{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T11:04:56Z","timestamp":1764587096975,"version":"3.41.2"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institute of Health","doi-asserted-by":"publisher","award":["5P01AI045897"],"award-info":[{"award-number":["5P01AI045897"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["S10OD030282"],"award-info":[{"award-number":["S10OD030282"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Thymokidneys (TK) have been constructed to transplant life-supporting kidney grafts containing donor thymic tissue to induce transplant tolerance. Historically, TKs were constructed by inserting pieces of thymus tissue under the kidney capsule using an intra-abdominal or posterior retroperitoneal (lateral\/flank) approach. The intra-abdominal approach is technically easier but causes intra-abdominal adhesions and makes kidney procurement more challenging. The posterior retroperitoneal approach causes fewer complications, but thymus tissue implantation is technically demanding due to limited visibility and exposure of the kidney. We herein describe the anterior retroperitoneal approach that overcomes these challenges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>8-week-old GalTKO-swine (<jats:italic>n<\/jats:italic>\u2009=\u20092) were sedated, intubated, and draped. Cervical thymus lobes were isolated and excised. Via a small midline abdominal incision, the peritoneum was dissected bilaterally from the abdominal muscles, identifying both kidneys without entering the peritoneal cavity. Multiple thymus pieces were inserted under the kidney capsule. After 8 weeks, TKs were recovered for flow cytometric and histopathological analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all kidneys, we successfully constructed TKs with functional thymus tissue under the kidney capsule, verified by histopathology and flow cytometry. No surgical complications were observed, and no adhesions were observed intra-abdominally nor around the kidney, as the peritoneum covered the implanted tissue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The anterior retroperitoneal approach to constructing thymokidneys is easy to perform, offers excellent kidney exposure, allows a larger volume of thymus tissue to be implanted, and decreases the risk of intra-abdominal adhesions. Such constructed TKs are easy to procure with minimal risk of injury to the vascularized thymus as the prerenal peritoneum covers it.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frtra.2024.1473281","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T06:22:15Z","timestamp":1731565335000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Anterior retroperitoneal approach in constructing thymokidney organs in swine for xenotransplantation"],"prefix":"10.3389","volume":"3","author":[{"given":"M. Esad","family":"Gunes","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Wolbrom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sho","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Qudus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Cadelina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Nowak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1038\/s41581-022-00624-6","article-title":"Progress in xenotransplantation: overcoming immune barriers","volume":"18","author":"Sykes","year":"2022","journal-title":"Nat Rev Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"eaau6298","DOI":"10.1126\/sciimmunol.aau6298","article-title":"Transplanting organs from pigs to humans","volume":"4","author":"Sykes","year":"2019","journal-title":"Sci Immunol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/MOT.0000000000000795","article-title":"Progress towards xenogenic tolerance","volume":"25","author":"Duggan","year":"2020","journal-title":"Curr Opin Organ Transplant"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2669","DOI":"10.1111\/j.1600-6143.2009.02849.x","article-title":"Results of gal-knockout porcine thymokidney xenografts","volume":"9","author":"Griesemer","year":"2009","journal-title":"Am J Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1097\/01.tp.0000184445.70285.4b","article-title":"Vascularized thymic lobe transplantation in a pig-to-baboon model: a novel strategy for xenogeneic tolerance induction and T-cell reconstitution","volume":"80","author":"Yamamoto","year":"2005","journal-title":"Transplantation"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1097\/00007890-199912150-00011","article-title":"Thymic transplantation in miniature swine. 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