Attitudes of patients with renal disease on xenotransplantation: A systematic review.
A systematic review of 14 studies (3,114 kidney patients) found that 63% would accept a xenotransplant if its function were comparable to an allotransplant, but acceptance fell sharply when xenograft function was framed as inferior or as a bridge organ.
Background
Recent milestones, including the first pig-to-human heart transplant, a brain-dead recipient model for kidney xenotransplantation, and registration of the first xenokidney clinical trial, have brought clinical translation closer. Understanding the attitudes and reservations of patients with kidney disease is considered crucial to successful trials and eventual widespread implementation.
Study design
This PROSPERO-registered, PRISMA-reported systematic review searched MEDLINE, Embase, and Web of Science from inception to July 15, 2022 for studies assessing attitudes toward and willingness to undergo xenotransplantation among patients with end-stage renal disease, including prior transplant recipients. Of 1,992 studies identified, 14 met inclusion criteria, conducted across eight countries (four in the United States), totaling 3,114 patients on the kidney waitlist or with a transplant; 58% were male and all were over 17.
Key findings
Acceptance was assessed by survey in 12 studies. Sixty-three percent (n=1,354) of kidney patients reported they would accept a xenotransplant with function comparable to an allotransplant. Acceptance was substantially lower for xenografts with inferior function (15%) or as bridge organs to allotransplantation (35%). Specific concerns included graft function, infection, social stigma, and animal rights. Subgroup analyses showed higher acceptance among already-transplanted versus waitlist patients and among White versus Black Americans.
Clinical implications
Understanding patient attitudes and reservations is key to executing the first xenotransplantation clinical trials. The review compiles factors to consider, including patient concerns, attitudes toward practical clinical scenarios, and the influence of demographic factors on acceptance of this emerging technology.
Category
Transplant
Source
Xenotransplantation
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