Baboon-to-human cardiac xenotransplantation in a neonate

TLDR

Cardiac allotransplantation and baboon‑to‑human xenotransplantation are being explored as investigational therapies for neonatal hypoplastic left heart syndrome (HLHS). This study reports the first baboon‑to‑human cardiac xenotransplantation in a newborn with HLHS. The authors performed pre‑transplant immunologic testing of donor and recipient, then monitored the patient’s pre‑ and post‑operative course until death 20 days after surgery. The infant survived 20 days, but autopsy showed only minimal cell‑mediated rejection while a progressive humoral response led to graft failure, indicating that baboon‑to‑human cardiac xenotransplantation is technically feasible yet limited by immune rejection.

Abstract

This report details the first case of cardiac xenotransplantation in a neonate. The recipient, a victim of hypoplastic left heart syndrome (HLHS), survived 20 days. Autopsy findings are documented. The cardiac graft showed only traces of cell-mediated rejection. Graft failure appears to have resulted from a progressive, potentially avoidable humoral response, unmodified by immunosuppression. Cardiac allotransplantation and selective baboon-to-human xenotransplantation deserve further exploration as investigational therapy for neonatal HLHS.The first transplantation of a baboon heart into a newborn (Baby Fae) with hypoplastic left heart syndrome (HLHS) is reported by the team involved in the operation. Details of the pretransplant immunologic testing of the organ recipient and potential baboon donors, and the pre-and post-operative course of the patient until her death 20 days after surgery are discussed. Autopsy findings showed only traces of cell-mediated rejection. Graft failure appears to have resulted from a progressive, potentially avoidable humoral response, unmodified by immunosuppression, perhaps as a result of crossing the ABO blood barrier. The authors believe that cardiac replacement by xenotransplantation is technically feasible and a reasonable investigative option for newborns with HLHS.