Xijing Hospital Team Publishes World's First Research on Xenogeneic Orthotopic Whole Liver Transplantation

Background

The worldwide demand for liver transplants far exceeds the supply of human donor organs. Xenotransplantation, the use of organs from a different species, is one area of research aimed at addressing this shortage. Pigs are often studied because of similarities in organ size and physiology with humans, though immune rejection and physiological compatibility present major challenges, especially for the complex liver.

What was achieved

Xijing Hospital's team led by Chinese Academy of Sciences Academician Dou Kefeng published a paper in Nature Biomedical Engineering reporting the first orthotopic pig-to-human liver xenotransplantation in a brain-dead recipient. The paper, published online in September 2026, details results from a six-gene-edited porcine liver that survived for an 11-day observation period after the recipient's own liver was completely removed.

During this period the xenograft maintained continuous albumin synthesis and secretion, demonstrating protein production function. It also produced bile continuously with normal biochemical composition, although secretion levels were relatively low compared to a native human liver and insufficient for full functional replacement. The study characterized the rejection mechanism as involving immune injury, liver sinusoidal endothelial activation and coagulation disorder. Histopathology showed minimal T and B lymphocyte infiltration and limited IgG deposition, indicating effective control of adaptive immunity, with innate immune cells as the primary mediators. Co-corresponding authors include Dou Kefeng, Tao Kaishan, Wang Lin and Pan Dengke. Co-first authors include Tao Kaishan, Yang Zhaoxu, Zhang Xuan, Zhang Hongtao and Lin Zhibin.

How it works

In orthotopic whole liver xenotransplantation the recipient's native liver is surgically removed and the donor organ is placed in the identical anatomical position. Blood vessels are connected to restore inflow via the portal vein and hepatic artery and outflow via hepatic veins, along with bile duct management to allow drainage. The six-gene-edited pig liver was used to reduce antigenicity and improve compatibility.

Conducted in a brain-dead recipient with maintained systemic support, the procedure permitted close monitoring without risk to a living patient. Upon reperfusion the liver produced bile immediately. Over 11 days, clinicians tracked albumin levels, bile composition, coagulation parameters including thrombocytopenia and clotting factor activity, hemodynamics and perfusion via imaging. Tissue analysis at the end of observation documented endothelial activation, microthrombosis contributing to later perfusion decline, and immune cell involvement. This decedent model isolated the xenograft's independent performance and provided data on the specific rejection pathway observed.

What it means for international patients

The research advances understanding of whether gene-edited pig livers can sustain core liver functions in a human orthotopic setting, offering insights relevant to the global organ shortage affecting patients with liver failure. As this was a research study in a brain-dead model, sources do not report it as a current clinical treatment option for living patients.

Xijing Hospital maintains an international ward and provides services for foreign patients including English-speaking coordinators for registration, interpretation and case management. The hospital has experience with patients from regions such as the Middle East, Central Asia and Southeast Asia. International patients interested in the hospital's hepatobiliary or transplantation expertise should contact the facility directly to confirm eligibility, current programs and any requirements, as suitability must be assessed individually.

About the hospital

Xijing Hospital, officially the First Affiliated Hospital of Air Force Medical University (also referred to as Fourth Military Medical University), is a Class A tertiary comprehensive hospital located at No. 127 Changle West Road, Xincheng District, Xi'an, Shaanxi Province. Its predecessor dates to 1939 and it integrates medical treatment, teaching, scientific research and prevention.

With approximately 2,600 beds it serves as a referral center for complex diseases in northwest China. It hosts national key disciplines and clinical specialties with recognized strengths in hepatobiliary surgery, organ transplantation, digestive diseases and related research institutes. The Department of Hepatobiliary Surgery led the reported xenotransplantation study.