","DOI":"10.3727\/096368910X486316","article-title":"Islet isolation from juvenile porcine pancreas after 24-h hypothermic machine perfusion preservation","volume":"19","author":"Taylor","year":"2010","journal-title":"Cell Transplant."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.cryobiol.2012.01.007","article-title":"Persufflation (or gaseous oxygen perfusion) as a method of organ prese rvation","volume":"64","author":"Suszynski","year":"2012","journal-title":"Cryobiology"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/tri.12313","article-title":"Portal Venous Oxygen Persufflation of the Donation after Cardiac Death pancreas in a rat model is superior to static cold storage and hypoth ermic machine perfusion","volume":"27","author":"Reddy","year":"2014","journal-title":"Transpl. Int."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1097\/MPA.0000000000000196","article-title":"Pancreatic ductal perfusion at organ procurement enhances islet yield in human islet isolation","volume":"43","author":"Takita","year":"2014","journal-title":"Pancreas"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1111\/ajt.13303","article-title":"Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discar ded Human Donor Pancreases","volume":"15","author":"Barlow","year":"2015","journal-title":"Am. J. Transplant."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jss.2017.11.052","article-title":"Development of pancreatic machine perfusion: Translational steps from porcine to human models","volume":"223","author":"Hamaoui","year":"2018","journal-title":"J. Surg. Res."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e388","DOI":"10.1097\/TXD.0000000000000829","article-title":"Hypothermic oxygenated machine perfusion of the human donor pancreas","volume":"4","author":"Leemkuil","year":"2018","journal-title":"Transplant. Direct"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.cryobiol.2018.10.002","article-title":"Hypothermic pulsatile perfusion of human pancreas: Preliminary technic al feasibility study based on histology","volume":"85","author":"Branchereau","year":"2018","journal-title":"Cryobiology"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ijsu.2018.04.057","article-title":"Ex vivo normothermic porcine pancreas: A physiological model for prese rvation and transplant study","volume":"54","author":"Kumar","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/tri.13797","article-title":"Successful pancreas allotransplantations after hypothermic machine per fusion in a novel diabetic porcine model: A controlled study","volume":"34","author":"Kervella","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1111\/tri.13927","article-title":"Hypothermic oxygenated machine perfusion of the human pancreas for cli nical islet isolation: A prospective feasibility study","volume":"34","author":"Doppenberg","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1093\/bjs\/znab212","article-title":"Outcomes for circulatory death and brainstem death pancreas transplant ation with or without use of normothermic regional perfusion","volume":"108","author":"Richards","year":"2021","journal-title":"Br. J. Surg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1111\/tri.13990","article-title":"Development of ex situ normothermic reperfusion as an innovative method to assess pancreases after preservation","volume":"34","author":"Ogbemudia","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"10419","DOI":"10.3389\/ti.2022.10419","article-title":"Current Trends in Organ Preservation Solutions for Pancreas Transplantation: A Single-Center Retrospective Study","volume":"35","author":"Lozano","year":"2022","journal-title":"Transpl. Int."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1111\/ajt.17019","article-title":"Normothermic ex situ pancreas perfusion for the preservation of porcin e pancreas grafts","volume":"22","author":"Mazilescu","year":"2022","journal-title":"Am. J. Transplant."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Parmentier, C., Ray, S., Mazilescu, L.I., Selzner, M., and Reichman, T.W. (2022). Normothermic Ex Vivo Pancreas Perfusion for the Preservation of Pancre as Allografts before Transplantation. J. Vis. Exp., e63905.","DOI":"10.3791\/63905-v"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Parmentier, C., Ray, S., Mazilescu, L.I., Kawamura, M., Noguchi, Y., Nogueira, E., Ganesh, S., Arulratnam, B., Kalimuthu, S.N., and Selzner, M. (2023). Normothermic Ex Vivo Machine Perfusion of Discarded Human Pancreas Allografts: A Feasibility Study. Transpl. Int., 36.","DOI":"10.3389\/ti.2023.10936"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Ferrer-F\u00e0brega, J., Mesnard, B., Messner, F., Doppenberg, J.B., Drachenberg, C., Engelse, M.A., Johnson, P.R.V., Leuvenink, H.G.D., Oniscu, G.C., and Papalois, V. (2023). European Society for Organ Transplantation (ESOT) Consensus Statement on the Role of Pancreas Machine Perfusion to Increase the Donor Pool for Beta Cell Replacement Therapy. Transpl. Int., 36.","DOI":"10.3389\/ti.2023.11374"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"e1834","DOI":"10.1097\/TXD.0000000000001834","article-title":"Is 2 h of Hypothermic Machine Perfusion for Pancreas Preservation Effective in Improving Graft Reperfusion?","volume":"11","author":"Mesnard","year":"2025","journal-title":"Transpl. Direct"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e1888","DOI":"10.1097\/TXD.0000000000001888","article-title":"Comparison of \u201cContinuous\u201d and \u201cEnd-ischemic\u201d Approaches of Oxygenated Hypothermic Machine Perfusion for Pancreas Preservation","volume":"12","author":"Elzawahry","year":"2026","journal-title":"Transplant. Direct"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11892-019-1165-y","article-title":"Machine Perfusion and the Pancreas: Will It Increase the Donor Pool?","volume":"19","author":"Hamaoui","year":"2019","journal-title":"Curr. Diabetes Rep."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/TP.0000000000005111","article-title":"Pancreas Preservation: Hypothermic Oxygenated Perfusion to Improve Graft Reperfusion","volume":"109","author":"Mesnard","year":"2025","journal-title":"Transplantation"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1111\/tri.13951","article-title":"Consensus statement on normothermic regional perfusion in donation after circulatory death: Report from the European Society for Organ Transplantation\u2019s Transplant Learning Journey","volume":"34","author":"Jochmans","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1111\/tri.14121","article-title":"A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation","volume":"34","author":"Vandendriessche","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.ajt.2024.11.025","article-title":"The concept of immunothrombosis in pancreas transplantation","volume":"25","author":"Masset","year":"2025","journal-title":"Am. J. Transplant."