World’s First Pig-to-Human Liver Xenotransplant in a Living Recipient Reported in the Journal of Hepatology

An important new study in the Journal of Hepatology,published by Elsevier, reports the world’s first auxiliary liver xenotransplant from a genetically engineered pig to a living human recipient. The patient survived for 171 days, offering proof-of-concept that genetically modified porcine livers can support key metabolic and synthetic functions in humans, while also underscoring the complications that currently limit long-term outcomes.

According to the World Health Organization, thousands of patients die every year while waiting for organ transplants due to the limited supply of human organs. In China alone, hundreds of thousands experience liver failure annually, yet only around 6,000 people received a liver transplant in 2022. This pioneering case offers a potential new avenue to bridge the gap between organ demand and availability.

The case involved a 71-year-old man with hepatitis B-related cirrhosis and hepatocellular carcinoma who was not eligible for resection or human liver transplantation. Surgeons implanted an auxiliary graft from a genetically modified Diannan miniature pig with 10 gene edits, including xenoantigen knockouts and human transgenes to enhance immune and coagulation compatibility.

For the first month after surgery, the graft functioned effectively, producing bile and synthesizing coagulation factors, with no evidence of hyperacute or acute rejection. However, on day 38, the graft was removed following the development of xenotransplantation-associated thrombotic microangiopathy (xTMA), a serious complication related to complement activation and endothelial injury. Treatment with the complement inhibitor eculizumab and plasma exchange successfully resolved the xTMA. Despite this, the patient later experienced repeated episodes of upper gastrointestinal hemorrhage and passed away on day 171.

“This case proves that a genetically engineered pig liver can function in a human for an extended period,” explained lead investigator Beicheng Sun, MD, PhD, Department of Hepatobiliary Surgery, and President of the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China. “It is a pivotal step forward, demonstrating both the promise and the remaining hurdles, particularly regarding coagulation dysregulation and immune complications, that must be overcome.”

“This report is a landmark in hepatology,” commented Heiner Wedemeyer, MD, Co-Editor, Journal of Hepatology, and Department. of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany, in an accompanying editorial.“It shows that a genetically modified porcine liver can engraft and deliver key hepatic functions in a human recipient. At the same time, it highlights the biological and ethical challenges that remain before such approaches can be translated into wider clinical use. Xenotransplantation may open completely new paths for patients with acute liver failure, acute-on-chronic liver failure, and hepatocellular carcinoma. A new era of transplant hepatology has started.”

“The publication of this case reaffirms the Journal of Hepatology as the world’s leading liver journal. We are committed to presenting cutting-edge translational discoveries that redefine what is possible in hepatology,”added Vlad Ratziu, MD, PhD, Editor in Chief, Journal of Hepatology, and Institute for Cardiometabolism and Nutrition, Sorbonne Université and Hospital Pitié Salpêtrière, Paris, France.

Notes for editors

The article is “Genetically Modified Porcine-to-Human Liver Xenotransplantation,” by Wenjie Zhang, Qingxiang Xu, Kaixiang Xu, Runqiu Jiang, Shouyu Wang, Meijuan Zheng, Nian Liu, Deling Jiao, Zhangding Wang, Jian Ge, Xianfu Lu, Guoqiang Li, Fan Huang, Lei Liu, Yin Yin, Yang Liu, Jianxiong Guo, Kai Liu, Hong-Jiang Wei, Beicheng Sun (https://doi.org/10.1016/j.jhep.2025.08.044).

The article is openly available for 60 days at https://www.journal-of-hepatology.eu/article/S0168-8278(25)02497-3/fulltext.

Journalists wishing to interview the authors should contact Beicheng Sun, MD, PhD, at [email protected].

The editorial is “The First Human Xenogeneic Liver Transplantation – A Landmark Event, But What Does It Mean for Hepatology?” by Heiner Wedemeyer, Frank Tacke, Phil Newsome, and Vlad Ratziu (https://doi.org/10.1016/j.jhep.2025.09.015).

The editorial is openly available for 60 days at https://www.journal-of-hepatology.eu/article/S0168-8278(25)02496-1/fulltext.

To reach the authors for comment contact Heiner Wedemeyer, MD, at [email protected].

The article and editorial appear online in advance of the Journal of Hepatology, volume 84, issue 3 (March 2026), published by Elsevier.

About the Journal of Hepatology

The Journal of Hepatology, the premier journal devoted to liver diseases, is the official journal of the European Association for the Study of the Liver (EASL). It publishes original papers, reviews, case reports, and letters to the Editor concerned with clinical and basic research in the field of hepatology. The journal has a 2024 Impact Factor of 33 (Source: Journal Citation Reports™ from Clarivate, 2025). www.journal-of-hepatology.eu

About EASL

In the fifty plus years since EASL was founded, it has grown from a small organization that played host to 70 participants at its first meeting, to becoming the leading international liver association. EASL attracts the foremost hepatology experts as members and has an impressive track record in promoting research in liver disease, supporting wider education, and promoting changes in European liver policy. www.easl.eu

About Elsevier

Elsevier is a global leader in advanced information and decision support. For over a century, we have been helping advance science and healthcare to advance human progress. We support academic and corporate research communities, doctors, nurses, future healthcare professionals and educators across 170 countries in their vital work. We do this by delivering mission-critical insights and innovative solutions that combine trusted, evidence-based scientific and medical content with cutting-edge AI technologies to help impact makers achieve better outcomes. We champion inclusion and sustainability by embedding these values into our products and culture, working with the communities that we serve. The Elsevier Foundation supports research and health partnerships around the world.

Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. For more information, visit www.elsevier.com and follow us on social media @ElsevierConnect.