Infectious disease surveillance and management in clinical xenotransplantation: Experience with the first human porcine kidney transplant.
This report outlines the comprehensive infectious disease management strategy deployed in the first living human recipient of a genetically modified pig kidney, covering donor screening and pathogen mitigation, recipient monitoring before and after transplant, infectious complications and their management, and implications for future xenotransplantation protocols.
Background
The success and safety of clinical xenotransplantation are determined by the technical aspects of surgery, the nature and intensity of immunosuppression, xenograft function, and the ability to avoid immunologic, hematologic, infectious and malignant complications. In clinical xenotransplantation from swine, infectious challenges relate both to the potential spread of pig pathogens to immunosuppressed humans and to manifestations of infection in the recipient arising from prior exposures to common human organisms.
Study design
The authors report the infectious disease management strategy used in the first living human recipient of a genetically modified pig kidney, describing the approach across four elements: donor screening and pathogen mitigation; pretransplant and posttransplant infection monitoring of the recipient; infectious complications and their management; and implications for future xenotransplantation protocols.
Key findings
Robust strategies are required for donor screening, recipient monitoring and infection prevention in clinical xenotransplantation. The report documents how each of these was implemented in this first living recipient, spanning pathogen mitigation in the source animal through to surveillance and management of infectious complications in the recipient after transplantation.
Clinical implications
The experience is presented to inform infectious disease protocols for future clinical xenotransplantation, where the combination of swine-derived pathogen risk and intensive immunosuppression means that donor screening, structured pre- and posttransplant recipient monitoring, and infection prevention must be planned as an integral part of the transplant programme.
Category
Transplant
Source
Am J Transplant
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