Surgeons in Boston have transplanted a kidney from a genetically engineered pig into a sick 62-year-old man, the first such operation. If successful, the breakthrough would bring hope to hundreds of thousands of Americans suffering from kidney failure.
So far, the signs are promising.
The kidneys remove waste products and excess fluid from the blood. Doctors at Massachusetts General Hospital said the patient’s condition continues to improve after the new kidney began producing urine shortly after last weekend’s surgery. He has walked the halls of the hospital and will likely be discharged soon.
The patient is a black man, and the procedure may have special significance for black patients who have a high incidence of end-stage renal disease.
The new kidney source “could solve a vexing problem in the field — the lack of access to kidney transplants for minority patients,” said Winfred Williams, associate chief of nephrology at Massachusetts General Hospital and the patient’s primary kidney doctor. said the doctor.
Dr. Leonardo V. Riella, medical director of kidney transplantation at Massachusetts General Hospital, said that if kidneys from genetically modified animals could be transplanted on a large scale, dialysis “would become obsolete.” The hospital’s parent organization, Massachusetts General Hospital Brigham, develops 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 people are waiting to receive a transplanted kidney from a living or deceased human donor.
Additionally, tens of millions of Americans suffer from chronic kidney disease, which can lead to organ failure.
While dialysis can keep a person alive, the gold standard treatment is an organ transplant. However, due to an acute shortage of organs, thousands of patients die every year while waiting for a kidney. Only 25,000 kidney transplants are performed each year.
For decades, xenotransplantation — transplanting organs from animals into humans — has been considered a potential solution that could make kidneys more widely available. But the body’s immune system can reject foreign tissue, leading to life-threatening complications, and experts say long-term rejection can occur even if the donor is a good match.
In recent years, scientific advances including gene editing and cloning have brought xenotransplantation closer to reality, making it possible to modify an animal’s genes to make the organ more compatible and less likely to be rejected by the immune system.
The kidneys came from pigs engineered by biotech company eGenesis, which removed three genes linked to potential rejection of the organ. Additionally, seven human genes have been inserted for enhanced human compatibility. Pigs carry retroviruses that can infect humans, and the company also inactivates the pathogens.
In September 2021, surgeons at NYU Langone Health transplanted a genetically modified pig kidney into a brain-dead human and watched it begin to function and produce urine. Soon after, scientists at the University of Alabama at Birmingham announced that they had performed a similar procedure and achieved similar results.
Surgeons at the University of Maryland have twice transplanted hearts from genetically modified pigs into heart patients. Although the organs were functioning normally and the first organ did not appear to be rejected, the two patients with advanced disease died soon after.
(Patients who agree to these cutting-edge experimental treatments are often very sick and have few options; often they are too sick to qualify for waiting lists for precious human organs or are ineligible for other reasons.)
Boston transplant patient Richard “Rick” Slayman, director of the state Department of Transportation, suffered from diabetes and high blood pressure for more than a decade and was a patient at Massachusetts General Hospital. Treatment.
After his kidneys failed, Slimane underwent dialysis for seven years before finally receiving a human kidney in 2018. But the donated organ failed within five years, and he developed other complications, including congestive heart failure, Dr. Williams said.
Dr. Williams said that when Mr. Slimane returned to dialysis in 2023, he developed severe vascular complications – his blood vessels were clotting and failing – and he required repeated hospitalizations.
As Mr. Sleiman continued to work despite his health problems, he faced a long wait for another human kidney and “he became increasingly frustrated,” Dr. Williams said. “He said, ‘I can’t go on like this. I can’t go on like this. I started thinking about extraordinary measures that we could take.”
“He would have to wait five to six years to get a human kidney. He would not survive,” Dr. Williams added.
When Dr. Williams asked Mr. Sleiman about receiving a pig kidney, Mr. Sleiman had many questions but ultimately decided to go ahead.
“I saw this as a way not only to help me, but to give hope to the thousands of people who need a transplant to survive,” he said in a statement provided by Massachusetts General Hospital.
So far, Mr. Sleiman’s new kidney appears to be functioning normally, and he has been able to stop dialysis. The new pig kidneys are making urine and filtering out creatinine, a waste product.
Other measures are improving every day, his doctor said. Doctors will continue to monitor Mr. Slimane for signs of organ rejection.
“He looked just like himself. It was amazing,” Dr. Williams said.
The surgery has not been without criticism. Cathy Guillermo, PETA’s senior vice president, said xenotransplantation brings the prospect of greater use of animals and the potential for introducing new pathogens into humans.
“Using pigs as a source of spare parts is dangerous for human patients, lethal for animals and could trigger the next pandemic,” she said. “It is impossible to eliminate or even identify all viruses carried by pigs. Researchers need to focus on cleaning up the organ donation system and not disturbing the animals.”
The four-hour surgery was performed by a team of surgeons, including Dr. Tatsuo Kawai and Dr. Nahel Elias, director of the Legoretta Clinical Transplant Tolerance Center at Massachusetts General Hospital.
The surgery was performed under an agreement with the U.S. Food and Drug Administration called a “compassionate use provision,” which is granted to patients with life-threatening illnesses who may benefit from unapproved treatments. The regimen also uses new drugs that suppress the immune system and prevent organ rejection.
“He was very brave in coming forward,” Dr. Williams said of Mr. Slayman. “Hats off to him. He made a huge contribution to this.”
