Xenotransplantation: the potential and the challenges

Bloom, ET; Moulton, AD; McCoy, James R.; Le, Chapman; Patterson, AP

doi:10.4037/ccn1999.19.2.76

Cited by 10 publications

(7 citation statements)

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“…However, a major stumbling block, with which the world has no experience, is the possibility of transmitting a disease from the animal species to the human species, with an uncertain chance of a pandemic. (Bloom, Moulton, McCoy, Chapman, & Patterson, 1999;Plat, 1999;Robson, Schulte am Esch, & Bach, 1999;Sim, Marinov, & Levy, 1999). Another alternative is in initial stages of development.…”

Section: Organ Shortages and Psychosocial Implicationsmentioning

confidence: 99%

Psychosocial aspects of the organ transplant experience: What has been established and what we need for the future

Engle¹

2001

J Clin Psychol

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This article briefly describes the current status and limitations of the organ transplant process that has now become a routine medical procedure. The article discusses how transplantation is not a cure for end-stage organ disease but an alternative form of treatment with both potential medical and psychosocial problems. Both transplant candidates and recipients encounter psychosocial problems. The article examines how these psychosocial problems affect transplant patients prior to transplant, immediately following surgery, and posttransplant. The psychosocial problems include psychiatric diagnoses, individual and family adjustment and relationship problems, sexual dysfunction, return-to-work (RTW) difficulties, and compliance problems and variables related to noncompliance. The article also reviews the special problems of pediatric and adolescent transplant recipients. The need for empirically supported interventions is noted in each of the problem areas. The author outlines problems with previous research studies that hamper solid interpretations of the data, and discusses literature suggesting that the psychosocial problems of transplant candidates and recipients are likely to be underreported. The article concludes with recommendations about the need to switch research efforts toward intervention studies in the problem areas already solidly identified by the literature.

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Section: Organ Shortages and Psychosocial Implicationsmentioning

confidence: 99%

Psychosocial aspects of the organ transplant experience: What has been established and what we need for the future

Engle¹

2001

J Clin Psychol

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“…All the steps that are taken to perform liver support using a xenoperfusion system must be considered according to the guidelines of the WHO and the FDA regarding xenotransplantations to humans. 63,64 Other important problems in artificial liver support using xenoperfusion are the evaluation of molecular incompatibility, and the occurrence of anaphylactoid reactions caused by heterologous products entering the patient's blood stream. A recent report indicated that pig livers perfused with human blood could clear the serum of potentially toxic human bile acids and excrete them into bile.…”

Section: Further Problems In the Clinical Application Of A Xenoperfusmentioning

confidence: 99%

“…In any case, to overcome these problems, close co‐operation between animal‐producing or animal‐handling facilities and medical facilities is indispensable. All the steps that are taken to perform liver support using a xenoperfusion system must be considered according to the guidelines of the WHO and the FDA regarding xenotransplantations to humans 63,64…”

Section: Aspects Of Artificial Liver Support By Xenoperfusion Using Pmentioning

confidence: 99%

Aspects of our liver support systems using extracorporeal xenoperfusion of pig or baboon liver: review

Sugiyama

Terajima

Ikai

et al. 2001

Journal of Hepato-Biliary-Pancreatic Surgery

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Artificial liver support systems using xenoperfusion of pig or baboon liver have metabolic activity and there is the possibility that they could substitute for total liver functions; however, several problems have yet to be solved. In our early clinical experience, a method of cross-hemodialysis with interposed cuprophane membrane was employed in order to avoid immunological reactions in patients. Sixteen patients with hepatic failure were treated by this method. Although the coma grade was ameliorated in 65% of the patients, the ultimate survival rate was 18.9%. In this clinical trial, the indication for liver support was clarified based on hepatic mitochondrial functions. This unsatisfactory result could also be attributed to insufficient effects of the device, due to the interposed membrane, and also to damage of the supporting livers due to hyperacute xenoperfusion injury. Recent investigations in the field of xenotransplantations have shown us possibilities for controlling xenogeneic hyperacute rejection. Suppression of complement activation enabled long-term xenoperfusion of supporting livers with high metabolic activity. The administration of prostaglandin E1 or soluble complement receptor type 1, and the use of transgenic pig livers expressing human decay-accelerating factor, may be promising methods to establish highly active artificial liver support systems using xenoperfusion.

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“…This results in complement activation, destroying the vascular endothelium of a porcine xenograft within minutes of implantation. 7 Retroviruses budding from normal pig cells also bear surface ␣-gal residues, rendering them susceptible to lysis by the ␣-galspecific antibody and complement found in normal human serum. The sensitivity of pig cell-derived PERV to inactivation and lysis by human serum has been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Xenogeneic Infections and Public Health

Chapman¹

1999

Clin Exp Pharma Physio

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1. The scarcity of available human donor organs for use in allotransplantation has fuelled interest in xenotransplantation, the therapeutic use of living animal tissue in humans. The use of living animal tissue for therapeutic purposes in humans has raised concerns that xenotransplantation clinical trials may pose a presently unquantifiable but undeniable risk to public health. 2. Xenotransplantation has the potential to introduce new infections to the human community by infecting human recipients with agents that were not previously endemic in human populations (xenogeneic infections). 3. Manipulations intended to prevent xenograft rejection may also facilitate the transmission of agents that rarely or never infect humans under natural circumstances. 4. The US Food and Drug Administration (the government agency responsible for monitoring drug safety) has chosen to allow limited numbers of xenotransplantation clinical trials to proceed under carefully monitored conditions outlined in the Public Health Service (PHS) Guideline on Infectious Disease Issues in Xenotransplantation. 5. This PHS guideline particularly emphasizes the importance of pretransplantation screening and post-transplantation surveillance for safety monitoring. 6. Laboratory based surveillance for endogenous retroviruses and other identifiable agents that cannot be removed from the xenograft can augment clinical surveillance. 7. Laboratory based studies of xenograft survivors increase our ability to quantify xenotransplant-associated risks and, thereby, expand our capacity to make science-based assessments of appropriate public policy.

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Xenotransplantation: the potential and the challenges

Cited by 10 publications

References 0 publications

Psychosocial aspects of the organ transplant experience: What has been established and what we need for the future

Psychosocial aspects of the organ transplant experience: What has been established and what we need for the future

Aspects of our liver support systems using extracorporeal xenoperfusion of pig or baboon liver: review

Xenogeneic Infections and Public Health

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