1. Pig-to-non-human primate heart transplantation: the final step toward clinical xenotransplantation?
- Author
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Reinhard Ellgass, Uwe Fiebig, Andrea Baehr, Audrius Paskevicius, Stig Steen, Mayuko Kurome, Julia Radan, Ralf R. Tönjes, Robert Rieben, Lara Issl, Barbara Kessler, Riccardo Sfriso, Jan-Michael Abicht, Trygve Sjöberg, Sebastian Michel, Thomas Kirchner, Christoph Walz, David Ayares, Luise Krüger, Paolo Brenner, Anastasia Milusev, Tanja Mayr, Christian Hagl, Uwe Schönmann, Bruno Reichart, Jiawei Ying, Matthias Längin, Antonia W. Godehardt, Ann Kathrin Fresch, Stefanie Egerer, Ines Buttgereit, Stefan Buchholz, Joachim Denner, Maren Mokelke, Elisabeth Kemter, Nikolai Klymiuk, Maks Mihalj, Karen Lampe, Valeri Zakhartchenko, and Eckhard Wolf
- Subjects
Graft Rejection ,0301 basic medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Thrombotic microangiopathy ,Swine ,Xenotransplantation ,medicine.medical_treatment ,Transplantation, Heterologous ,Heart preservation ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Animals ,Humans ,Lung transplantation ,610 Medicine & health ,Heart transplantation ,Transplantation ,Non human primate ,business.industry ,Graft Survival ,medicine.disease ,620 Engineering ,Tissue Donors ,Regimen ,030104 developmental biology ,Cardiology ,Heart Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The demand for donated human hearts far exceeds the number available. Xenotransplantation of genetically modified porcine organs provides an alternative. In 2000, an Advisory Board of the International Society for Heart and Lung Transplantation set the benchmark for commencing clinical cardiac xenotransplantation as consistent 60% survival of non-human primates after life-supporting porcine heart transplantations. Recently, we reported the stepwise optimization of pig-to-baboon orthotopic cardiac xenotransplantation finally resulting in consistent success, with 4 recipients surviving 90 (n = 2), 182, and 195 days. Here, we report on 4 additional recipients, supporting the efficacy of our procedure. Results The first 2 additional recipients succumbed to porcine cytomegalovirus (PCMV) infections on Days 15 and 27, respectively. In 2 further experiments, PCMV infections were successfully avoided, and 3-months survival was achieved. Throughout all the long-term experiments, heart, liver, and renal functions remained within normal ranges. Post-mortem cardiac diameters were slightly increased when compared with that at the time of transplantation but with no detrimental effect. There were no signs of thrombotic microangiopathy. The current regimen enabled the prolonged survival and function of orthotopic cardiac xenografts in altogether 6 of 8 baboons, of which 4 were now added. These results exceed the threshold set by the Advisory Board of the International Society for Heart and Lung Transplantation. Conclusions The results of our current and previous experimental cardiac xenotransplantations together fulfill for the first time the pre-clinical efficacy suggestions. PCMV-positive donor animals must be avoided.
- Published
- 2020
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