Revolutionizing medicine: Exploring the breakthroughs in liver xenotransplantation

The critical shortage of liver transplant donors necessitates innovative solutions, with xenotransplantation emerging as a promising alternative. Despite significant ethical, scientific, and practical challenges, recent advancements in liver xenotransplantation, particularly using pigs as donors for non-human primates (NHPs), have extended graft survival duration. However, life-threatening issues such as thrombocytopenia and coagulation disorders persist, limiting survival to under a month. Advances in genetic engineering have enabled the modification of pig genomes to match the human immune system better, targeting genes responsible for immune rejection and increasing compatibility. While these breakthroughs enhance the potential for human transplantation, the challenges of immune rejection and long-term functionality remain substantial. This review highlights recent progress in liver xenotransplantation from pigs to NHPs and explores the implications for potential human clinical application.