Enhancing Kidney Transplantation and the Role of Xenografts: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

Andrew B Adams; Emily A Blumberg; John S Gill; Eliezer Katz; Tatsuo Kawai; Jesse D Schold; Megan Sykes; Alfred Tector; David H Sachs

doi:10.1053/j.ajkd.2023.12.025

Enhancing Kidney Transplantation and the Role of Xenografts: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

Am J Kidney Dis. 2024 Mar 5:S0272-6386(24)00629-2. doi: 10.1053/j.ajkd.2023.12.025. Online ahead of print.

Authors

Andrew B Adams¹, Emily A Blumberg², John S Gill³, Eliezer Katz⁴, Tatsuo Kawai⁵, Jesse D Schold⁶, Megan Sykes⁷, Alfred Tector⁸, David H Sachs⁹

Affiliations

¹ Department of Surgery, School of Medicine, University of Minnesota, Minneapolis, Minnesota.
² Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
³ Division of Nephrology, University of British Columbia, British Columbia, Vancouver, Canada.
⁴ eGenesis Bio, Cambridge, Massachusetts.
⁵ Massachusetts General Hospital, Harvard University, Boston, Massachusetts; Center for Transplantation Sciences, Harvard University, Boston, Massachusetts.
⁶ Department of Surgery and Epidemiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado.
⁷ Department of Medicine, Columbia Center for Translational Immunology, and Department of Medicine, Department of Microbiology and Immunology, and Department of Surgery; Columbia University, New York, New York.
⁸ DeWitt Daughtry Family Department of Surgery, School of Medicine, University of Miami, Miami, Florida.
⁹ Massachusetts General Hospital, Harvard University, Boston, Massachusetts; Medical School, Harvard University, Boston, Massachusetts; Columbia University Medical Center, New York, New York. Electronic address: dhs2142@cumc.columbia.edu.

PMID: 38452918
DOI: 10.1053/j.ajkd.2023.12.025

Abstract

Chronic kidney disease affects an estimated 37 million people in the United States; of these,>800,000 have end-stage renal disease requiring chronic dialysis or a kidney transplant to survive. Despite efforts to increase the donor kidney supply, approximately 100,000 people are registered on the kidney transplant wait-list with no measurable decrease over the past 2 decades. The outcomes of kidney transplantation are significantly better than for chronic dialysis: kidney transplant recipients have lower rates of mortality and cardiovascular events and better quality of life, but wait-list time matters. Time on dialysis waiting for a deceased-donor kidney is a strong independent risk factor for outcomes after a kidney transplant. Deceased-donor recipients with wait-list times on dialysis of<6 months have graft survival rates equivalent to living-donor recipients with waitlist times on dialysis of>2 years. In 2021,>12,000 people had been on the kidney transplant waitlist for ≥5 years. As the gap between the demand for and availability of donor kidneys for allotransplantation continues to widen, alternative strategies are needed to provide a stable, sufficient, and timely supply. A strategy that is gaining momentum toward clinical application is pig-to-human kidney xenotransplantation. This report summarizes the proceedings of a meeting convened on April 11-12, 2022, by the National Kidney Foundation to review and assess the state of pig-to-human kidney xenotransplantation as a potential cure for end-stage renal disease.

Keywords: Donor kidneys; end-stage kidney disease; xenotransplantation.