The first transplant surgery to combine a mechanical heart pump as well as a gene-edited pig kidney has been performed on an American woman.
Lisa Pisano (54) had heart failure and end-stage kidney disease requiring routine dialysis, but couldn’t have a standard heart or kidney transplant because of other chronic medical conditions and because of an overall lack of donor organs in the US.
According to the Organ Procurement and Transplantation Network, roughly 27 000 kidneys were transplanted in 2023, but nearly 89 000 people were on the waiting list for those organs, reports CNN.
Pisano received the heart pump on 4 April and on 12 April, a gene-edited pig kidney along with the pig’s thymus gland.
Her case is the first reported organ transplant in a person with a mechanical heart pump, and the second known transplant of a gene-edited pig kidney into a living recipient, and the first transplanted along with the thymus.
The first living recipient of a gene-edited pig kidney, 62-year-old Rick Slayman, received the organ at Massachusetts General Hospital in March and was able to go home this month. Pig hearts have also been transplanted into two living people who died within weeks of receiving the organs.
In addition to kidney disease, Pisano has congestive heart failure and has had stents placed in her heart as well as multiple catheterisations. In 2020, she learned that she had colon cancer and had “a large portion” of her colon removed.
“She was getting sicker and sicker, and her life expectancy could be measured in days or weeks,” said Dr Robert Montgomery, director of the NYU Langone Transplant Institute, who led the surgery.
Her doctors received permission from the US Food and Drug Administration to do the new procedures under its expanded-access or “compassionate use” policies, which give terminally ill patients without other options access to investigational medical products outside clinical trials.
The kidney came from a pig genetically engineered to disrupt a gene responsible for the production of a sugar found on the surface of animal cells called alpha-gal, which can be recognised by human antibodies and attacked.
The pig’s thymus gland, which plays a role in immunity, was placed under the cover of the kidney in an attempt to help Pisano’s immune system recognise the organ.
Montgomery said the gene edits used in the pig in this case are much simpler than those used in other xenotransplants in living humans.
Pisano has “a long way to go”, he said, but “her kidney is functioning beautifully. … Her heart is in much better shape”.
Now, doctors are watching for issues such as rejection and infection. She is recovering in the ICU, and her doctors anticipate at least another month of rehabilitation before she might be discharged.
CNN article – Surgeons perform first combined heart pump and pig kidney transplant (Open access)
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Genetically engineered pigs put xenotransplantation back in the spotlight