Study of ChoironeX GalKO Porcine Thymokidney Xenotransplantation in End-Stage Renal Disease

Inclusion Criteria * ESRD receiving hemodialysis or peritoneal dialysis for ≥6 months * Eligible for kidney transplantation per site criteria * \<50% likelihood of receiving a standard deceased-donor kidney transplant within 12 months * Blood type and immunologic compatibility with study transplant confirmed by testing * EBV seropositive * Up to date on recommended vaccinations for immunocompromised individuals * Willing to use protocol-required contraception * Able to provide informed consent and comply with lifelong follow-up Exclusion Criteria: * Requirement for multi-organ transplantation * Living donor available who is ABO-incompatible * Kidney disease with high risk of post-transplant recurrence * Polycystic kidney disease without prior native nephrectomy * Unable or unwilling to comply with study procedures * History of non-adherence to medical treatment * Identified as vulnerable by psychological assessment * Significant uncontrolled psychiatric illness * Inadequate social support or caregiver unavailable/unwilling * Current drug or alcohol misuse * Serious non-renal illness with life expectancy \<1 year * BMI \<16 or \>35 kg/m² * Known hypercoagulable disorder * Uncontrolled hypertension or hemodynamic instability at enrollment * Clinically significant cardiovascular disease, including poorly controlled coronary artery disease, reduced left ventricular function, recent myocardial infarction or cardiac intervention, or clinically significant arrhythmia requiring treatment * Serious liver disease or impaired liver function * Diabetes mellitus with poor glycemic control (HbA1c \>10%) * Active infection at time of transplantation * Positive serology for hepatitis B, hepatitis C, or HIV * Current, active, or untreated tuberculosis * Malignancy within 5 years prior to enrollment, excluding adequately treated non-melanoma skin cancer * Current systemic immunosuppressive therapy (excluding permitted corticosteroids) * Participation in another interventional drug trial within 60 days prior to enrollment * Pregnant or breastfeeding * Known severe hypersensitivity to a required study medication with no acceptable alternative