Can Pediatric Renal Disease be Eligible for Xenotransplantation?

Abstract

Adult porcine xenotransplantation for adult renal failure patients is underway in some countries, but currently requires strong immunosuppression, extensive facilities and large amounts of money to maintain the pigs. Porcine fetal kidney xenotransplantation differs from that of adult in many aspects. Fetal kidneys are hypoimmunogenic and do not require the long-term maintenance of pigs, thus reducing the size and funding of facilities. We are advocating the clinical application of fetal pig kidney transplantation for renal oligohydramnios sequence. The concept is to transplant a fetal porcine kidney into the fetus with renal oligohydramnios sequence to produce urine, avoid renal replacement therapy during the postnatal period of respiratory and circulatory instability, and provide a bridging therapy until renal replacement therapy can be more safely initiated. Xenotransplantation to the fetus requires more careful caution in terms of ethics, and we believe it is important to carefully explore the path to clinical application through multifaceted discussions involving patients’ families, medical professionals, and ethics experts, in parallel with basic research.