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Rodger D, Smith JA. Exploring attitudes toward xenotransplantation: A scoping review of healthcare workers, healthcare students, and kidney patients. Xenotransplantation 2024; 31:e12860. [PMID: 38716636 DOI: 10.1111/xen.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/27/2024] [Accepted: 03/28/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Recent advances mean that formal clinical trials of solid organ xenotransplantation are increasingly likely to begin and patients requiring a kidney transplant could be the first participants. Healthcare workers and healthcare students constitute the current and future workforce that will influence public opinion of xenotransplantation. The attitudes of these populations are important to consider before recruitment for formal clinical trials begins. METHODS This scoping review was reported according to the PRISMA extensions for scoping reviews checklist and the Joanna Briggs Institute methodology for scoping reviews. The Scopus, PubMed, and ScienceDirect databases were searched to identify articles that studied the attitudes of healthcare workers, healthcare students, or kidney patients toward xenotransplantation. RESULTS The search generated 816 articles, of which 27 met the eligibility criteria. The studies were conducted in 14 different countries on five different continents. Participants from the 27 studies totaled 29,836-this was constituted of 6,223 (21%) healthcare workers, 21,067 (71%) healthcare students, and 2,546 (8%) kidney patients. All three groups had an overall positive attitude toward xenotransplantation. However, in studies where participants were asked to consider xenotransplantation when the risks and results were not equal to allotransplantation-the overall attitude switched from positive to negative. The results also found that Spanish-speaking populations expressed more favorable views toward xenotransplantation compared to English-speaking populations. CONCLUSION The results of this review suggest that while attitudes of the three groups toward xenotransplantation are-on the face of it-positive, this positivity deteriorates when the risks and outcomes are framed in more clinically realistic terms. Only formal clinical trials can determine how the risks and outcomes of xenotransplantation compare to allotransplantation.
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Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, London South Bank University and Birkbeck, University of London, London, UK
| | - Jonathan A Smith
- Department of Psychological Sciences, University of London, Birkbeck, UK
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Tarabeih M, Amiel A, Na'amnih W. The view of the three monotheistic religions toward xenotransplantation. Clin Transplant 2024; 38:e15192. [PMID: 37975531 DOI: 10.1111/ctr.15192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Xenotransplantation, transplanting animal organs into humans, may offer a solution to the shortage of organs for transplantation. This would increase the chances for scheduled, elective transplantation, even for patients currently ineligible for receiving a human organ. However, xenotransplantation raises specific ethical and philosophical issues, that is, a personal identification of the body parts with the soul and spirit, the relationships between humans and animals, and challenges related to issues of medical and social ethics. The three monotheistic religions have laws and perspectives pertaining to xenotransplantation. This scholarly review examines the theology and viewpoints of the three monotheistic religions and their concerns regarding xenotransplantation (interspecies) in terms of religious-legal rulings, the ethical considerations related to the procedure, through religious scriptures and rulings of scholars of the three faith communities. This review should be viewed as a continuation of an extensive investigation of these issues, as the field of transplantation advances toward clinical trials. It was found that there are no fundamental religious reasons presented by any of the three religions to prohibit the use of animal organs as a means of treating severe and life-threatening conditions. However, there are certain limitations prescribed by each religion relating to the treatment of the animals and the choice of organs to be transplanted.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Aliza Amiel
