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Heterotopic intrathoracic fox-to-dog heart transplants remained beating (but not working) for an average of 20 days using cyclosporine and cortisone.5,6 In contrast, PNABs were augmented across divergent species (discordant systems); corresponding experiments yielded discouraging results since the grafts never functioned longer than a few hours, in spite of aggressive additional treatments with either lymphatic drainage or plasmapheresis.7 Both Brendel and Hammer were therefore convinced "that concordant non-human primate to human xenotransplantation would ultimately become a clinical reality", but in their opinion, discordant procedures would remain unrealistic. Intrathoracic heterotopic heart transplantation was clinically introduced by Christiaan Barnard 50 years ago,44,45 whereby the donor organ is placed within the right chest and next to the recipient heart. GLO:FSO/01nov20:xen12637-fig-0002.jpg PHOTO (COLOR): 2 Post-mortem frontal view after heterotopic intrathoracic pig-to-baboon heart transplantation (porcine transplant to the right of the recipient organ; pulmonary end-to-side anastomosis with interposition graft shown): note transplant overgrowth on post-operative day 19, it was initially smaller than the recipient heart (from48; at that time we could not explain the phenomenon) gl Taken together, we concluded that intrathoracic heterotopic xenogeneic heart transplantation would be a useful clinical tool provided an immunosuppression was less toxic. [Extracted from the article]