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Review
. 2023 Mar;44(1):201-214.
doi: 10.1016/j.ccm.2022.11.003.

Future of Lung Transplantation: Xenotransplantation and Bioengineering Lungs

Justin C Y Chan  1 , Ryan Chaban  2 , Stephanie H Chang  3 , Luis F Angel  3 , Robert A Montgomery  3 , Richard N Pierson 3rd  4
Affiliations
Review

Future of Lung Transplantation: Xenotransplantation and Bioengineering Lungs

Justin C Y Chan et al. Clin Chest Med. 2023 Mar.

Abstract

Xenotransplantation promises to alleviate the issue of donor organ shortages and to decrease waiting times for transplantation. Recent advances in genetic engineering have allowed for the creation of pigs with up to 16 genetic modifications. Several combinations of genetic modifications have been associated with extended graft survival and life-supporting function in experimental heart and kidney xenotransplants. Lung xenotransplantation carries specific challenges related to the large surface area of the lung vascular bed, its innate immune system's intrinsic hyperreactivity to perceived 'danger', and its anatomic vulnerability to airway flooding after even localized loss of alveolocapillary barrier function. This article discusses the current status of lung xenotransplantation, and challenges related to immunology, physiology, anatomy, and infection. Tissue engineering as a feasible alternative to develop a viable lung replacement solution is discussed.

Keywords: Bioengineering; Ex vivo lung perfusion; Lung transplant; Tissue engineering; Xenotransplantation.

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Figures

Fig. 1.
Fig. 1.
Lobar anatomy of the porcine lung, ventral view.
Fig. 2.
Fig. 2.
Monopodial branching pattern of the bronchial tree in the pig. (From Monteiro A, Smith RL. Bronchial tree Architecture in Mammals of Diverse Body Mass. International Journal of Morphology. 2014;32:312–316.)
Fig. 3.
Fig. 3.
Decellularization/recellularization process used in tissue engineering.
See this image and copyright information in PMC

References

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