Pig-to-Human Lung Xenotransplantation Into a Brain-Dead Recipient

This article reports the first pig-to-human lung xenotransplantation, marking a major milestone in thoracic transplantation research. A six-gene-edited porcine lung was transplanted into a 39-year-old brain-dead human recipient and monitored for 216 hours. The xenograft remained viable without evidence of hyperacute rejection or infection, demonstrating the feasibility of this approach. However, challenges emerged. Severe edema resembling primary graft dysfunction occurred within 24 hours, likely due to ischemia-reperfusion injury, and antibody-mediated rejection contributed to graft injury on postoperative days three and six, with partial recovery by day nine. The study employed an intensive multidrug immunosuppressive regimen tailored to the immune status throughout the monitoring period.  This case is highly significant for the CTSNet global cardiothoracic surgery audience, as it represents a proof-of-concept step toward lung xenotransplantation as a potential solution to donor shortages. While rejection and immunologic barriers remain formidable, these findings provide critical insights that will guide future preclinical and translational research.