Immunosuppressive and Non-Immunosuppressive Drugs for Heart Xenotransplantation in Humans: Is Europe Ready?

Xenotransplantation is becoming an emerging field of interest for the treatment of end-stage heart disease. In fact, the shortage of human heart donors in European countries requires the increasing investigation of alternative strategies such as heart xenotransplantation. Among different limitations in this peculiar field, the experimental pharmacological management of patients who undergo heart xenotransplantation is primarily narrowed by the indications for which these drugs have been previously authorized by international medicines agencies. In fact, many of these medications have been never authorized for transplant rejection therapy, or for xenotransplantation, but their mechanism of action might stop the molecular pathways which are involved in xenograft antibody-mediated rejection. Additionally, drugs costs and supply can restrict their availability for xenotransplantation practice. The aim of this review is to describe the current drugs which have been used in the clinical cases of heart xenotransplantation performed to date, to analyze the indications for which they are authorized, and to evaluate the future medications which might be implemented in heart xenotransplantation field, with a particular focus on the European scenario.