Korean J Transplant.  2023 Nov;37(Suppl 1):S270. 10.4285/ATW2023.F-8802.

A report on the longest graft survival of a porcine kidney transplanted into a non-human-primate in Korea

• Min S
• Park KS
• Choi WS
• Hwang SA
• Hwang JH
• Kim HI
• Choi KM
• Hwang HP
• Yun IJ

• KMID: 2551899
• DOI: http://doi.org/10.4285/ATW2023.F-8802

Abstract

Long-term survival of a porcine kidney graft transplanted into a non-human primate (NHP) for more than 6 months is a prerequisite for the successful clinical translation of xenotransplantation in the current era. We recently achieved long-term porcine kidney graft survival in an NHP and share our experience here. A kidney was harvested from a genetically modified pig (Optipharm Inc., Cheongju, Korea). The donor pigs genetic modifications include triple knockout (GGTA1, CMAH, and B4galNT2) and double knock-in (hCD55 and hCD39). The donor pig weighed 11.5 kg, and the transplanted kidney weighed 28 g. The recipient was a cynomolgus macaque weighing 3 kg. Rituximab and thymoglobulin were used for induction immunosuppression. Maintenance immunosuppression included once-daily tacrolimus, mycophenolate mofetil, steroids, and anti-CD154 monoclonal antibody. Cobra venom factor was employed to inhibit the complement response. Following a midline incision, the porcine kidney was transplanted into the recipients right iliac fossa. Immediate posttransplant urine output was satisfactory. The recipient’s right kidney was removed simultaneously, and the left kidney was removed on posttransplant day 75. Following native kidney removal, the recipients renal function remained stable. Serum creatinine was 0.77 mg/dL on posttransplant day 98, a favorable result compared to the recipient’s baseline level of 0.94 mg/dL. Renal function remained stable until posttransplant day 182 (serum creatinine was 0.98 mg/dL). However, renal function deteriorated after posttransplant day 210, leading to euthanasia on posttransplant day 221 due to renal failure. Histopathologic findings are pending. We present a case of long-term survival involving a porcine kidney transplanted into nonhuman primates and anticipate the clinical translation of xenotransplantation in the near future.