Current status of corneal xenotransplantation

• Corneal xenotransplantation may solve the donor shortage.
• Corneal xenografts are challenged by immunobiological barriers.
• Corneal xenotransplantation in nonhuman primates show encouraging results.
• Consensus on clinical trials for corneal xenotransplantation have been established.

Corneal allo-transplantation is a well-established technique to treat corneal blindness. However, the limited availability of human donors demands the exploration of alternative treatments such as corneal xenotransplantation (e.g., pigs as donors) and bioengineered corneas. Since the first attempt of corneal xenotransplantation using a donor pig cornea in 1844, great advances have been made in the development of genetically-engineered pigs, effective immunosuppressive protocols and the establishment of guidelines for the conduction of clinical trials. We highlight immunological and physio-anatomical barriers of corneal xenotransplantation, recent progress of corneal xenotransplantation in non-human-primates studies, and regulatory guidelines to conduct clinical trials for corneal xenotransplantation.