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Surgeons transplant a pig kidney into a patient, a medical milestone

Boston surgeons have transplanted a kidney from a genetically modified pig into a sick 62-year-old man, the first procedure of its kind. If successful, this breakthrough will offer hope to hundreds of thousands of Americans whose kidneys are failing.

For now, the signs are promising.

The kidneys remove waste and excess fluid from the blood. The new kidney began producing urine shortly after last weekend’s surgery and the patient’s condition continues to improve, according to doctors at Massachusetts General Hospital, known as Mass General. He’s already walking the halls of the hospital and could soon be released from the hospital.

The patient is a black man and the procedure may have particular meaning for black patients, who suffer high rates of end-stage renal disease.

A new source of kidneys “could solve an intractable problem in this field: minority patients’ inadequate access to kidney transplants,” said Dr. Winfred Williams, associate chief of Mass General’s division of nephrology and a physician specialist. of the patient’s kidneys.

If kidneys from genetically modified animals can 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 people are on a waiting list to receive a kidney transplant from a living or dead human donor. End-stage renal disease is three times more common among Black Americans than among whites.

Additionally, tens of millions of Americans suffer from chronic kidney disease, which can lead to organ failure.

Although dialysis keeps people alive, the gold standard treatment is organ transplantation. However, thousands of patients die each year while waiting for a kidney, due to a severe shortage of organs. Only 25,000 kidney transplants are performed each year.

Xenotransplantation – the implantation of an organ from an animal into a human being – has been proposed for decades as a potential solution that could make kidneys much more widely available. But the human immune system rejects foreign tissue, leading to life-threatening complications, and experts note that long-term rejection can occur even when donors are well matched.

In recent years, scientific advances, including gene editing and cloning, have brought xenografts closer to reality, making it possible to modify animal genes to make organs more compatible and less likely to be rejected by the immune system.

The kidney came from a pig engineered by biotechnology company eGenesis, which removed three genes implicated in potential rejection of the organ. Additionally, seven human genes were inserted to improve human compatibility. Pigs carry retroviruses that can infect humans, and the company has also inactivated the pathogens.

In September 2021, surgeons at NYU Langone Health in New York attached a kidney from a genetically modified pig to a brain-dead man and watched as it began to function and produce urine. Shortly after, scientists at the University of Alabama at Birmingham announced that they had performed a similar procedure with similar results.

Surgeons at the University of Maryland have twice transplanted hearts from genetically modified pigs into patients with heart disease. While the organs were functioning and the first did not appear to be rejected, the two patients, whose disease was advanced, died shortly after.

(Patients who accept these cutting-edge experimental treatments are usually extremely ill and have few options; often they are too ill to qualify for the waiting list for a valuable human organ or are not eligible for further treatment. other reasons.)

The Boston transplant patient, state Department of Transportation supervisor Richard “Rick” Slayman, had suffered from diabetes and hypertension for many years and had been under treatment at Mass General for more than a decade.

After his kidneys failed, Mr Slayman was on dialysis for seven years, before receiving a human kidney in 2018. But the donated organ failed within five years and he developed other complications, including kidney failure. congestive heart disease, Dr. Williams said.

When Mr. Slayman returned to dialysis in 2023, he suffered serious vascular complications — his blood vessels were clotting and failing — and he required recurrent hospitalization, Dr. Williams said.

Mr. Slayman, who continued to work despite his health problems, had to wait a long time to get another human kidney, and “he was becoming more and more discouraged,” Dr. Williams said. “He said, ‘I just can’t keep doing this. I can’t keep doing this. I started thinking about what extraordinary measures we could take.

“We would have had to wait five to six years to obtain a human kidney. He couldn’t have survived it,” Dr Williams added.

When Dr. Williams asked Mr. Slayman if he could receive a pig kidney, Mr. Slayman asked many questions, but ultimately decided to go ahead.

“I saw it not only as a way to help myself, but also as a way to give hope to 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 working so far and he has been able to stop dialysis. The new pig kidney produces urine and filters creatinine, a waste product.

Other measures are also improving day by day, his doctors said. Doctors will continue to monitor Mr. Slayman for any signs of organ rejection.

“He looks like himself. It’s remarkable,” 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 human populations, said Kathy Guillermo, senior vice president of People for the Ethical Treatment of Animals.

“Using pigs as a source of spare parts is dangerous for human patients, deadly for animals and could cause the next pandemic,” she said. “It is impossible to eliminate, or even identify, all the viruses that pigs carry. Researchers should focus on cleaning up the organ donation system and leaving the animals alone.

The four-hour operation was performed by a team of surgeons, including 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 known as the compassionate use provision, which is granted to patients with a life-threatening disease who could benefit from an unapproved treatment . New medications intended to suppress the immune system and prevent organ rejection were also used as part of the protocol.

“He showed remarkable courage in coming forward,” Dr. Williams said of Mr. Slayman. “Hats off to him. He makes a huge contribution with that.

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