Transplant surgeons at Massachusetts General Hospital in Boston have performed the first successful transplantation of a genetically-modified pig kidney into a living patient.
This achievement in xenotransplantation could herald a potential solution to the worldwide shortage of organs for transplantation. In the United States alone, more than 89,000 were awaiting a kidney as of March 21, according to the Organ Procurement and Transplantation Network.
During the 4-hour-long surgery, the patient, a 62-year-old man from Weymouth, Massachusetts, received a pig kidney that was genetically edited to remove harmful pig genes and add human genes to improve its compatibility with human beings. The procedure was performed under the US Food and Drug Administration’s Expanded Access Protocol. The patient received infusions of the novel immunosuppressant medications tegoprubart and ravulizumab.
Mike Curtis, CEO of eGenesis in Cambridge, Massachusetts, which supplied the pig kidney, said the achievement “represents a new frontier in medicine and demonstrates the potential of genome engineering to change the lives of millions of patients globally suffering from kidney failure.”
“Moving forward, if this clinical approach is successful, it will need to be applied to more kidney disease patients before we can say that dialysis will be obsolete,” said Roslyn B. Mannon, MD, Chair of the American Society of Nephrology’s Policy and Advocacy Committee. “But it is an important step in that direction, and kudos to the team but importantly, [gratitude] to the patient who took a pioneering step for the field.”
Dr Mannon noted that the post-transplant therapy used is unique in that it includes both costimulatory blockade as well as infusion therapy aimed at complement inhibition.
She pointed out that the risks for infection and antibody- or cell-mediated rejection will be important key barriers to overcome over the next few months.
Previously, teams at NYU Langone2 in New York, New York, and the University of Alabama at Birmingham3,4 demonstrated successful transplantation of genetically modified pig kidneys into brain-dead individuals. There was no hyperacute antibody-mediated rejection, and NYU team reported a lengthy period of function of 32 days.5
References:
- Massachusetts General Hospital. World’s first genetically-edited pig kidney transplant into living recipient performed at Massachusetts General Hospital. [press release].
- Montgomery RA, Stern JM, Lonze BE, et al. Results of two cases of pig-to-human kidney xenotransplantation. N Engl J Med. 2022;386(20):1889–1898. doi:10.1056/NEJMoa2120238.
- Porrett PM, Orandi BJ, Kumar V, et al. First clinical-grade porcine kidney xenotransplant using a human decedent model. Am J Transplant. 2022;22(4):1037–1053. doi:10.1111/ajt.16930.
- Locke JE, Kumar V, Anderson D, Porrett PM. Normal graft function after pig-to-human kidney xenotransplant. JAMA Surg. 2023;158(10):1106–1108. doi:10.1001/jamasurg.2023.2774.
- NYU Langone Health. Two-month study of pig kidney xenotransplantation gives new hope tothe future of the organ supply NYU Langone Health. [press release]