AI-generated explanations in kidney transplantation: accuracy vs. readability and implications for patient education

Background: Effective patient education is critical for informed decision-making and adherence in kidney transplantation. Generative artificial intelligence (AI), particularly large language models (LLMs), has the potential to enhance patient education in kidney transplantation; however, its factual accuracy and readability remain incompletely characterized. Methods: We evaluated the performance of the GPT-5.1 (2025) model in generating plain-language explanations for 100 clinically relevant kidney transplantation terms. Explanations were generated using a standardized prompt (first round) and a revised prompt explicitly requesting an eighth-grade reading level or lower (second round). Accuracy was assessed by expert reviewers using a 5-point Likert scale, while readability was evaluated using the Flesch Reading Ease (higher score indicated easier readability of the text) and Flesch-Kincaid Grade Level (higher score indicated higher education level required to understand the text) score. The study was conducted in November 2025. Results: All AI-generated explanations demonstrated high accuracy, with no clinically significant errors. In the first round, the mean Flesch Reading Ease score was 23.6 ± 23.4, indicating very difficult readability, and 46% of explanations required a college-level reading ability (mean Flesch-Kincaid Grade Level 13.4 ± 4.8). Following prompt revision, readability improved substantially. The mean Flesch Reading Ease score increased to 62.4 ± 7.5, corresponding to standard readability, and all explanations were written at a middle school level or below (mean Flesch-Kincaid Grade Level 6.3 ± 1.1). Conclusion: GPT-5.1 generated highly accurate explanations of kidney transplantation terms across prompting strategies. Explicit readability-focused prompting substantially improved readability without compromising accuracy, underscoring the importance of prompt design when deploying LLMs for patient-centered education in transplantation.