Surgeons have accomplished the first-ever combined mechanical heart pump and gene-edited pig kidney transplant surgery.
The procedure was performed on a 54-year-old woman suffering from heart and kidney failure by a team at NYU Langone Health in the US.
It was conducted in two stages, beginning with the implantation of the heart pump, followed by the landmark transplant.
The transplant included a gene-edited pig kidney and the pig’s thymus gland to mitigate rejection.
The recipient, Lisa Pisano, a resident of New Jersey, faced a dire health situation with heart failure and end-stage kidney disease, necessitating regular dialysis.
Traditional human organ transplants were not viable due to Pisano’s complex medical history and organ scarcity.
The ground-breaking surgery marks the first instance of a mechanical heart pump recipient undergoing an organ transplant.
It also represents only the second documented case of a gene-edited pig kidney transplant into a living person and the first with the inclusion of the thymus gland.
Two surgical teams conducted a series of procedures spanning nine days.
Initially, surgeons implanted a left ventricular assist device (LVAD), commonly used for patients awaiting heart transplants or deemed ineligible. Pisano’s survival without this device would have been limited to days or weeks.
Then Dr Robert Montgomery, the lead surgeon overseeing the transplant, led a xenotransplant – the patient’s elevated levels of harmful antibodies to human tissue and the unavailability of a suitable human kidney prompting him to explore alternative options.
Through collaboration with the United Therapeutics Corporation, an investigational gene-edited pig kidney devoid of alpha-gal sugar was identified as a viable match.
This approach, termed a UThymoKidney, combined the xenokidney with thymus tissue from the donor pig to mitigate rejection risks.
United Therapeutics Corporation genetically modified the pig, focusing on disrupting the alpha-gal-producing gene.
This single alteration proved instrumental in averting hyper-acute rejection, as evidenced by prior NYU Langone studies. The procedural protocol adhered strictly to ethical and regulatory guidelines, including approval from NYU Langone's Institutional Review Board and the U.S. Food and Drug Administration's Expanded Access Program.
Dr Montgomery emphasised the significance of using minimally modified pigs for xenotransplantation, highlighting their potential for sustainable organ production.
This approach, devoid of excessive genetic alterations and medications, offers a promising solution to the organ shortage crisis, facilitating quicker access to life-saving procedures.
He praised the collaborative efforts of medical professionals, researchers, and support staff at NYU Langone Health, acknowledging their dedication and skill in making this achievement possible.
The surgery comes at a crucial time, with over 104,000 individuals awaiting organ transplants in the US, the majority of whom require kidneys.
Despite the high demand, organ availability remains limited, with only a fraction of those in need able to undergo transplantation each year.
Pic credit: Joe Carrotta for NYU Langone Health
