Xenotransplantation and the kidney
- Jeffrey L Platt, MD
Jeffrey L Platt, MD
- Professor of Surgery and Microbiology and Immunology
- University of Michigan
- Section Editor
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
The transplantation of cells, tissues, and organs between individuals of different species is referred to as xenotransplantation. The clinical application of xenotransplantation has been a goal of transplant clinicians since the beginning of the twentieth century. Kidneys of animals were used during the first attempts at clinical transplantation because it was not readily apparent how human kidneys could be ethically retrieved . Today, the shortage of human kidneys available for transplantation impels ongoing consideration of xenotransplantation.
The shortage of human kidneys for transplantation makes kidney transplantation unavailable for some and significantly increases waiting time for others. The increasing prevalence of end-stage renal disease makes these challenges worse. Other approaches to renal replacement, such as implantable devices, cell or stem cell therapies, and organogenesis are being explored ; however, xenotransplantation could provide the most widely available and cost-effective approach [3-5]. Additional benefits may include the ability to prevent the recurrence of some infectious diseases (as animal organs are not susceptible to certain viruses, such as hepatitis B and C) and the ability to introduce extrinsic genetic material for therapeutic purposes .
Despite these possible benefits, xenotransplantation remains a matter of controversy. This controversy stems from the ongoing challenge of overcoming the immune hurdles to xenografting and the theoretical possibility that a xenograft may pose risks to public health by the introduction of infectious agents. A review of xenotransplantation and these challenges is presented in this topic review.
SOURCES OF XENOGRAFTS
The most obvious animal to use as a source of xenografts is one that is genetically close to humans, such as the chimpanzee. In the early 1960s, a series of transplants of chimpanzee kidneys into patients with renal failure were performed . These transplants functioned for up to nine months; in some cases, the cause of transplant failure and patient death was intercurrent disease and not rejection.
More recently, baboon livers functioned for months after transplantation into two patients with hepatic failure . As with some of the chimpanzee kidney transplants, intercurrent illness rather than intrinsic failure of the livers resulted in patient death.
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- SOURCES OF XENOGRAFTS
- BARRIERS TO XENOTRANSPLANTATION
- Immunologic reactions
- - Hyperacute rejection
- - Acute vascular rejection
- - Cellular rejection
- - Chronic rejection
- Physiologic function
- Ethical considerations
- POSSIBLE FUTURE INDICATIONS
- Presensitized patients
- Human immunodeficiency virus infection
- FUTURE APPROACH
- SUMMARY AND RECOMMENDATIONS