Infectious Disease Surveillance and Management in Clinical Xenotransplantation: Experience with the First Human Porcine Kidney Transplant

The success and safety of clinical xenotransplantation are determined by 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 to the potential spread of pig pathogens to immunosuppressed humans as well as manifestations of infections of the recipient from prior exposures to common human organisms. Robust strategies are required for donor screening, recipient monitoring, and infection prevention. This report outlines the comprehensive infectious disease management strategy deployed in the first living human recipient of a genetically modified pig kidney, including the following: (1) donor screening and pathogen mitigation, (2) pretransplant and posttransplant infection monitoring of the recipient, (3) infectious complications and management, and (4) implications for future xenotransplantation protocols.