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Wasef Na'amnih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tu Y, Zhao X, Chen G, Zhu L. A study of knowledge and acceptance of kidney xenotransplantation among Chinese kidney transplant recipients and candidates. Xenotransplantation 2024; 31:e12843. [PMID: 38407927 DOI: 10.1111/xen.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND In recent years, the implementation of the first case of pig-to-human heart xenotransplantation and the report of three cases of pig-to-brain-dead human recipient kidney transplantation indicate that xenotransplantation is getting closer to clinical application. In the near future, China may also launch clinical trials of kidney xenotransplantation. Therefore, it is necessary to investigate the level of knowledge and acceptance of xenotransplantation among kidney transplant recipients and candidates in China. This study aims to investigate the level of comprehension and acceptance of kidney xenotransplantation in kidney transplant recipients and explore related factors, providing a reference for promoting the application and clinical trials of xenotransplantation in the near future. METHODS A questionnaire was completed by 211 kidney transplant recipients and 21 candidates. Answers to the questionnaires were self-administered by the respondents. Scores were compared using nonparametric tests, as well as using Chi-square test or Fisher's exact test to compare differences in answers. RESULTS Respondents demonstrated a high score of 75 (out of 100) on knowledge and acceptance of kidney xenotransplantation. The sector "Knowledge and Attitude" received the overall highest score from respondents (85.0 out of 100), while "Risks and Concerns" received the lowest score (50 out of 100). Interestingly, respondents paid more attention to infection risks but showed less concern about rejection or unknown risks. Furthermore, 191 respondents (82.3%) expected that pig kidney xenografts could function for at least 5 years or more. The scores were statistically significant in terms of age, gender, level of education, level of knowledge on the case of xenotransplantation clinical trial, and willingness to donate organs. cognition CONCLUSIONS: The awareness rates of xenotransplantation are high among kidney transplant recipients and candidates, for which the majority showed a generally favorable attitude towards this procedure. Respondents did not have a comprehensive understanding of the specific knowledge of xenotransplantation and expressed more concern about the risk of infection compared to the risk of rejection and other unknown risks, while also expecting long-term survival similar to allograft transplantation for pig kidney xenografts.
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Affiliation(s)
- Yuhao Tu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Xiangli Zhao
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Gang Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Lan Zhu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
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Martínez-Alarcón L, Flores-Medina J, Ramis G, Gómez-Laguna J, Moll X, Falceto V, San Román-Ascaso F, San Román-Llorens F, Quereda JJ, Herrero JM, Mendonça L, Martin-Barrasa JL, Fernández OM, Muñoz A, Ramírez P, Gutiérrez P, López-Chicheri I, López-Navas A, Ríos A. Organ xenotransplantation acceptance in veterinary students: A multicentric opinion study in Spain. Xenotransplantation 2023; 30:e12823. [PMID: 37695105 DOI: 10.1111/xen.12823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The shortage of available transplant organs has made it necessary to search for alternatives, one of which is xenotransplantation. However, the use of animal organs could face rejection from society and the personnel involved in its implementation. OBJECTIVES (a) to analyze the attitudes of Veterinary Degree students in six Spanish Universities towards xenotransplantation; and (b) to determine the factors that affect its acceptance. METHODS Of the 2815 students surveyed in the degree program, 2683 valid surveys were obtained. Attitudes towards organ xenotransplantation were evaluated using a validated questionnaire of organ donation. RESULTS If xenotransplantation was confirmed as a clinical reality, 93% (n = 2493) of those surveyed would accept a xenotransplanted organ, whilst 7% would not. If the results of xenotransplantation were worse than those obtained with human donors and it entailed more risk, 12% (n = 318) would be in favor. 56% (n = 1497) of the students would accept a xenotransplantation provisionally pending the arrival of a human organ. Attitudes towards xenotransplantation were affected by the academic year in which a student was studying, with more favorable attitudes among students in the last year (88% in first year vs. 95% in fifth year; p < .001). More favorable attitudes are also observed depending on the attitude they have towards organ transplantation, with those students being more in favor of donating their organs when they die (94% vs. 88%; p < .001). CONCLUSION Veterinary students would have a very favorable attitude toward xenotransplantation if these animal organs functioned as well as human organs. Therefore, these students could play an important role in the future promotion of this technique.
