{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:40:39Z","timestamp":1785328839305,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T00:00:00Z","timestamp":1529625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81470608"],"award-info":[{"award-number":["81470608"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Xenotransplantation"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In current non\u2010human primate models, full\u2010thickness porcine grafts could not achieve long\u2010term survival without using potent systemic immunosuppressors. Moreover, the thickness disparity in xeno\u2010<jats:styled-content style=\"fixed-case\">PKP<\/jats:styled-content> proved to be hard to manipulate and may cause several complications which also could prevent the grafts from long survival. Considering the advantages of Descemet's stripping automated endothelial keratoplasty (<jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content>) derived from its ultrathin graft and lower rejection rate, we hypothesize xeno\u2010<jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> may overcome these imperfections in xeno\u2010<jats:styled-content style=\"fixed-case\">PKP<\/jats:styled-content>. The aim of this study was to explore the feasibility and efficacy of xeno\u2010<jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> and to investigate the possibility of long\u2010term survival of porcine <jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> grafts only using local immunosuppressors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nine rhesus monkeys were divided into two groups. In the <jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> group (n\u00a0=\u00a07), Descemet's membrane stripping was performed to establish the bullous keratopathy model followed by the endothelial graft transplant. In the control group (n\u00a0=\u00a02), only <jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content> stripping was performed. Betamethasone 3.5\u00a0mg was injected subconjunctivally every 10 days for a total of 10 times in the <jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> group. After the surgery, all grafts were evaluated by slit lamp microscopy for at least 6\u00a0months. In addition, anterior segment optical coherence tomography (<jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">OCT<\/jats:styled-content>) and confocal laser microscopy (<jats:styled-content style=\"fixed-case\">CLM<\/jats:styled-content>) were hired to evaluate the graft attachment and survival. To investigate the rejection mechanism for xeno\u2010<jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content>, pathological and immunity examinations, including immunohistochemistry, immunofluorescence, T\u2010cell subgroups, cytokine concentration, and anti\u2010<jats:styled-content style=\"fixed-case\">GAL<\/jats:styled-content> antibodies, were performed and compared between the survived and rejected grafts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the control group, the corneal opacity gradually increased with the development of corneal swelling and neovascularization. In the <jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> group, five recipients (n\u00a0=\u00a05\/7) re\u2010established their transparencies within 30\u00a0days after xeno\u2010<jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content>, and four grafts survived &gt;180\u00a0days (&gt;180, &gt;180, &gt;298, &gt;270) only by injecting betamethasone subconjunctivally, whereas two grafts (n\u00a0=\u00a02\/7) rejected in 30\u00a0days. The <jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">OCT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CLM<\/jats:styled-content> showed the survived grafts attached firmly to the host beds, and the endothelial cell density was adequate (&gt;2000cells\/mm<jats:sup>2<\/jats:sup>) to maintain the graft function at post\u2010operative month 6. The immunohistochemistry showed predominantly T cells (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4+ and <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>8+) and macrophages infiltrated in the rejected grafts, although a few B cells (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>20+) were also observed. Moreover, immunofluorescence demonstrated donor\u2010specific antibody (IgG) and complement (C3c) were also involved in the immune rejection. However, T\u2010cell subgroups and cytokine concentrations (except for <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106) showed no significant differences between the rejected and survived grafts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Xeno\u2010<jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> is feasible and effective, and the technique may reduce the complications common to xeno\u2010<jats:styled-content style=\"fixed-case\">PKP<\/jats:styled-content>. More importantly, the porcine <jats:styled-content style=\"fixed-case\">DSAEK<\/jats:styled-content> grafts could survive for a long term without using systemic immunosuppressors and exhibit promising future for clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/xen.12433","type":"journal-article","created":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T09:31:15Z","timestamp":1529659875000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Porcine endothelial grafts could survive for a long term without using systemic immunosuppressors: An investigation of feasibility and efficacy of xeno\u2010Descemet's stripping automated endothelial keratoplasty from <scp>WZS<\/scp>\u2010pig to rhesus monkey"],"prefix":"10.1111","volume":"26","author":[{"given":"Yang","family":"Liu","sequence":"first","affiliation":[{"name":"Beijing Tongren Eye Center Beijing Tongren Hospital Capital Medical University Beijing 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