Kidney transplantation is the treatment of choice for patients with kidney failure, but the shortage of donor organs continues to limit access. Despite many advances, long-term dialysis is still associated with high morbidity, poor quality of life, and excess cardiovascular risk, and many patients die before receiving a transplant. These challenges have renewed interest in xenotransplantation as a potential approach to expand the organ supply. In recent years, genetically engineered pig kidneys have shown promise in preclinical nonhuman primate studies and in short-term experiments in brain-dead human recipients (decedent model).