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Affiliation(s)
- Laura Martínez-Alarcón
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Juan Flores-Medina
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Guillermo Ramis
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Jaime Gómez-Laguna
- Department of Anatomy and Comparative Pathology and Toxicology, University of Córdoba, Córdoba, Spain
| | - Xavier Moll
- Faculty of Veterinary Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Victoria Falceto
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Zaragoza, Zaragoza, Spain
| | - Fidel San Román-Ascaso
- Department of Animal Medicine and Surgery, Faculty of Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Fidel San Román-Llorens
- Department of Animal Pathology, Faculty of Veterinary, University of Zaragoza, Zaragoza, Spain
| | - Juan José Quereda
- Department of Animal Production and Health, Veterinary Public Health and Food Science and Technology, Faculty of Veterinary, University Cardenal Herrera-CEU, Valencia, Spain
| | - Juan Manuel Herrero
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Livia Mendonça
- Faculty of Veterinary, Universidade Federal de Goiás, Goiania, Brazil
| | - José Luis Martin-Barrasa
- Experimental Animal Facility, Research Unit, Hospital Universitario de Gran Canaria, Dr. Negrín, Las Palmas de Gran Canaria, Arucas, Spain
- Animal Infectious Diseases and Ictiopatology, University Institute of Animal Health (IUSA), University of Las Palmas de Gran Canaria, Arucas, Spain
| | - Olga María Fernández
- Animalario libre de Patógenos Arrixaca-Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Antonio Muñoz
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Pablo Ramírez
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - Pedro Gutiérrez
- Urology Service, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
- Departmen of Surgery, University of La Laguna, San Cristóbal de la Laguna, Tenerife, Spain
| | - Isabel López-Chicheri
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Ana López-Navas
- International Collaborative Donor Project, Murcia, Spain
- Department of Psychology, Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Antonio Ríos
- International Collaborative Donor Project, Murcia, Spain
- Surgery Service, Transplant Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology, University of Murcia, Murcia, Spain
- Department of Animal Production, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
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DeLaura I, Anwar IJ, Ladowski J, Patino A, Cantrell S, Sanoff S. Attitudes of patients with renal disease on xenotransplantation: A systematic review. Xenotransplantation 2023; 30:e12794. [PMID: 36880602 DOI: 10.1111/xen.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/09/2022] [Accepted: 01/26/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Recent years have seen major advancements in xenotransplantation: the first pig-to-human heart transplant, the development of a brain-dead recipient model for kidney xenotransplantation, and the registration of the first xenokidney clinical trial. The attitudes of patients with kidney disease or transplants on xenotransplantation and an assessment of their reservations and considerations regarding the technology are crucial to successful clinical translation and eventual widespread implementation. METHODS This systematic review was registered through PROSPERO (CRD42022344581) prior to initiation of the study and reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We included studies that evaluated attitudes towards and willingness to undergo xenotransplantation in patients with end-stage renal disease (ESRD), including those who had already undergone transplantation. MEDLINE (via Ovid), Embase (via Elsevier), and Web of Science (via Clarivate) were searched from database inception to July 15, 2022 by an experienced medical librarian for studies on xenotransplantation and attitudes. Abstracts and full text were screened using Covidence software and data items regarding study methodology, patient demographics, and attitudes regarding xenotransplantation were extracted using Microsoft Excel. Risk of bias assessments were performed using the Critical Appraisal Skills Programmed and National Institute of Health study quality assessment tools. RESULTS Of 1992 studies identified, 14 studies met the inclusion criteria. These studies were conducted across eight countries, four in the United States, for a total of 3114 patients on the kidney waitlist or with a kidney transplant. All patients were over 17 years old and 58% were male. Acceptance of a xenotransplant was assessed using surveys in 12 studies. Sixty-three percent (n = 1354) of kidney patients reported that they would accept a xenotransplant with function comparable to that of an allotransplant. Acceptance of xenografts with inferior function to allografts (15%) or as bridge organs (35%) to allotransplantation was lower. Specific concerns expressed by patients included graft function, infection, social stigma, and animal rights. Subgroup analyses showed higher acceptance in already transplanted compared to waitlist patients and white compared to Black Americans. CONCLUSION An understanding of patient attitudes and reservations is key to the successful execution of the first xenotransplantation clinical trials. This study compiles important factors to consider, such as patient concerns, attitudes regarding practical clinical scenarios for the use of xenotransplantation, and the impact of demographic factors on acceptance of this emerging technology.
