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Editorial
. 2023 Sep;166(3):960-967.
doi: 10.1016/j.jtcvs.2022.09.001. Epub 2022 Sep 6.

Consensus statement on heart xenotransplantation in children: Toward clinical translation

Igor E Konstantinov  1 , David K C Cooper  2 , Iki Adachi  3 , Emile Bacha  4 , Mark S Bleiweis  5 , Richard Chinnock  6 , David Cleveland  7 , Peter J Cowan  8 , Francis Fynn-Thompson  9 , David L S Morales  10 , Muhammad M Mohiuddin  11 , Bruno Reichart  12 , Martine Rothblatt  13 , Nathalie Roy  9 , Joseph W Turek  14 , Simon Urschel  15 , Lori West  16 , Eckhard Wolf  17
Affiliations
Editorial

Consensus statement on heart xenotransplantation in children: Toward clinical translation

Igor E Konstantinov et al. J Thorac Cardiovasc Surg. 2023 Sep.

Abstract

Keywords: congenital heart disease; genetically engineered; heart; infants; neonates; pediatric; pig; xenotransplantation.

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Conflict of interest statement

Conflict of Interest Statement

Dr Cooper is a consultant to eGenesis, but the opinions expressed in the manuscript are his own and not necessarily those of eGenesis. Dr Rothblatt is Chairperson and Chief Executive Officer of United Therapeutics Corporation. Revivicor, Inc, a subsidiary of United Therapeutics Corporation, owns a variety of issued patents and pending patent applications broadly relevant to xenotransplantation. All other authors reported no conflicts of interest.

The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Producing a genetically modified pig from somatic cells. Nuclear transfer of the edited genetic code to enucleated mature pig oocytes is performed to produce cloned genetically modified pigs as founder animals of the herds. Subsequent cycles of breeding and genetic modification produce the genetically modified pig suitable for organ donation.
FIGURE 2.
FIGURE 2.
Transporting the pig or pig heart for clinical heart xenotransplantation. (1) The pig can be transported to the hospital under high-efficiency particulate air–filtered biosecurity conditions so that ischemia of the heart is eliminated almost entirely. In this case, the ischemic time is basically reduced to that required for the surgical procedure of pig heart removal and implantation. (2) The heart can be removed from the pig at the animal production facility and transported to the recipient hospital using cold nonischemic heart preservation. Regardless of the mode of donor heart delivery, the intraoperative ischemic time could be further reduced by anastomosis of the 2 left atria and 2 aortas first to allow myocardial perfusion to be initiated before the caval and pulmonary artery anastomoses are completed.
FIGURE 3.
FIGURE 3.
Heart xenotransplantation: key points pertinent to research, industry, and clinical translation. Successful clinical translation of heart xenotransplantation is dependent on several key points; each key point, in turn, requires utmost ethical scrutiny.
See this image and copyright information in PMC

References

    1. Cooper DKC, Raza SS, Chaban R, Pierson RN III. Shooting for the moon: genome editing for pig heart xenotransplantation. J Thorac Cardiovasc Surg. May 6, 2022. [Epub ahead of print]. - PMC - PubMed
    1. Langin M, Mayr T, Reichart B, Michel S, Buchholz S, Guetholf S, et al. Consistent success in life-supporting porcine cardiac xenotransplantation. Nature. 2018;564:430–3. - PubMed
    1. Mohiuddin MM, Goerlich CE, Singh AK, Zhang T, Tatarov I, Lewis B, et al. Progressive genetic modifications of porcine cardiac xenografts extend survival to 9 months. Xenotransplantation. 2022;29:e12744. - PMC - PubMed
    1. Rothblatt M. Commentary on achievement of first life-saving xenoheart transplant. Xenotransplantation. 2022;29:e12746. - PubMed
    1. Reardon S. First pig-to-human transplant: what can scientists learn? Nature. 2022;601:305–6. - PubMed

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