Boston surgeons transplanted a kidney from a genetically modified pig into a sick 62-yr-old man, the primary such procedure. If the invention is successful, the breakthrough will give hope to lots of of 1000’s of Americans whose kidneys have failed.
So far, the signs are promising.
The kidneys remove waste products and excess fluid from the blood. According to doctors at Massachusetts General Hospital, referred to as Mass General, the brand new kidney began producing urine shortly after surgery last weekend, and the patient’s condition continues to enhance. He is already walking the corridors of the hospital and should be discharged soon.
The patient is a black man, and the procedure could also be of particular importance for black patients, who often suffer from end-stage renal disease.
The latest source of kidneys “could solve an intractable problem in the field — inadequate access to kidney transplants for minority patients,” said Dr. Winfred Williams, deputy chief of nephrology at Mass General and the patient’s primary nephrologist.
If the kidneys of genetically modified animals may be transplanted on a large scale, dialysis “will become obsolete,” said Dr. Leonardo V. Riella, medical director of kidney transplantation at Mass General. The hospital’s parent organization, Mass General Brigham, developed the transplant program.
More than 800,000 Americans suffer from kidney failure and require dialysis, a procedure that filters toxins from the blood. More than 100,000 individuals are on the waiting list for a transplanted kidney from a living or dead donor. End-stage renal disease is 3 times more common amongst black Americans than amongst white people.
Additionally, tens of thousands and thousands of Americans suffer from chronic kidney disease, which may result in organ failure.
While dialysis keeps people alive, the gold standard of treatment is an organ transplant. However, 1000’s of patients die yearly while waiting for a kidney because of acute organ shortage. Only 25,000 kidney transplants are performed annually.
Xenotransplantation, i.e. the implantation of an animal organ into a human, has been proposed for a long time as a potential solution that might significantly increase the supply of kidneys. However, the human immune system rejects foreign tissue, causing life-threatening complications, and experts note that long-term rejection can occur even when donors are well-matched.
Scientific advances in recent years, including gene editing and cloning, have brought xenografts closer to reality, making it possible to change animals’ genes to make organs more compatible and fewer prone to rejection by the immune system.
The kidney got here from a pig designed by the biotechnology company eGenesis, which removed three genes chargeable for potential rejection of the organ. In addition, seven human genes were introduced to extend compatibility with humans. Pigs carry retroviruses that may infect humans, and the corporate has also inactivated pathogens.
In September 2021, surgeons at NYU Langone Health in New York attached the kidney of a genetically modified pig to a brain-dead man and watched because it began to operate and produce urine. Shortly thereafter, researchers on the University of Alabama at Birmingham announced that that they had performed a similar procedure with similar results.
Surgeons on the University of Maryland have twice transplanted the hearts of genetically modified pigs into patients with heart disease. Although the organs were functioning and the primary one didn’t appear to have been rejected, each patients, who had advanced disease, died shortly thereafter.
(Patients who conform to these cutting-edge experimental treatments are frequently seriously in poor health and have few options available; they are sometimes too sick to qualify for the waiting list for a precious human organ or are otherwise ineligible.)
Boston transplant patient Richard “Rick” Slayman, head of the state Department of Transportation, had suffered from diabetes and hypertension for a few years and had been treated at Mass General for greater than a decade.
After suffering kidney failure, Mr. Slayman underwent dialysis for seven years until he finally received a human kidney in 2018. However, the donated organ failed inside five years and developed other complications, including congestive heart failure, Dr. Williams said.
When Mr. Slayman resumed dialysis in 2023, he experienced serious vascular complications – his blood vessels clotted and stopped working – and required frequent hospitalization, Dr. Williams said.
Mr. Slayman, who continued to work despite health problems, faced a long wait for one more human kidney and “was becoming increasingly depressed,” Dr. Williams said. “He said, ‘I can’t go on living like this.’ I can’t keep doing this. I started thinking about extraordinary measures we could take.”
“He would have to wait five to six years for a human kidney. He wouldn’t be able to survive it,” Dr. Williams added.
When Dr. Williams asked Mr. Slayman about accepting the pig kidney, Mr. Slayman had many questions but ultimately decided to proceed.
“I saw this not only as a way to help myself, but also as a way to provide hope to the thousands of people who need a transplant to survive,” he said in a statement provided by Mass General.
Mr. Slayman’s new kidney appears to be functional now and he has been able to stop dialysis. The new pig kidney produces urine and filters creatinine, a waste product.
His doctors say other measures are also improving every day. Doctors will continue to monitor Mr. Slayman for signs of organ rejection.
“He looks like him. It’s extraordinary,” Dr. Williams said.
The operation was not without criticism. Xenotransplantation raises the prospect of even greater exploitation of animals and could introduce new pathogens into the human population, said Kathy Guillermo, senior vice president of People for the Ethical Treatment of Animals.
“Using pigs as a source of spare parts is dangerous to patients, deadly to animals and could cause another pandemic,” she said. “It is impossible to eliminate or even identify all viruses transmitted by pigs. “Scientists need to focus on cleaning up the organ donation system and leave animals alone.”
The four-hour surgery was performed by a team of surgeons that included Dr. Tatsuo Kawai, director of the Legorreta Center for Clinical Transplant Tolerance at Mass General, and Dr. Nahel Elias.
The procedure was performed under a Food and Drug Administration protocol called the compassionate use rule, which grants patients with life-threatening illnesses who may benefit from unapproved treatments. The protocol also used new drugs to suppress the immune system and prevent organ rejection.
“He is incredibly brave to step forward,” Dr. Williams said of Mr. Slayman. “Hats off to him. He makes a huge contribution to this.”
