Strategies for Operationalizing Xenotransplantation

Abstract Purpose of Review Xenotransplantation represents the most readily available solution to the shortage of donor organs for transplantation. This review seeks to address progress made in xenotransplantation thus far, and forecast barriers and opportunities for eventual clinical translation. Recent Findings Over the past several years, significant progress has been made to advance xenotransplantation to the clinic. Increasingly complex genetic manipulation of the donor source pigs has allowed for prevention of hyperacute rejection and graft function with clinically-available, FDA-approved immunosuppression. The Parsons Model utilizing recently deceased humans as recipients has allowed for the study of xenografts in a pre-clinical human model. These studies have confirmed function of kidney xenografts and maintenance of renal physiology. Two cases of human heart xenotransplantation have been reported, with limited early success. Two human recipients have received porcine kidney grafts. Moving forward, careful recipient selection will be needed for the first clinical trials. Diligent screening of the donor animals will reduce the risk of zoonotic infection, and post-transplant surveillance of recipients will remain important. Summary Studies to date have demonstrated the feasibility of xenotransplantation with promising early results. With additional studies designed to address the remaining unanswered questions, xenotra nplantation may finally realize its potential and become a clinical reality.