Porcine xenotransplantation in the clinical era: converging advances and unresolved barriers on the path to clinical translation - a narrative review

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Porcine xenotransplantation offers a scalable alternative to human allotransplantation amid a global organ donor shortage.
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Advancements in genetic modification and immunomodulation have improved graft survival and reduced rejection in porcine models.
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Successful pig-to-human heart and kidney transplants have been achieved, demonstrating early clinical translation of porcine xenotransplantation.
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Challenges such as antibody-mediated rejection and regulatory issues remain significant barriers to the widespread application of porcine xenotransplantation.
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Complementary models, including pig-to-pig transplantation and human-to-pig chimerism, are being explored to enhance immune tolerance and graft compatibility.

Frontiers In Immunology

by Douglas Henderson, Leonard Knoedler, Olivier Mathieu, Nathalie Rouas-Freiss, Curtis L. Cetrulo, Gilles Lemaitre, David M. Smadja, Nicolas O. Fortunel, Alexandre G. Lellouch
June 15, 2026

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