REVIEW article
Front. Nephrol.
Sec. Kidney Transplantation
Xeno Kidney: Revolutionizing Kidney Disease Treatment
Provisionally accepted
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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The prevalence of end-stage kidney failure has been exponentially increasing, leading to a gross mismatch between the number of patients who may benefit from transplantation and the limited supply of suitable donor organs. Since renal transplantation remains a viable and most effective option for end-stage disease, the fact remains that the availability of eligible human donor organs is highly unlikely to meet the projected demand. This undermines the need for alternative strategies, including therapies and the development of transplant substitutes. In this context, xenotransplantation has emerged as a lucrative avenue for renal failure patients struggling to obtain a suitable graft in time. The pig is currently, the most preferred animal donor for kidney, because of their physiological analogies to humans. Nevertheless, xenotransplantation is associated with certain complications as well, these broadly include the risk of hyperacute rejection mediated by pre-existing antibodies to xenogeneic antigens, the stimulation of innate immune responses, and thereby possibility of chronic rejection. Recent advances in xenotransplantation research offers hope in overcoming these roadblocks and transforming the field of nephrology in the coming years. Genetic engineering has enabled to create low immunogenicity grafts from donor pigs, including GalTKO (lacking α-Gal epitopes/Galactose-α-1,3-galactose knockout) and gene knockouts that limit the complement system activation and clot formation. Furthermore, advances in immunosuppressive regimens, such as costimulation blocking and anti-complement treatment, hold great promise for xenograft acceptance and long-term results. In addition, numerous strategies are being explored to induce tolerance, such as mixed chimerism or regulatory T-cell therapy, to achieve a condition of acceptable graft tolerance without dependency on life-long immunosuppressive treatments. Collectively, these developments support the translational potential of xenotransplantation as a standalone or adjunct to standard renal replacement therapies. Despite the setbacks, ongoing preclinical research and early clinical trials are expected to refine safety, durability and clinical applicability in a xeno transplantation setting.
Keywords: clinical trials, Genetic modifications, immunosuppressive, Kidney, nonhuman primates, Transgenic Animals, Xenoantigen, xenotransplantation
Received: 17 Sep 2025; Accepted: 27 Jan 2026.
Copyright: © 2026 Makkar, Gakhar and Rakha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aruna Rakha
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