Mapping the evolution of solid organ xenotransplantation research: A systematic review
Ivana Juric1,2, Marc Raynaud1, Lea Skoric15, Solaf Al-Awadhi16, Agathe Truchot1, Marta Sablik1, Xiaoqian Ma3, Kaikai Lv4, Huanxi Zhang4, Kevin Louis1, Nikolina Basic-Jukic2, Renaud Tissier5, Thierry Hauet6, Emanuele Cozzi7, Gabriel Oniscu8, Massimo Mangiola9, Joseph Tector10, Leonardo Riella11, Jayme Locke12, Didier Samuel14, Raphaël Meier13, Muhammad Mohiuddin13, Robert Montgomery9, Alexandre Loupy1.
1PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité,, INSERM, Paris, France; 2Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, Croatia; 3Institute for Cell Transplantation and Gene Therapy, the 3rd Xiangya Hospital of Central South University, Changsha, People's Republic of China; 4Organ Transplant Center, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; 5IMRB, Ecole Nationale Vétérinaire d'Alfort, Paris, France; 6INSERM IRMETIST U1313, Université de Poitiers, Paris, France; 7Transplant Immunology Unit, Padua University Hospital-Ospedale Giustinianeo, Padova, Italy; 8Transplantation Surgery Division, Karolinska Institutet, Stockholm, Sweden; 9NYU Langone Transplant Institute, NYU Langone Health, New York, United States; 10Miami Transplant Institute, University of Miami School of Medicine, Miami, United States; 11Transplant Center, Massachusetts General Hospital, Boston, United States; 12Department of Surgery, University of Alabama at Birmingham, Birmingham, United States; 13Department of Surgery, University of Maryland School of Medicine, Baltimore, United States; 14Inserm research unit 1193, Université Paris-Saclay, Paris, France; 15Medical School University of Zagreb, Medical School University of Zagreb, Zagreb, Croatia; 16Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Huston, United States
INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité.
Introduction: Xenotransplantation has emerged as a promising solution to address organ shortage, generating numerous publications. To date, no studies have analyzed the dynamics of xenotransplantation research. We aimed to provide a systematic assessment of xenotransplantation publication activity.
Methods: A systematic literature search was conducted in PubMed, with a search period limited only with the end date, November 22, 2024. Publications written in English were included, with no limitation on study design or publication type. Eight independent reviewers screened the publications retrieved with a search. Studies on xenotransplantation of solid organs and islets of Langerhans from animals to humans, or perfusion with human blood and its derivate were included. For each included publication, following data were collected: (1) publication basic information including title, date of publication, affiliated country of the first author; (2) publishing journal; (3) publication type; (4) organ studied; (5) donor species studied; (6) topics covered.
Results: Among 2, 944 publications identified, 706 met the inclusion criteria. Among these, 291 were original articles (41.2%), 290 (41.1%) reviews, 101 (14.2%) publications without original data, 11 (1.6%) case reports, 9 (1.3%) research letters, and 4 (0.6%) systematic reviews and meta-analyses. Publication activity displayed two peaks: first in the 1990s, driven by the advancements in genetic engineering, mainly attributed to publications with original data, and the second in the early 2020s following the first pig-to-human deceased recipient transplantation, marked by a predominance of reviews and publications without original data. The top five publishing countries were the USA with 340 (48.2%), Germany with 72 (10.2%), UK with 38 (5.4%), Sweden with 34 (4.8%) and China with 30 (4.2%) of publications. Xenotransplantation journal accounts for 19.7% of all publication activity, while six transplantation journals together accounted for 27.6%, and general medical journals for 5.4%. Islets of Langerhans were studied in 23.1% studies, and the most studied organs were heart (21.2%), followed by kidney (17.1%), liver (12.2%) and lung (6.2%). A total of 356 topics were identified and grouped into 20 thematic groups. The most represented thematic groups were rejection (n=170), immune mechanisms (n=165), challenges (n=118), genetic engineering (n=115) and current research and prospects (n=97).
Conclusion: This study is the first systematic assessment of xenotransplantation research underscoring its growing global interest and evolving focus areas. The low proportion of publications with original data underscores the crucial need for original studies to advance the field forward. The limited presence of xenotransplantation research in general medical journals highlights the importance of engaging a broader audience as xenotransplantation nears clinical trials.
[1] xenotransplantation
[2] systematic review
[3] publication activity
[4] research trends
[5] transplantation