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This chapter reviews the issue of xenotransplantation as a vector for infection to humans and considers potential mechanisms for disease, screening systems, and evaluations that need to be carried out to identify these risks as the field moves forward. Knowledge of donor-associated infections after allotransplantation and of zoonotic infections is used to help estimate the potential risk of xenotransplantation. Bacterial or fungal infections in the airway of the donor can lead to disease after lung or heart-lung transplantation, and histoplasmosis has been transmitted with cadaveric kidneys. These types of acute donor-associated infections can theoretically be less of a risk after xenotransplantation as source animals can be maintained under optimal healthy conditions and surgery would be performed on an elective schedule rather than under the current time pressures of allotransplantation. In an attempt to minimize the risk of xenozoonoses and to learn how to evaluate animal-associated infections after xenotransplantation, more extensive protocols began to be developed in the early and mid-1990s that continue to be expanded upon today. Some microbes, particularly viruses, are considered to be "species specific." If this is the case, it is possible that xenotransplantation carries less risk of donor-transmitted infections than does allotransplantation. Acute viremia can lead to donor-associated infections after allotransplantation and would likewise be expected to have the same risk after xenotransplantation. Xenotransplantation may have positive implications for decreasing the risk of some infections after transplantation.
Algorithm to determine whether to use infected animal tissue in transplantation.
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