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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
3.2K
Liver xenotransplantation.
Madhukar S Patel1, Nathan Louras, Parsia A Vagefi
1aDepartment of Surgery, Massachusetts General Hospital bHarvard Medical School, Boston, Massachusetts, USA.
Current Opinion in Organ Transplantation
|August 18, 2017
Summary
Recent advancements in pig-to-nonhuman primate liver xenotransplantation (LXT) have overcome previous survival limitations. Genetically engineered pig organs now support nonhuman primate life for nearly a month, paving the way for clinical trials.
Area of Science:
- Xenotransplantation research
- Organ replacement strategies
- Immunology and rejection
Background:
- Liver failure presents a critical unmet medical need due to organ donor shortages.
- Temporary support for liver failure remains limited.
- Orthotopic liver xenotransplantation (LXT) offers a potential solution.
Purpose of the Study:
- To review recent advancements in pig-to-nonhuman primate (NHP) liver xenotransplantation (LXT).
- To assess the progress and potential of LXT for liver failure patients.
Main Methods:
- Utilizing genetically engineered pig organs (α(1,3)-galactosyltransferase knockouts, CMV-negative).
- Employing NHP recipients (baboons).
- Administering coagulation factors and co-stimulation blockade to recipients.
Main Results:
- Early pig-to-NHP LXT survival was limited to 9 days, primarily due to hyperacute rejection and coagulopathy.
- Recent studies show survival of nearly a month in NHP recipients with genetically modified porcine livers.
- Lethal coagulopathy has been overcome through genetic engineering and supportive therapies.
Conclusions:
- Consistent survival beyond two weeks in pig-to-NHP LXT supports its consideration as a bridge to allotransplantation for acute liver failure.
- Further genetic modifications and research are necessary for LXT to be used as definitive therapy.