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Affiliation(s)
- Isabel DeLaura
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Imran J Anwar
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph Ladowski
- Duke Transplant Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott Sanoff
- Department of Medicine, Division of Nephrology, Duke University, Durham, North Carolina, USA
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Cozzi E, Schneeberger S, Bellini MI, Berglund E, Böhmig G, Fowler K, Hoogduijn M, Jochmans I, Marckmann G, Marson L, Neuberger J, Oberbauer R, Pierson RN, Reichart B, Scobie L, White C, Naesens M. Organ transplants of the future: planning for innovations including xenotransplantation. Transpl Int 2021; 34:2006-2018. [PMID: 34459040 DOI: 10.1111/tri.14031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
The future clinical application of animal-to-human transplantation (xenotransplantation) is of importance to society as a whole. Favourable preclinical data relevant to cell, tissue and solid organ xenotransplants have been obtained from many animal models utilizing genetic engineering and protocols of pathogen-free husbandry. Findings have reached a tipping point, and xenotransplantation of solid organs is approaching clinical evaluation, the process of which now requires close deliberation. Such discussions include considering when there is sufficient evidence from preclinical animal studies to start first-in-human xenotransplantation trials. The present article is based on evidence and opinions formulated by members of the European Society for Organ Transplantation who are involved in the Transplantation Learning Journey project. The article includes a brief overview of preclinical concepts and biology of solid organ xenotransplantation, discusses the selection of candidates for first-in-human studies and considers requirements for study design and conduct. In addition, the paper emphasizes the need for a regulatory framework for xenotransplantation of solid organs and the essential requirement for input from public and patient stakeholders.
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Affiliation(s)
- Emanuele Cozzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Transplant Immunology Unit, Padua University Hospital, Padua, Italy
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Erik Berglund
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Transplantation Surgery, Karolinska Institute and ITB-MED, Stockholm, Sweden
| | - Georg Böhmig
- Division of Nephrology and Dialysis, Medical University Vienna, Vienna, Austria
| | - Kevin Fowler
- The Voice of the Patient, Inc., Chicago, IL, USA
| | - Martin Hoogduijn
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lorna Marson
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Richard N Pierson
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bruno Reichart
- Walter Brendel Center for Experimental Medicine, LMU Munich, Munich, Germany
| | - Linda Scobie
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Javier MFDM, Javier Delmo EM, Hetzer R. Heart transplantation: the Berlin experience and perspectives. Cardiovasc Diagn Ther 2021; 11:243-253. [PMID: 33708496 DOI: 10.21037/cdt-20-290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In patients with end-stage heart failure, heart transplants are now an ingrained practice, as they provide satisfying long-term results with good predictability and quality of life. The successful outcome has evolved from the development of effective immunosuppression, recognition of allograft rejection through diagnostic modalities and improvement in donor organ perfusion. Unfortunately, transplant availability is constrained by the shortage of donor organs and is therefore considered a casuistic therapy. The outcome is defined by unwanted effects of immunosuppressants, increased tumor occurrence and chronic transplant angiopathies. In the long term, patients fear primarily the occurrence of renal insufficiency and secondly osteoporosis with its skeletal complications and corresponding pain. Nevertheless, the overall quality of life is not very limited; on the contrary, patients demonstrate a surprisingly meaningful lives 10-20 years after the transplant. Their physical presentation is similar to those with varying co-morbidities. Most of the 20-year surviving patients are physically active and happy with their daily lives. Medical ambition has seen heart transplantation become reality and develop into an influential force regarding heart surgery, immunology, pharmacology, organ logistics and medical ethics. Its development has also molded our definitions of death and has driven public and health care approval of medical advances. It has provided a strong solidarity among politicians, sociologists, physicians and citizens. Problems regarding ethics continue to endure, and will forecast heart transplants as a defining, but temporary era in human medicine. The donor organ shortage has stimulated the use of resuscitated donor hearts and encouraged exploration and advancement of mechanical circulatory support systems and xenotransplantation as alternatives in the management of end-stage heart failure.
