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British Medical Bulletin 2006 75-76(1):99-114; doi:10.1093/bmb/ldh061
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Published online 24 May 2006

© The Author 2006. Published by Oxford University Press on behalf of The British Council. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Xenotransplantation—current status and future perspectives

Emanuele Cozzi1,2,3,*, Erika Bosio2,3, Michela Seveso2, Marta Vadori2,3 and Ermanno Ancona2,3,4

1 Direzione Sanitaria, Padua General Hospital, Via Giustiniani 3, 35128, Padua, Italy, 2 CORIT (Consorzio per la Ricerca sul Trapianto d’Organi), Passaggio Gaudenzio 1, 35131, Padua, Italy, 3 Department of Medical and Surgical Sciences, University of Padua, Via Ospedale 105, 35128, Padua, Italy and 4 Clinica Chirurgica III, Padua General Hospital, Via Giustiniani 2, 35128, Padua, Italy.

* Correspondence to: Emanuele Cozzi, Department of Medical and Surgical Sciences, University of Padua, Clinica Chirurgica III, Via Giustiniani, 2, 35128 Padova, Italy. Tel.: +39 049 8218841; fax: +39 049 8218841; e-mail: emanuele.cozzi{at}unipd.it

Research efforts have shed light on the immunological obstacles to long-term survival of pig organs transplanted into primates and allowed the identification of targets for specific immune intervention. Accordingly, the development of genetically engineered animals has overcome the hyperacute rejection barrier, with acute humoral xenograft rejection (AHXR) currently remaining the most important immunological obstacle. At this stage, a better control of the elicited anti-pig humoral immune response and avoidance of coagulation disorders are the two primary research fronts being pursued in order to overcome AHXR. Nonetheless, it is encouraging that porcine xenografts can sustain the life of non-human primates for several months. Proactive research aimed at the development of a safer organ source is also underway. It is anticipated that ongoing research in several fields, including accommodation, tolerance, immune suppression and genetic engineering, will result in further improvements in non-human primate survival. However, until convincing efficacy data and a more favourable risk/benefit ratio can be established in relevant animal models, progression to the clinic should not be viewed as an option.

Keywords: xenotransplantation • pig • primate • humoral rejection • genetic engineering • coagulation • safety


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