ReviewClinical transplantation and research2026
Beyond conventional immunosuppression: tailoring perioperative management protocols for clinical xenotransplantation.
Review in Clinical transplantation and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
2 authors.
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Abstract
Clinical xenotransplantation offers a conceptually unlimited supply of donor organs, owing to transformative advances in gene-editing technologies. However, the pharmacological and physiological distinctions between allo- and xenotransplantation pose a major challenge. Unlike allografts, xenografts simultaneously trigger complement-amplified humoral rejection, thromboregulatory incompatibility driven by porcine-human molecular mismatch, and species-specific innate inflammatory cascades. However, conventional calcineurin-based immunosuppression provides no meaningful coverage for these pathways. We analyzed these differences to provide the mechanistic foundation for a dedicated perioperative framework. The proposed framework encompasses immunologic assessment; porcine cytomegalovirus (PCMV)/roseolovirus-free donor certification; intensified induction; third-generation anti-CD154 monoclonal antibodies with pharmacokinetically verified trough targets; normothermic machine perfusion with anti-inflammatory perfusate supplementation; and thromboregulatory rescue protocols incorporating tranexamic acid, heparin, and antiplatelet agents. Furthermore, we aimed to address consumptive coagulopathy; targeted suppression of macrophage- and neutrophil-driven innate inflammatory cascades, alongside activation of xenoreactive natural killer cells; and multimodal surveillance integrating flow cytometry, donor-derived cell-free DNA, and metagenomic sequencing for porcine endogenous retrovirus and PCMV monitoring. By combining compassionate-use failure analysis with prospective trial design aligned with the 2026 International Society for Heart and Lung Transplantation consensus statement, this review proposes a standardized perioperative management protocol that is applicable to clinical xenotransplantation.
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