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Yoon CH, Choi HJ, Kim MK. Corneal xenotransplantation: Where are we standing? Prog Retin Eye Res 2021; 80:100876. [PMID: 32755676 PMCID: PMC7396149 DOI: 10.1016/j.preteyeres.2020.100876] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 02/08/2023]
Abstract
The search for alternatives to allotransplants is driven by the shortage of corneal donors and is demanding because of the limitations of the alternatives. Indeed, current progress in genetically engineered (GE) pigs, the introduction of gene-editing technology by clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9, and advanced immunosuppressants have made xenotransplantation a possible option for a human trial. Porcine corneal xenotransplantation is considered applicable because the eye is regarded as an immune-privileged site. Furthermore, recent non-human primate studies have shown long-term survival of porcine xenotransplants in keratoplasty. Herein, corneal immune privilege is briefly introduced, and xenogeneic reactions are compared with allogeneic reactions in corneal transplantation. This review describes the current knowledge on special issues of xenotransplantation, xenogeneic rejection mechanisms, current immunosuppressive regimens of corneal xenotransplantation, preclinical efficacy and safety data of corneal xenotransplantation, and updates of the regulatory framework to conduct a clinical trial on corneal xenotransplantation. We also discuss barriers that might prevent xenotransplantation from becoming common practice, such as ethical dilemmas, public concerns on xenotransplantation, and the possible risk of xenozoonosis. Given that the legal definition of decellularized porcine cornea (DPC) lies somewhere between a medical device and a xenotransplant, the preclinical efficacy and clinical trial data using DPC are included. The review finally provides perspectives on the current standpoint of corneal xenotransplantation in the fields of regenerative medicine.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
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Liu C, Liu S. Knowledge of and attitude toward xenotransplantation among medical students in China: A cross-sectional study. Xenotransplantation 2020; 28:e12654. [PMID: 33051907 DOI: 10.1111/xen.12654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/07/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are great challenges in the psychosocial aspects of xenotransplantation. The aim of this study was to investigate the knowledge of and attitude toward xenotransplantation among medical students in China. METHODS A questionnaire consisting of 12 questions was distributed to 1000 first-to-fifth grade medical students, with 200 students in each grade. The questionnaire was self-administered and completed anonymously with no information beforehand. RESULTS The response rate of the questionnaire was 91.5%. Most students had a good knowledge about xenotransplantation. If the results of xenotransplantation were similar with human donation, the acceptance was 63.9% when both organs were available, 70.3% to shorten the waiting time, and 86.4% to save one's life. As for the risks of xenotransplantation, 46.2%, 46.1%, and 36.9% of the respondents were worried about the risk of disease transmission, immunosuppressants, and other unknown risks, respectively. With regard to the psychosocial impacts, 38.4%, 31.9%, and 52.3% were worried about changing one's nature as a human being, changing one's personality, and discrimination by others, respectively. CONCLUSION Most medical students in China had a favorable attitude toward xenotransplantation. Students in the clinical years had a better knowledge of and more favorable attitude toward xenotransplantation. Their concern about the risks of xenotransplantation resolved slightly with seniority, but their concern about psychosocial impacts did not resolve with seniority.
