[Risk and risk management connected with xenograft]

Transmission of an animal virus to man is probably a constant reality. Pathogenicity is is not inevitable. Some vaccines were contaminated by cell culture but remain safe. Haemorrhagic fevers, despite limited outbreaks, are often cited in the media. On the other hand, the influenza A virus has been responsible for a large mortality. The cases of human infection with simian viruses (herpes virus B, cytomegalovirus, spumavirus, immunodeficiency virus) were accidental and have always remained asymptomatic. Monkeypox virus emerges in only some outbreaks. No transmission of animal endogenous retrovirus has been described. The precautionary principle, in the face of an unquantifiable risk, supposes that preventive measures should be taken in advance to reduce the risk at each step: isolation of the animal source after hysterotomy, transport in a germ-free environment, procurement and transplantation in rigorous surgical conditions, long-term follow-up surveillance of the patient, his or her family and healthcare workers. All the phases of the xenotransplantation procedure should be taken to limit the number of places and persons coming into contact with the recipient. Surveillance means regular clinical information. Various samples should be taken from the animal source, recipient, his or her family contacts, medical staff and cryogenically preserved as 'biological memory'. A National Xenotransplantation Register should be set up to gather and share all information on incidents.