Hawthorne Wayne John, Thomas Adwin, Pierson Richard N
The Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Department of Surgery, School of Medical Sciences, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia.
The Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
Semin Nephrol. 2022 Jul;42(4):151288. doi: 10.1016/j.semnephrol.2022.151288. Epub 2022 Dec 30.
Xenotransplantation has seen recent global interest peak as a result of several clinical xenotransplants being performed in decedents and a live cardiac recipient. However, underpinning these latest transplants have been decades of invested scientific research programs that have been developing the ideal donor source animals to avoid the overwhelming hyperacute xenograft rejection seen using nongenetically modified animal organs, tissues, and cells. However, this also needs to be undertaken along with the development of safe and efficacious xenotransplantation technologies, immunosuppression, monitoring, disease screening, patient selection, societal education, and acceptance. Paralleling the advent of such extraordinary transplants have been several decades of establishment of world xenotransplantation authorities such as the International Xenotransplantation Association, and the development of guidance documents and regulations for the assessment of these cutting-edge technologies. Similar to all new technologies there remain outdated concerns and fears of the theoretical potential for transmission of xenozoonosis, ethical concerns, and outdated or appropriately educated societal concerns and religious views of the benefits or risks and issues for xenotransplantation use of organs, tissues, or cells from animals to human beings. Here, we discuss the development of xenotransplantation and the intricate balance in managing the various challenges with which we are faced: in the absolute benefits of xenotransplantation and the dichotomy in balancing the pros and cons of xenotransplantation with social, religious, ethical, scientific, and medical opinions. Ultimately, the benefits are to those patients suffering from the many and various diseases that drive the need for xenotransplantation. The hope is that it will be implemented as soon as possible to help the many millions of patients who can truly benefit.
由于在死者和一名心脏移植活体受者身上进行了几例临床异种移植手术，异种移植最近在全球引起了极大关注。然而，在这些最新的移植手术背后，是几十年投入的科研项目，这些项目一直在培育理想的供体动物源，以避免使用非基因改造的动物器官、组织和细胞时出现的压倒性超急性异种移植排斥反应。然而，这也需要与安全有效的异种移植技术、免疫抑制、监测、疾病筛查、患者选择、社会教育和接受度的发展同步进行。与这些非凡移植手术的出现并行的是，几十年来建立了诸如国际异种移植协会等世界异种移植权威机构，并制定了评估这些前沿技术的指导文件和法规。与所有新技术一样，仍然存在过时的担忧和恐惧，即异种人畜共患病传播的理论可能性、伦理问题，以及对异种移植使用动物器官、组织或细胞给人类带来的益处或风险和问题的过时或缺乏适当教育的社会担忧和宗教观点。在此，我们讨论异种移植的发展以及应对我们所面临的各种挑战时的复杂平衡：异种移植的绝对益处，以及在将异种移植的利弊与社会、宗教、伦理、科学和医学观点进行权衡时的二分法。最终，受益者是那些患有驱动异种移植需求的众多疾病的患者。希望这项技术能尽快实施，以帮助数百万真正能从中受益的患者。
