Integrative analysis of swine infectious diseases in the context of xenotransplantation.

Abstract

BACKGROUND: The initiation of clinical pig xenotransplantation trials offers the prospect of alleviating global organ shortage. However, current knowledge of swine-derived microorganisms relevant to xenotransplantation remains fragmented due to the limited availability of data on infections. OBJECTIVE: This review provides a comprehensive understanding of risks posed by porcine pathogens in xenotransplantation by integrating their pathogenic characteristics with transplantation relevance. METHODS: The xenosis potential of swine pathogens was assessed based on their epidemiology and biological characteristics following the PRISMA guidelines using data from over 4500 publications and multiple global pathogen databases. RESULTS: Documented cases of zoonotic transmission in both allotransplantation and xenotransplantation should be addressed as a priority. In particular, these include known xenozoonotic pathogens such as porcine cytomegalovirus, as well as common pig zoonoses that have demonstrated donor-derived transmission in allotransplantation. Meanwhile, biosafety considerations in xenotransplantation must take into account the potential impact of hyper-virulent pig-specific pathogens on donor organs. Notably, periodic reassessment of xenosis risks from donor pigs is imperative given the continued emergence and re‑emergence of pathogens and the increasing zoonotic potential of pig‑specific agents. CONCLUSION: Our review summarizes the pig microbiota and discusses their relationship with xenotransplantation; however, it remains challenging to accurately predict how most porcine microorganisms will behave in the context of xenotransplantation based on the limited available evidence.