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First-Ever Successful Pig-To-Human Kidney Transplantation

by Karishma Abhishek on October 20, 2021 at 5:13 PM

Highlights:

Life-saving pig kidney transplantation has been performed for the first time in the world
The transplant has been successfully tested with no immediate graft rejection on a deceased woman
This significant step may help overcome the dire scarcity of human organs for the life-saving transplants

Pig kidney has been successfully transplanted into a human for the first time by a team of xenotransplant surgical team last month (September 2020) at NYU Langone Health, New York, U.S.

Animal-To-Human Transplants

Transplantation of animal organs to humans is called xenotransplantation. The desperate struggles to make the technique a reality date back to the 17th century, when animal blood was used for transfusions.

Breakthrough attempts were made by the 20th century, when surgeons attempted the transplantation of a baboon heart into humans - Baby Fae (a dying infant) who lived 21 days post-transplantation.

‘Decades-long hunt to utilize animal organs for life-saving transplants one day � becomes a reality as a xenotransplant surgical team successfully transplants the pig kidney onto a human for the first time in the world.’

Since then, several attempts were witnessed when the scientific community bowed from primates to pigs for bridging the species gap. Moreover, as pigs' organs are comparable to humans and are utilized for food, it raises relatively lesser ethical concerns than monkeys and apes.

Existing Hurdles in Transplant

Several biotech companies have carried out the development of suitable pig organs for transplantation, to bring a revolution in the care of patients.

It is estimated that >90,000 people await kidney transplants in the U.S., among which 12 die every day, as per the United Network for Organ Sharing.

However, xenotransplant may invite an entity called graft rejection, where the recipient's body attacks the new grafted organ as a foreign body/obstacle or infection. This results in serious immune reactions that may even be fatal.

A subsidiary of United Therapeutics Corp's (UTHR.O) - Revivicor unit advances the barricade by genetically engineering the pig (dubbed GalSafe). The pig lacks a gene responsible for producing a sugar (alpha-gal) that is responsible for provoking the immediate attack on the human immune system post-transplantation.

Food and Drug Administration (FDA) had also approved the safety of the genetic alteration in the Revivicor pigs for humans (food consumption and medicine) in December 2020. However, FDA warranted further validation for the use of pig organs in transplantation.

"This is an important step forward in realizing the promise of xenotransplantation, which will save thousands of lives each year in the not-too-distant future," says United Therapeutics CEO Martine Rothblatt in a statement.

First Pig-to-Human Transplant

The valves of a pig's heart have successfully been in use for humans for decades. Moreover, other organs like skin grafts, pig corneas, and a blood thinner drug - heparin have been successfully derived from pigs.

The present surgical team utilized the body of a brain-dead deceased woman (upon her family's consent) on a ventilator who had signs of kidney dysfunction. The woman had already consented to her wish to donate her organs, but they failed to meet the criteria for donation.

Major Advancement

Due to the increasing organ shortage of humans, the scientific community explores pigs to surmount the barriers. However, significant concern hovers with the very speculation of graft rejection.

The present team overpowered this by the use of gene-editing in the animal that bypasses the immune system attack. The team tested the recipient's immune system for an immediate rejection for three days by attaching the pig kidney to a pair of large blood vessels outside the body of the deceased recipient.

To their anticipation, the graft witnessed no failure and the recipient's creatinine level (an indicator of poor kidney function) reverted to normal post-transplant. The transplanted kidney also produced urine with normal waste filtering capacity. This serves as a major advancement in the medical transplantation field to ease a dire scarcity of human organs.

"It had absolutely normal function. It didn't have this immediate rejection that we have worried about," says Dr. Robert Montgomery who led the surgical team at NYU Langone Health and is a recipient of heart transplantation himself.

Revolutionary Era of Transplantation - Key Points

Despite substantial trials on public awareness for organ donation, there is no significant improvement in the figures of organ donors but rather faces even a down curve.

It is stated that almost two-thirds of the Americans assent for cross-species transplantation as a feasible prospect to overcome the shortage of organ and tissue transplantation as per a National Kidney Foundation survey in 1997.

In addition, the use of genetic advancements by the present team overcomes even the preeminent barrier of graft rejection. Although the transplant experiment included only a single transplant of the kidney, it paves the way for safer trials in critically ill patients with end-stage kidney failure.

With proper addressal of appropriate safeguards, xenotransplantation may soon become a promising reality to medical treatment.

References:

XENOTRANSPLANTATION: The Benefits and Risks of Special Organ Transplantation - (https:archive.bio.org/articles/xenotransplantation-benefits-and-risks-special-organ-transplantation)
Physiologic and Immunologic Hurdles to Xenotransplantation - (https:jasn.asnjournals.org/content/jnephrol/12/1/182.full.pdf?with-ds=yes)

Source: Medindia

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