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However, there is a great limitation in the availability of deceased human cardiac donors of a suitable size. Hearts from genetically engineered pigs may provide an alternative source. The relatively immature immune system in infants (eg, absence of anti\u2010carbohydrate antibodies, reduced complement activation, reduced innate immune cell activity) should minimize the risk of early antibody\u2010mediated rejection of a pig graft. Additionally, recipient thymectomy, performed almost routinely as a preliminary to orthotopic heart transplantation in this age\u2010group, impairs the T\u2010cell response. Because of the increasing availability of genetically engineered pigs (eg, triple\u2010knockout pigs that do not express any of the three known carbohydrate antigens against which humans have natural antibodies) and the ability to diagnose congenital heart disease during fetal life, cardiac xenotransplantation could be preplanned to be carried out soon after birth. Because of these several advantages, prolonged graft survival and even the induction of tolerance, for example, following donor\u2010specific pig thymus transplantation, are more likely to be achieved in infants than in adults. In this review, we summarize the factors in the infant immune system that would be advantageous in the success of cardiac xenotransplantation in this age\u2010group.<\/jats:p>","DOI":"10.1111\/petr.13795","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T17:29:11Z","timestamp":1599067751000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The immune system in infants: Relevance to xenotransplantation"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3100-0041","authenticated-orcid":false,"given":"Mohamed","family":"Bikhet","sequence":"first","affiliation":[{"name":"Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Morsi","sequence":"additional","affiliation":[{"name":"Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetaka","family":"Hara","sequence":"additional","affiliation":[{"name":"Xenotransplantation Program Department of Surgery University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie A.","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5460-9079","authenticated-orcid":false,"given":"Waldemar F.","family":"Carlo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cleveland","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovascular Surgery Children's Hospital of Alabama Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K. 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