First Human recipient of a pig kidney transplant has passed away

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Richard Slayman made history in March of this year as the first person to undergo a modified pig kidney transplant. This procedure, known as xenotransplantation, raises questions about its purpose and potential complications.

First Human recipient of a pig kidney transplant has passed away
First Human recipient of a pig kidney transplant has passed away

Tragically, Richard Slayman passed away on Saturday, May 11, approximately two months after receiving the transplant. Both his family and Massachusetts General Hospital, where the surgery took place, stated that there was no apparent link between the transplant and his death.

The hospital released a statement affirming, “We have no indication that [Slayman’s death] was the result of his recent transplant.” Slayman’s family expressed gratitude towards the medical team, acknowledging that the xenotransplantation extended his life by seven weeks.

To understand the significance of xenotransplantation, it’s essential to grasp the procedure, its potential, and the risks involved.

 

What is Xenotransplantation ?

As defined by the US Food and Drug Administration (FDA), xenotransplantation encompasses any medical procedure that involves transplanting, implanting, or infusing live cells, tissues, or organs from nonhuman animal sources into human recipients, or human body fluids, cells, tissues, or organs that have been in contact with live nonhuman animal cells, tissues, or organs outside of the body.

In essence, xenotransplantation utilizes animal cells and organs to address medical conditions in humans. The first attempts at xenotransplantation involving the heart in humans occurred in the 1980s. This approach became necessary due to the significant disparity between the number of patients in need of organ transplants and the limited availability of human donor organs.

According to a 2024 article in Nature, nearly 90,000 individuals in the United States alone are awaiting kidney transplants, with over 3,000 dying each year while on the waiting list.

Columbia University’s Department of Surgery website also highlights evidence suggesting that animal cells and tissues have been utilized in treating neurodegenerative disorders and diabetes. This innovative approach offers hope for addressing critical medical needs using xenotransplantation techniques.

How does xenotransplantation happen?

In 2023, Dr. Robert Montgomery, chief of New York University Langone’s Transplant Institute, emphasized to the Associated Press that implanting a pig kidney into a recipient’s body is not significantly different from a standard transplant. He noted that the use of post-surgery immune-suppressing drugs is standard practice in both cases.

However, there are several critical additional steps involved in xenotransplantation. One key requirement is genetic modification of the selected animal organ to prevent rejection by the human body.

According to a report from Harvard Medical School, the physicians involved in Richard Slayman’s operation made 69 genomic edits to the pig kidney used in his case. They employed CRISPR-Cas9 gene editing technology to remove specific pig genes responsible for producing sugars that trigger immune system reactions in humans. Additionally, they added certain human genes to enhance the kidney’s compatibility with human physiology.

Even after the transplantation procedure, continuous monitoring is essential to assess the body’s response to the transplanted organ and ensure its long-term function.

Why are pigs often used for xenotransplantation?

For over 50 years, pig heart valves have been utilized to replace damaged human heart valves. The anatomical and physiological similarities between pigs and humans make pig organs suitable for transplantation. Pigs are extensively bred on farms, making them a practical and cost-effective source of organs for medical use.

The availability of various pig breeds also allows for customization of organ sizes to match specific human recipient needs. This flexibility in organ selection enhances the success and compatibility of xenotransplantation procedures.

In January 2022, a significant milestone was achieved with the first xenotransplantation of a genetically-modified pig heart. Unfortunately, the patient passed away after two months due to multiple factors, one of which was the presence of a latent virus in the pig heart. This virus likely contributed to the dysfunction of the transplant and highlights the ongoing challenges and risks associated with xenotransplantation research and practice.

What are the complications in xenotransplantation?

The first critical step in xenotransplantation is ensuring that the recipient’s body does not reject the transplanted organ. According to information from the NYU Langone website, one approach to achieving this involves embedding the pig’s thymus gland beneath the outer layer of the organ, where it can educate the recipient’s immune system. This method helps mitigate the risk of new or delayed immune responses against the transplanted organ.

Additionally, the FDA has raised concerns about potential infection risks for recipients, including exposure to both recognized and unrecognized infectious agents. There is a particular concern regarding the possibility of these infections being transmitted to close contacts or spreading within the general human population.

Another significant public health concern related to xenotransplantation is the potential for cross-species infection by retroviruses. These viruses can be latent and remain undetected for years before potentially causing disease in humans who receive xenotransplants.

Addressing these safety and infection control challenges is crucial for advancing the field of xenotransplantation while minimizing risks to both individual recipients and public health at large.

 

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