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Tsuji, Y., Yamada, K., Kisimoto, M., Isoda, H., and Chiba, T. (2014). Pancreatic Blood Flow Measurements in the Pig Pancreatitis Model Using Perfusion CT with Deconvolution Method, Springer.","DOI":"10.1007\/978-3-319-13692-9_9"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000343806","article-title":"Microdialysis in early detection of temporary pancreatic ischemia in a porcine model","volume":"49","author":"Blind","year":"2012","journal-title":"Eur. Surg. Res."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/B978-0-12-824011-3.00001-1","article-title":"Pancreas resuscitation for whole pancreas transplantation","volume":"1","author":"Friend","year":"2022","journal-title":"Pancreas Beta Cell Replace."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/j.1600-6143.2004.00663.x","article-title":"In vivo imaging of human pancreatic microcirculation and pancreatic ti ssue injury in clinical pancreas transplantation","volume":"5","author":"Schaser","year":"2005","journal-title":"Am. J. Transplant."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.trre.2018.02.001","article-title":"Preserving and perfusing the allograft pancreas: Past, present, and fu ture","volume":"32","author":"Dholakia","year":"2018","journal-title":"Transplant. Rev."},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Prud\u2019homme, T., Mulvey, J.F., Young, L.A.J., Hunter, J.P., and Branchereau, J. (2021). Ischemia-reperfusion injuries assessment during pancreas preservation. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22105172"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/00006676-200303000-00009","article-title":"Noninvasive in vivo assessment of the pancreatic microcirculation: Ort hogonal polarization spectral imaging","volume":"26","author":"Biberthaler","year":"2003","journal-title":"Pancreas"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.hpb.2025.12.036","article-title":"Objective assessment of remnant pancreatic perfusion using intraoperat ive indocyanine green angiography: A novel technique to predict postop erative pancreatic fistula","volume":"28","author":"Tufekci","year":"2026","journal-title":"HPB"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1097\/MPA.0000000000001627","article-title":"Multimodal Device and Computer Algorithm-Based Monitoring of Pancreati c Microcirculation Profiles in Vivo","volume":"49","author":"Li","year":"2020","journal-title":"Pancreas"},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Seryogina, E.S., Mezentsev, M.A., Piavchenko, G.A., Mamoshin, A.V., and Dunaev, A.V. (2019). Laser Speckle Contrast Imaging of Abdominal Organs in Mouse Model, SPIE.","DOI":"10.1117\/12.2523185"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jss.2016.03.004","article-title":"N-acetylcysteine amid reduces pancreatic damage in a rat model of acut e necrotizing pancreatitis","volume":"203","author":"Usta","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.transci.2010.05.012","article-title":"Techniques to assess tissue oxygenation in the clinical setting","volume":"43","author":"Sakr","year":"2010","journal-title":"Transfus. Apher. Sci."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1159\/000078856","article-title":"Exogenous and endogenous nitric oxide donors improve post-ischemic tis sue oxygenation in early pancreatic ischemia\/reperfusion injury in the rat","volume":"36","author":"Obermaier","year":"2004","journal-title":"Eur. Surg. Res."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.bja.2026.01.047","article-title":"Physiology, monitoring, and optimisation of perioperative tissue oxyge nation: A narrative review","volume":"136","author":"Meier","year":"2026","journal-title":"Br. J. Anaesth."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1097\/TP.0b013e318285558f","article-title":"Current state of pancreas preservation and implications for DCD pancreas transplantation","volume":"95","author":"Barlow","year":"2013","journal-title":"Transplantation"},{"key":"ref_134","first-page":"427","article-title":"Applications of Quantitative Perfusion and Permeability in the Body","volume":"1","author":"Chen","year":"2020","journal-title":"Adv. Magn. Reson. Technol. Appl."},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"Resch, T., Cardini, B., Oberhuber, R., Weissenbacher, A., Dumfarth, J., Krapf, C., Boesmueller, C., Oefner, D., Grimm, M., and Schneeberger, S. (2020). Transplanting Marginal Organs in the Era of Modern Machine Perfusion a nd Advanced Organ Monitoring. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.00631"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.hpb.2023.05.007","article-title":"Postoperative pancreatitis and pancreatic fistulae: A review of curren t evidence","volume":"25","author":"Chui","year":"2023","journal-title":"HPB"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.trre.2015.06.002","article-title":"Extracorporeal machine perfusion of the pancreas: Technical aspects and its clinical implications--a systematic review of experimental models","volume":"30","author":"Kuan","year":"2016","journal-title":"Transpl. Rev."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/aor.12770","article-title":"A Study of Normothermic Hemoperfusion of the Porcine Pancreas and Kidney","volume":"41","author":"Kuan","year":"2017","journal-title":"Artif. Organs"},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Ferrer-F\u00e0brega, J., Folch-Puy, E., Llaves-L\u00f3pez, A., Garc\u00eda-P\u00e9rez, R., and Fuster, J. (2022). Breaking the limits of experimental pancreas transplantation: Working toward the clinical ideal graft. Front. Transplant., 1.","DOI":"10.3389\/frtra.2022.1035480"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6774\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:59:27Z","timestamp":1788242367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":139,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176774"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176774","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}