Woman Returns to Dialysis After Pig Kidney Transplant Removal

A woman who received a pig kidney transplant is back on dialysis after surgeons had to remove the gradually failing organ just 47 days post-transplant.

Lisa Pisano was the second person to receive a kidney from a gene-edited pig. NYU Langone Health announced that she is stable following an operation to remove the organ earlier this week.

Background and Initial Progress

Pisano’s heart and kidneys were failing when, in a dramatic pair of surgeries in April, doctors implanted a mechanical pump to keep her heart beating and then the pig kidney. Initially, her recovery seemed promising. However, Dr. Robert Montgomery, who led the transplant, cited “unique challenges” in managing both the heart pump and the new kidney. Her blood pressure dropped too low multiple times, hindering optimal blood flow to the kidney.

Despite these efforts, the kidney's function declined to the point where continuing immune-suppressing medications was no longer justified. A recent biopsy of the kidney showed no signs of rejection, which is a primary concern in highly experimental animal-to-human transplants, but it revealed significant injury from insufficient blood flow.

The First Pig Kidney Transplant Case

The first patient to receive a pig kidney transplant, Richard “Rick” Slayman at Massachusetts General Hospital, died in early May, nearly two months after his transplant. Doctors there reported no indication that his death resulted from the experimental transplant.

Pisano’s Journey and Hopes for Xenotransplantation

Montgomery emphasized that Pisano was not a candidate for a traditional kidney transplant due to her heart disease, and her heart condition also barred her from receiving a life-prolonging heart pump while on dialysis. Despite the transplant’s outcome, Pisano's determination and courage have been a source of inspiration for the medical team.

“We are hoping to get Lisa back home to her family soon,” Montgomery said. “Her strength and bravery in the face of adversity inspires and drives us as we continue pursuing the hope and promise of xenotransplantation.”

Pisano shared with the Associated Press in April that she understood the risks involved with the pig kidney transplant. “I just took a chance. And you know, worst case scenario, if it didn’t work for me, it might have worked for someone else,” she said.

The Future of Xenotransplantation

More than 100,000 people are on the U.S. transplant waiting list, with the majority needing a kidney. Thousands die waiting for a transplant. To address this critical shortage, several biotech companies are genetically modifying pigs to make their organs more human-like and less likely to be rejected by the human immune system.

Formal studies of such organs are expected to begin next year. In the meantime, NYU and other research teams have conducted temporary pig kidney and heart transplants into brain-dead bodies with promising results. In addition to the Mass General pig kidney transplant, the University of Maryland has transplanted pig hearts into two men who had no other options; however, both men died within months.

Moving Forward

The removal of Pisano’s pig kidney transplant underscores the complexities and challenges of xenotransplantation. While setbacks like these highlight the hurdles yet to be overcome, the medical community remains hopeful. Continuous advancements and research are crucial for making xenotransplantation a viable solution to the organ shortage crisis.

The insights gained from Pisano’s experience and others like it will contribute to refining the process and improving outcomes for future patients. As the field progresses, the ultimate goal remains: to save lives and provide a sustainable alternative to human organ transplants.

Technical and Ethical Considerations

The experimental nature of xenotransplantation brings forth both technical and ethical considerations. Gene-editing pigs to create organs suitable for human transplants involves sophisticated biotechnological interventions designed to minimize immune rejection. However, the long-term implications and potential unforeseen consequences require rigorous scientific scrutiny and ethical debate.

Dr. Montgomery and his team continue to analyze the removed pig kidney to gather more data. Understanding the reasons behind the organ's failure, despite the absence of rejection signs, is critical for improving future xenotransplants. The team's findings could inform protocols for managing blood flow and other physiological factors crucial to the success of such transplants.

Broader Impact on Organ Donation

Pisano's case highlights the urgent need for alternative solutions to the organ shortage crisis. With over 100,000 people on the transplant waiting list in the U.S. alone, innovative approaches like xenotransplantation could significantly impact the availability of life-saving organs. However, each experimental procedure adds to the collective knowledge, paving the way for future breakthroughs.

The field of xenotransplantation stands at the intersection of advanced medical science and profound ethical considerations. As researchers and medical professionals strive to overcome the challenges, the broader goal remains to alleviate the suffering of those in need of transplants and offer hope through scientific innovation.