Clinical Xenotransplantation. Pathways and Progress in the Transplantation of Organs and Tissues Between Species

Introduction - taking xenotransplantation into the clinic

1. Xenotransplantation in nonhuman primates - the present position

Kidney xenotransplantation
Heart xenotransplantation

2. Donor genetics and potential infectious risks

The optimal genetically-engineered organ-source pig
Organ-source pig health status and potential infectious risks
Regulatory requirements for the organ-source pig

3. Antibody-mediated allotransplant rejection: lessons for xenotransplantation

The problem of anti-HLA antibodies
The problem of ABO blood group-incompatibility

4. Patient evaluation and selection for first clinical trials

Kidney transplantation
Heart transplantation in adults
Heart transplantation in infants and children
Heart transplantation vs mechanical circulatory support

5. Social and religious aspects of xenotransplantation
6. Economic implications of xenotransplantation
7. Summary - closing in on clinical xenotransplantation

This title provides an illuminating examination of the current state of xenotransplantation - grafting or transplanting organs or tissues between members of different species - and how it might move forward into the clinic. To be sure, this is a critical topic, as a major problem that remains worldwide is an inadequate supply of organs from deceased human donors, severely limiting the number of organ transplants that can be performed each year. Based on presentations given at a major conference on xenotransplantation, this title includes important views from many leading experts who were invited to present their data and opinions on how xenotransplantation can advance into the clinic. Attention was concentrated on pig kidney and heart transplantation as it is in regard to these organs that most progress has been made. Collectively, these chapters effectively highlight the many advantages of xenotransplantation to patients with end-stage organ failure, thereby encouraging the mapping of a concrete pathway to clinical xenotransplantation.

The book is organized across 22 chapters, beginning with background information on clinical and experimental xenotransplantation. Following this are discussions addressing how pigs can be genetically engineered for their organs to be resistant to the human immune response through deletion of pig xenoantigens, and the insertion of 'protective' human transgenes. Subsequent chapters analyze complications that arise in practice, comparing allotransplant and xenotransplant rejection. The selection of the ideal patients for the first clinical trials is discussed. Finally, the book concludes with an analysis on the regulatory, economic, and social aspects of this research, including FDA perspectives and the sensitive, psychosocial factors regarding allotransplantation and xenotransplantation.

A major and timely addition to the literature, Clinical Xenotransplantation will be of great interest to all researchers, physicians, and academics from other disciplines with an interest in xenotransplantation.

David K.C. Cooper MD, PhD, FRCS University of Alabama at Birmingham (UAB) Co-Director, Xenotransplantation Program Department of Surgery Birmingham, AL

Guerard W. Byrne, PhD Department of Surgery University of Alabama at Birmingham Birmingham, AL USA