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Clinical studies described graft physiology, immune infiltration, complement activation, coagulation incompatibility, and early function in living recipients, decedent models, and clinical islet xenotransplantation, including the first orthotopic multi\u2010organ decedent xenotransplantation model. Additional preclinical studies in pigs and nonhuman primates on kidney, heart, islets, and blood product models used more advanced engineering of donor organs, including up to ten genetic edits. They identified persistent issues such as thrombotic microangiopathy, renin\u2010angiotensin\u2010aldosterone system dysregulation, and hemolysis\u2010induced ferroptosis. 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