The pig as a source of cardiac xenografts

The inadequate availability of human donor hearts and other organs has inspired interest in the field of xenotransplantation. Historically, ten attempts to transplant animal hearts into human recipients have been reported. Those who received hearts from nonhuman primates (i.e., baboons and chimpanzees) survived rather longer than did those who received hearts from nonprimates (i.e., sheep and pigs). Nevertheless, current opinion is that the pig is the best candidate as a source of hearts for humans despite the considerable immunologic disparity between the two species. Pigs are available in large numbers and can be bred easily and rapidly. They grow to appropriate sizes and their cardiovascular system is similar to that of humans. Substantial knowledge has been accumulated regarding both genetic engineering and tolerance induction in pigs, two strategies that may help to overcome the existing immunologic barriers. Concern has been raised, however, with regard to the potential for the transfer of a porcine infection with the pig organ to the human recipient. This brief review addresses these and other aspects of the use of the pig as a source of hearts for patients with end-stage cardiac disease.