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Affiliation(s)
- Chang Liu
- Department of Psychology, College of the Humanities and Social Sciences, China Medical University, Shengyang, China
| | - Shiqing Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shengyang, China
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Hawthorne WJ, Tan P, Garkavenko O, Abalovich A, Cowan PJ. Sir Bob Elliot—“In Memoriam”. Xenotransplantation 2020. [DOI: 10.1111/xen.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Wayne J. Hawthorne
- Centre for Transplant and Renal Research The Westmead Institute for Medical Research Westmead Hospital Sydney NSW Australia
- Department of Surgery Western Clinical School University of Sydney Sydney NSW Australia
| | - Paul Tan
- NZeno Limited Auckland New Zealand
| | | | - Adrian Abalovich
- Hospital Eva Perón de San Martín Universidad Nacional de San Martín Buenos Aires Argentina
| | - Peter J. Cowan
- Immunology Research Centre St Vincent’s Hospital Melbourne Melbourne Vic. Australia
- Department of Medicine University of Melbourne Melbourne Vic. Australia
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11
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Fraux C, Muñoz Sastre MT, Kpanake L, Sorum PC, Mullet E. French People's Views Regarding Xenotransplantation. Transplant Proc 2020; 53:529-538. [PMID: 32988637 DOI: 10.1016/j.transproceed.2020.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND French laypeople's views on xenotransplantation were examined. METHODS A convenience sample of 224 adults (among them, 37 nurses) judged of the acceptability of xenotransplantation in 50 realistic scenarios composed of various combinations of 4 factors: 1. the type of graft (eg, pig cardiac valve), 2. the level of urgency (eg, critical condition with very high risk of death in the short term), 3. the patient's or the family's level of consent (eg, the members of the family are divided on the issue), and 4. whether the transplantation was temporary or definitive. The ratings were subjected to cluster analysis and analyses of variance. RESULTS Seven qualitatively different positions were found that were termed Never acceptable (12%), Urgency (4%), Family consent (33%), Religious concerns (15%), Family consent and urgency (10%), Depends on all circumstances (4%), and Always acceptable (11%). Vegans and vegetarians expressed the Never acceptable position more often than nonvegetarians. Health professionals expressed the Family consent position more often than the public. Regular church attendees expressed the Religious concerns position more often than atheists did. CONCLUSIONS Few participants, mostly vegetarians, were opposed to xenotransplantation on principle. About one-third expressed positive views regarding xenotransplantation, either irrespective of circumstances or at least in those cases in which the patient's death is imminent and the family is not opposed for religious reasons. About one-half expressed positive views but deferred to the wishes of the family. The type of xenograft proposed had practically no effect on participants' views.
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Affiliation(s)
- Cécile Fraux
- Department of Psychology, Jean-Jaurès University, Toulouse, France
| | | | - Lonzozou Kpanake
- Department of Social Sciences, University of Québec-TELUQ, Montréal, QC, Canada.
| | - Paul Clay Sorum
- Department of Pediatrics and Internal Medicine, Albany Medical College, Albany, New York
| | - Etienne Mullet
- Department of Ethics and Work, Institute of Advanced Studies (EPHE), Paris, France
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Mitchell C, Lipps A, Padilla L, Werkheiser Z, Cooper DKC, Paris W. Meta‐analysis of public perception toward xenotransplantation. Xenotransplantation 2020; 27:e12583. [DOI: 10.1111/xen.12583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Chace Mitchell
- Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA
| | - Alan Lipps
- School of Social Work Abilene Christian University Abilene TX USA
| | - Luz Padilla
- Department of Epidemiology and Surgery Pediatric and Congenital Heart Center of Alabama Children’s Hospital of Alabama Birmingham AL USA
| | - Zoie Werkheiser
- Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA
| | - David K. C. Cooper
- Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA
| | - Wayne Paris
- Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA
- School of Social Work Abilene Christian University Abilene TX USA
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13
