![]() However, there are several disadvantages with the use of NHPs as sources of organs and, with the advent of genetic engineering and cloning technologies, pigs are currently considered the animals most likely to resolve the problem of donor organ shortage (Table 1). A patient with a baboon liver transplant survived for 70 days in 1992. In 1964, the first (unsuccessful) heart transplant utilized a chimpanzee as the ‘donor’. In 1963–64, one patient returned to work for almost 9 months supported by a pair of chimpanzee kidneys. 3 Following the pioneering surgical work of Carrel, who developed the technique of blood vessel anastomosis, numerous attempts at nonhuman primate (NHP) organ transplantation in patients were carried out in the 20th century. 2 History of xenotransplantationĬlinical cross-species transplantation (xenotransplantation) has a long history going back to blood transfusions across species in the 17th century. It is against this backdrop that recent efforts utilizing genetically modified pig kidneys (and other organs) are moving towards clinical trials in humans. ![]() Thus, the current system supporting recovery of human kidneys for transplantation must be viewed as woefully inadequate. Since 2005, over 9000 wait-listed patients died or became too sick to transplant. In the USA alone, in 2016, 98 000 patients started the year on the waiting list, with 19 800 (20%) transplanted after a median waiting time essentially too long to calculate. Nonetheless, prospects for ESRD patients seeking transplantation remain bleak, and continue to worsen. An increasing percentage (15% in the USA) of transplants are carried out in patients in whom it has been necessary to ‘desensitize’ to their donor because of ABO blood group or major histocompatibility complex (MHC) (human leukocyte antigen (HLA)) incompatibility, or this incompatibility has been avoided by kidney paired donation. Criteria for donor/recipient relationships have liberalized, with many living kidney donors now genetically unrelated to their recipient. Donor nephrectomy is now widely performed as a minimally invasive procedure, with rapid postoperative recovery. Nowadays, the greatest potential for growth in numbers may reside in living kidney donation. There is also growing interest in improving organ quality via pump preservation and normothermic perfusion. Donated kidneys are also allocated on the basis of organ quality, tacitly acknowledging that growth in supply is likely to come from non-traditional sources such as donors after cardiac death or older donors with more comorbidity. Efforts are made to allocate organs to patients likely to survive the longest and also to those difficult to tissue match. To enhance availability of kidneys from deceased donors, most Western countries have developed elaborate organ recovery systems, some voluntary and others mandatory, with intricate allocation algorithms to promote both equity and optimal outcomes in recipients. The transplant community has responded with a full-court-press of approaches to remedy the imbalance between supply and demand. ![]() For at least a quarter of a century, the limiting factor precluding successful transplantation for thousands of wait-listed ESRD patients, and thousands more never listed, has been the relative shortage of available kidneys. Compared to financial costs associated with dialysis, a transplant is also estimated to save payers and society over $1 million per patient during an individual recipient’s lifetime. Regardless of age, kidney recipients on average live twice as long as comparable patients on dialysis, with less morbidity and superior quality of life. 1 Transplantation of a kidney from a deceased or living donor is optimal treatment for patients with irreversible kidney failure (end-stage renal disease, ESRD). The current shortage of donor organs for transplantation in patients with terminal organ failure is exemplified by the situation with kidney transplantation. Cells, genetic-engineering, organs, pig, xenotransplantation Introduction
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