Xenotransplantation in living human recipients: Where we stand in 2026: Vital Insights into Xenotransplantation.

Xenotransplantation has emerged as a potential solution to the persistent shortage of donor organs for patients with end-stage organ failure. After decades of preclinical work, recent advances in genetic engineering, immunosuppression, and perioperative management have enabled the first clinical xenotransplant procedures in living human recipients. This inaugural AJT XenoPulse review summarized the current peer-reviewed experience with cardiac, renal, and hepatic xenografts performed under compassionate-use or early clinical trial frameworks. Two porcine heart transplants demonstrated technical feasibility and short-term physiological support but were ultimately limited by antibody-mediated rejection and infectious complications. A genetically engineered porcine kidney transplant achieved immediate function and dialysis independence, with rejection successfully treated, although the recipient later died from an unrelated arrhythmia. The first auxiliary porcine liver xenotransplant showed early synthetic activity, but rejection and thrombotic microangiopathy led to graft explantation. Collectively, these early cases confirm the technical feasibility of clinical xenotransplantation while highlighting key challenges, including humoral immunity, infection, physiological incompatibilities, and optimal patient selection. These initial experiences provide critical insights that will guide iterative improvements in donor design, immunosuppressive strategies, and clinical trial protocols as the field advances toward broader clinical application.