Renal xenotransplant. Acute vascular rejection

• Published in: Actas urologicas españolas Vol. 32; no. 1; pp. 152 - 159
• Main Authors: González Martín, M, García Buitrón, J, Alonso Hernández, A, Cortés Centeno, A, López Peláez, E, Vázquez Martul, E, Mosquera Reboredo, J, Requejo Isidro, I, Máńez Mendiluce, R
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.01.2008
• Subjects: Acute Disease; Animals; Graft Rejection - etiology; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; Kidney Transplantation - pathology; Papio; Swine; Transplantation, Heterologous - adverse effects; Transplantation, Heterologous - methods; Vascular Diseases - etiology
• ISSN: 0210-4806
• DOI: 10.1016/S0210-4806(08)73805-1

Organ transplant is nowadays a usual and succesful practice, although with limited application due to the lack of organs. Yearly thousands of patients get access to the waiting list and finally will death while they are waiting for an organ. In the U.S.A., 2005 waiting list for kidneys, heart, liver lung and pancreas was around 94.419. Number of transplants performed was 27.966 and died patients while waiting for an organ, 41.392 (1). Pig xenotransplant is one of the possibilities to ameliorate the lack of organs for transplant. Arrangement of pigs with different genetic modifications generated great expectatives on the use of these organs in clinics. Although preclinical experimental studies with kidneys reached prolonged survivals, these are really insufficient to go on with the clinical appliance. Hyperacute rejection produces destruction of the organ immediately. This problem could be pharmacologically precluded in xeno-transplant. However, acute rejection or vascular rejection usually produces the lost of the implant. New inmunosuppresive schedules delay significantly rejection, but not definitively. Xenotransplant as a therapeutic option introduces important scientific problems, as well as ethical and social. This paper reports a summary of our experience in renal xenotransplant and the management of acute rejection. Twenty xenotransplants from transgenic pig (hDAF) as donor to babuine as receptor. Average weight of the animals ranged 11.4-75 kgrs and babuines 10-26 kg. Xenograft average weight ranged 39-160 grs. Implant was performed to aorta and cava. Four inmunosupressive schedules were used. Average survival was 7-9 days. Final Histological findings are described. Changes observed were secondary to acute tubular necrosis mixed with changes due to acute rejection. Three grafts were lost due to technical major problems. Although we have observed some promising results, xenotransplant is a very difficult problem to solve in the long-term. A lot of research is still needed-.