Current Status of Renal Xenotransplantation and Next Steps

Renal transplantation is the preferred treatment of ESRD, but the shortage of suitable donor kidneys from the cadaver pool means that many patients with ESRD will not receive a kidney transplant. Xenotransplantation has long represented a solution to the kidney shortage, but the occurrence of antibody-mediated rejection has precluded its clinical development. Developments in: somatic cell nuclear transfer in pigs, gene editing tools have led to the creation of new donor pigs with greatly improved crossmatches to patients. In addition, improvements in preclinical kidney xenotransplant survival using new anti-CD40/CD154 based immunosuppression, have pushed xenotransplantation to the point where it is reasonable to consider initiating a clinical trial to evaluate this potential therapy in patients.