Potential strategies in porcine liver xenotransplantation: A bridge to allotransplantation and beyond

Advances in both gene editing of organ-source pigs and novel immunosuppressive therapies have substantially propelled the field of heart and kidney xenotransplantation forward, and have helped in overcoming challenges associated with porcine liver transplantation. In this review, the recent experience with porcine liver xenotransplantation in China for both decedents and living patients is discussed. We suggest that porcine liver xenografts play a much greater role in the management of patients with hepatic failure awaiting or following liver allotransplantation. Additionally, we propose that brain-dead human subjects (decedents) be used to validate the efficacy of porcine livers in supporting split or marginal human liver grafts. These developments are expected to lay the groundwork for clinical trials aimed at improving the outcomes of patients with end-stage liver disease, potentially expanding the pool of transplantable organs and providing new therapeutic options for these patients.