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Rodriguez S, Lau H, Corrales N, Heng J, Lee S, Stiner R, Alexander M, Lakey JRT. Characterization of chelator-mediated recovery of pancreatic islets from barium-stabilized alginate microcapsules. Xenotransplantation 2019; 27:e12554. [PMID: 31495985 DOI: 10.1111/xen.12554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Islet recovery from within alginate-based microcapsules is necessary for certain analytical assays like flow cytometry; however, this technology has not been widely characterized. In this study, we explore the ability of EDTA, EGTA, and sodium citrate to induce reverse alginate polymerization via chelation and assess the toxicity of each chelator on pancreatic islets. METHODS EDTA, EGTA, and sodium citrate were used to dissolve single-layered Ba2+ alginate encapsulated islets and the rate of capsule breakdown calculated from analysis of imaging data. The effect of chelator exposure on islet viability and recovery was assessed using flow cytometry, while glucose-stimulated insulin release (GSIR) assay was used to measure effects on islet function. RESULTS EGTA demonstrated the most rapid microcapsule dissolving rate followed by EDTA and sodium citrate. Islet recovery was significantly better when encapsulated islets were treated with EDTA than EGTA and Na+ citrate. A decrease in viability and increase in apoptotic cells were observed when encapsulated islets were treated with Na+ citrate compared to islets treated with EDTA and EGTA. Islets treated with EDTA and EGTA demonstrated comparable stimulation index values to non-treated control. Conversely, islets treated with Na+ citrate exhibited significantly decreased SI values compared to control. All chelator groups showed significantly lower insulin secretion than non-treated islets. CONCLUSION Islet recovery from alginate microcapsule is possible using common chelators like Na+ citrate, EDTA, and EGTA. Chelation of encapsulated islets using EDTA demonstrated the most efficient dissolving capabilities with the least toxicity toward islet recovery and health.
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Affiliation(s)
- Samuel Rodriguez
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Hien Lau
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Nicole Corrales
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Jennifer Heng
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Sarah Lee
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Rachel Stiner
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Michael Alexander
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Jonathan R T Lakey
- Department of Surgery, University of California Irvine, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Orange, CA, USA
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14
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Wang R, Ruan M, Zhang R, Chen L, Li X, Fang B, Li C, Ren X, Liu J, Xiong Q, Zhang L, Jin Y, Li L, Li R, Wang Y, Yang H, Dai Y. Antigenicity of tissues and organs from GGTA1/CMAH/β4GalNT2 triple gene knockout pigs. J Biomed Res 2018; 33:235. [PMID: 30007952 PMCID: PMC6813527 DOI: 10.7555/jbr.32.20180018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022] Open
Abstract
Clinical xenotransplantations have been hampered by human preformed antibody-mediated damage of the xenografts. To overcome biological incompatibility between pigs and humans, one strategy is to remove the major antigens [Gal, Neu5Gc, and Sd(a)] present on pig cells and tissues. Triple gene (GGTA1, CMAH, and β 4GalNT2) knockout (TKO) pigs were produced in our laboratory by CRISPR-Cas9 targeting. To investigate the antigenicity reduction in the TKO pigs, the expression levels of these three xenoantigens in the cornea, heart, liver, spleen, lung, kidney, and pancreas tissues were examined. The level of human IgG/IgM binding to those tissues was also investigated, with wildtype pig tissues as control. The results showed that αGal, Neu5Gc, and Sd(a) were markedly positive in all the examined tissues in wildtype pigs but barely detected in TKO pigs. Compared to wildtype pigs, the liver, spleen, and pancreas of TKO pigs showed comparable levels of human IgG and IgM binding, whereas corneas, heart, lung, and kidney of TKO pigs exhibited significantly reduced human IgG and IgM binding. These results indicate that the antigenicity of TKO pig is significantly reduced and the remaining xenoantigens on porcine tissues can be eliminated via a gene targeting approach.
