The immunobiology and clinical use of genetically engineered porcine hearts for cardiac xenotransplantation

A summary of the scientific rationale of the advancements that led to the first genetically modified pig-to-human cardiac xenotransplantation is lacking in a complex and rapidly evolving field. Here, we aim to aid the general readership in the understanding of the gradual progression of cardiac (xeno)transplantation research, the immunobiology of cardiac xenotransplantation (including the latest immunosuppression, cardiac preservation and genetic engineering required for successful transplantation) and the regulatory landscape related to the clinical application of cardiac xenotransplantation for people with end-stage heart failure. Finally, we provide an overview of the outcomes and lessons learned from the first genetically modified pig-to-human cardiac heart xenotransplantation. Goerlich et al. review the history of cardiac allo- and xenotransplants, the progress in immunomodulation to prevent rejection, the regulatory requirements for clinical application and the lessons learned from the first genetically modified pig-to-human heart xenotransplantation.