title: Life-supporting pig-to-baboon heart xenotransplantation.
abstract: BACKGROUND
  The aim of this study was to investigate the effect of the expression of human decay-accelerating factor in transgenic pigs on hyperacute rejection in a pig-to-baboon heterotopic heart transplantation model and to assess the ability of such transgenic pig hearts in supporting the life of a primate when transplanted orthotopically.
  
  
  METHODS
  Hearts from pigs transgenic for human decay-accelerating factor were transplanted heterotopically (n = 3) and orthotopically (n = 5) into the baboon. All animals received cyclosporine, steroids, and cyclophosphamide. Blood was sampled regularly for total antipig antibody titers, trough cyclosporine levels, full blood count, electrolytes, and creatinine. Rejection of the heterotopic hearts was defined as the absence of palpable cardiac pulsation. Explanted hearts were examined histologically with hematoxylin and eosin and with immunochemistry for complement components C3, C4, C9, and immunoglobulin M.
  
  
  RESULTS
  None of the hearts were hyperacutely rejected. In the heterotopic group one heart underwent acute vascular rejection on day 13, and the remaining two recipients with beating xenografts were killed on days 2 and 21. In the orthotopic group, one recipient with a life-supporting xenograft was killed on day 9 because of poor general condition. Histologic examination demonstrated no evidence of rejection. Two xenografts stopped beating on day 5, and histologic study showed acute vascular rejection in both. There were also two graft failures for technical reasons in this group.
  
  
  CONCLUSIONS
  Hyperacute rejection is abrogated in pig-to-baboon heart xenotransplantation with the expression of the human decay-accelerating factor transgene. The human decay-accelerating factor transgenic pig heart is able to support primate life for a prolonged period.
authors.affiliation: Department of Surgery, University of Cambridge and Papworth Hospital, United Kingdom.
authors.forename: P D
authors.initials: PD
authors.lastname: Waterworth
authors.forename: J
authors.initials: J
authors.lastname: Dunning
authors.forename: M
authors.initials: M
authors.lastname: Tolan
authors.forename: E
authors.initials: E
authors.lastname: Cozzi
authors.forename: G
authors.initials: G
authors.lastname: Langford
authors.forename: G
authors.initials: G
authors.lastname: Chavez
authors.forename: D
authors.initials: D
authors.lastname: White
authors.forename: J
authors.initials: J
authors.lastname: Wallwork
mesh_terms: D000818:Animals; D030801:Animals, Genetically Modified; D018958:CD55 Antigens / Q000032:analysis / Q000235:genetics; D003186:Complement C9 / Q000032:analysis; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology; D007075:Immunoglobulin M / Q000032:analysis; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D010215:Papio; D013552:Swine; D014183:Transplantation, Heterologous / Q000276:immunology; D016042:Transplantation, Heterotopic
chemical_list: D018958:CD55 Antigens; D003186:Complement C9; D007075:Immunoglobulin M