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Affiliation(s)
| | | | | | - Lei Chen
- Jiangsu Key Laboratory of Xenotransplantation
| | - Xiaoxue Li
- Jiangsu Key Laboratory of Xenotransplantation
| | - Bin Fang
- Jiangsu Key Laboratory of Xenotransplantation
| | - Chu Li
- Jiangsu Key Laboratory of Xenotransplantation
| | - Xueyang Ren
- Jiangsu Key Laboratory of Xenotransplantation
| | - Jiying Liu
- Jiangsu Key Laboratory of Xenotransplantation
| | - Qiang Xiong
- Jiangsu Key Laboratory of Xenotransplantation
| | | | - Yong Jin
- Jiangsu Key Laboratory of Xenotransplantation
| | - Lin Li
- Jiangsu Key Laboratory of Xenotransplantation
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine
| | - Rongfeng Li
- Jiangsu Key Laboratory of Xenotransplantation
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine
| | - Ying Wang
- Jiangsu Key Laboratory of Xenotransplantation
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine
| | - Haiyuan Yang
- Jiangsu Key Laboratory of Xenotransplantation
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine
| | - Yifan Dai
- Jiangsu Key Laboratory of Xenotransplantation
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu 211166, China
- Shenzhen Xenotransplantation Medical Engineering Research and Development Center, Institute of Translational Medicine, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, China
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15
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Paris W, Seidler RJH, FitzGerald K, Padela AI, Cozzi E, Cooper DKC. Jewish, Christian and Muslim theological perspectives about xenotransplantation. Xenotransplantation 2018; 25:e12400. [PMID: 29687920 DOI: 10.1111/xen.12400] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/23/2018] [Accepted: 03/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND This paper is based on a theological symposium presented at the International Xenotransplantation Association's 14th Congress held in Baltimore, MD, September, 2017. METHODS The information explores the Jewish, Christian and Muslim theological perceptions and perspectives about cross-species (ie pig-to-human) organ transplantation, the genetic alterations required in the organ-source pig, and their potential to influence individual acceptance of the procedure. RESULTS/CONCLUSIONS This work should not be considered as the ultimate word about individual theological views, but rather as part of an ongoing conversation that will hopefully lead to wider consideration and exploration of these issues as xenotransplantation science advances towards clinical trials.
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Affiliation(s)
- Wayne Paris
- School of Social Work, Abilene Christian University, Abilene, TX, USA
| | | | - Kevin FitzGerald
- Dr David Lauler Chair of Catholic Care Ethics in the Center for Clinical Bioethics, Georgetown University, Washington, DC, USA.,Department of Oncology, Georgetown University, Washington, DC, USA
| | - Aasim I Padela
- Initiative on Islam and Medicine, Section of Emergency Medicine, Faculty, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Emanuele Cozzi
- Transplantation Immunology Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua Hospital, Padua, Italy
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama Birmingham, Birmingham, AL, USA
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Abstract
PURPOSE OF REVIEW To review the progress in the field of xenotransplantation with special attention to most recent encouraging findings which will eventually bring xenotransplantation to the clinic in the near future. RECENT FINDINGS Starting from early 2000, with the introduction of galactose-α1,3-galactose (Gal)-knockout pigs, prolonged survival especially in heart and kidney xenotransplantation was recorded. However, remaining antibody barriers to non-Gal antigens continue to be the hurdle to overcome. The production of genetically engineered pigs was difficult requiring prolonged time. However, advances in gene editing, such as zinc finger nucleases, transcription activator-like effector nucleases, and most recently clustered regularly interspaced short palindromic repeats (CRISPR) technology made the production of genetically engineered pigs easier and available to more researchers. Today, the survival of pig-to-nonhuman primate heterotopic heart, kidney, and islet xenotransplantation reached more than 900, more than 400, and more than 600 days, respectively. The availability of multiple-gene pigs (five or six genetic modifications) and/or newer costimulation blockade agents significantly contributed to this success. Now, the field is getting ready for clinical trials with an international consensus. SUMMARY Clinical trials in cellular or solid organ xenotransplantation are getting closer with convincing preclinical data from many centers. The next decade will show us new achievements and additional barriers in clinical xenotransplantation.
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