Second Patient Receives Gene-Edited Pig Kidney Transplant In Breakthrough Surgery
Source: Smithsonian Magazine, Will Sullivan
Photo: Doctors perform a pig kidney transplant on April 12. So far, the patient is recovering well, but doctors will need to continue to monitor her in the hospital and make sure her immune system doesn’t reject the transplanted organ. (Joe Carrotta for NYU Langone Health)
The woman, 54-year-old Lisa Pisano, also received a mechanical heart pump implant days earlier, making her the first person to undergo both procedures
Lisa Pisano, a 54-year-old woman from New Jersey, has become the second living person to receive a transplant of a gene-edited pig kidney. Doctors also implanted a mechanical heart pump, making Pisano the first person to receive both a heart pump and an organ transplant, according to a statement from NYU Langone Health, where the procedure was performed.
Pisano had been suffering from heart failure and end-stage kidney disease and was on dialysis before the surgery. Because of her medical conditions, she was ineligible for heart and kidney transplants from human donors. The Food and Drug Administration approved the experimental procedure through a “compassionate use” program for patients with serious or immediately life-threatening conditions.
The NYU team said Wednesday that Pisano is recovering well, according to Lauran Neergaard of the Associated Press (AP).
“I feel fantastic,” Pisano said from the hospital during a Wednesday press conference over Zoom, per Wired’s Emily Mullin. “When this opportunity came, I said, ‘I’m gonna take advantage of it.’”
While Pisano hasn’t shown signs of rejecting the transplant so far, the critical point for that may not come until a month after surgery, Robert Montgomery, who led the procedure and is the director of NYU Langone’s transplant institute, tells Scientific American’s Tanya Lewis.
Montgomery tells NPR’s Rob Stein that Pisano will probably need to recover in the hospital for several months. He can’t predict how much time the procedure will buy for her.
“We’re optimistic that she’ll be able to go home and spend time with her children and grandchildren and live a comfortable life,” he says to NPR.
Patients with conditions like Pisano’s aren’t candidates for typical transplants, in part because their odds of survival are low, and there are not currently enough organs available to meet the vast need. More than 100,000 people are on the national transplant waiting list—with the majority in need of a kidney—and 17 people die every day waiting for a transplant in the U.S. Of the nearly 808,000 people in the country with end-stage kidney disease, only about 27,000 received a transplant last year, per NYU’s statement.
Scientists hope pig organs could combat this shortage and help more people get transplants. The NYU team has previously experimented with transplanting gene-edited pig organs into brain-dead patients with the consent of their families. They have also twice transplanted pig hearts into deceased human patients.
Two living patients who were experiencing heart failure have received pig heart transplants. The first lived for two months following the procedure, and the second died after six weeks.
Last month, a patient at Massachusetts General Hospital received the first pig kidney transplant. He was discharged from the hospital in early April and continued to recover at home.
“I do think it’s incredibly exciting we now have a second genetically edited pig kidney that’s been put into a living person,” Jayme Locke, a transplantation surgeon at the University of Alabama at Birmingham, who previously transplanted pig kidneys into brain-dead patients, says to Scientific American.
Pisano received the heart pump implant first, on April 4. She would have lived for only days or weeks without the device, according to NYU. She then received the gene-edited pig kidney in a second procedure on April 12.
“Without the possibility of a kidney transplant, she would not have been eligible as a candidate for [a heart pump] due to the high mortality in patients on dialysis with heart pumps,” Nader Moazami, an NYU cardiac surgeon who performed the heart pump surgery, says in the statement.
The pig kidney was genetically altered to disrupt the production of a sugar called alpha-gal. In previous studies, the researchers had shown that making this edit prevented the recipient’s immune system from rejecting the transplant. The team also attached a pig thymus gland to the tissue to reduce the likelihood of rejection.
Some experts question the ethics of such experiments.
“I think there are worries about conducting these experiments in this way, where we are finding the most desperate patients who have no other options,” L. Syd Johnson, a bioethicist at SUNY Upstate Medical University, tells NPR. “Maybe those patients will benefit. Maybe they believe they will benefit and that the risks are worthwhile for them. But I do worry about whether or not we are taking advantage of particularly vulnerable and desperate patients in conducting these experiments.”
Doctors say this transplant, as well as the one last month, will provide key information about the safety and effectiveness of the procedure.
“Like with any other transplant, in the early days, we want to make sure that we have control of the immune system and that there aren’t early rejections,” Locke tells Scientific American. “If this works, that’s incredibly positive.”
Will Sullivan is a science writer based in Washington, D.C. His work has appeared in Inside Science and NOVA Next.