In a groundbreaking medical feat, doctors have successfully transplanted a pig kidney into a New Jersey woman who was on the brink of death, in a bid to save her life alongside a heart pump implant.
Lisa Pisano, whose severe heart and kidney failure disqualified her from a traditional transplant, became the recipient of this innovative approach by the medical team at New York University (NYU) Langone Health. The NYU specialists took a bold step by first implanting a mechanical pump to sustain her heart, followed by the transplantation of a kidney from a genetically altered pig days later.
The NYU team has reported that Lisa is on the mend following the procedures. She becomes only the second person to undergo a pig kidney transplant, hot on the heels of a similar operation last month at Massachusetts General Hospital, as scientists push the boundaries to make xenotransplantation a viable option.
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This week marked a significant milestone for the 54-year-old as she managed to take her first steps with the aid of a walker. She shared: "I was at the end of my rope.
"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 and it could have helped the next person."
Dr. Robert Montgomery, the director of NYU Langone Transplant Institute, described the moment the new organ began functioning, noting the operating room erupted in cheers when the kidney started producing urine. Dr Montgomery expressed optimism about the transformative potential of these early experimental results.
"But 'we're not off the hook yet,'" warned Dr. Nader Moazami, the NYU cardiac surgeon who performed the heart pump implantation. Todd Pisano, whose wife underwent the procedure, said on Wednesday: "With this surgery, I get to see my wife smile again."
The medical community is keeping a keen eye on the patient's progress post-transplant. "I have to congratulate them," admitted Dr. Tatsuo Kawai of Massachusetts General, comparing his pig kidney transplant patient's health to that of NYU's heart recipient. "When the heart function is bad, it's really difficult to do a kidney transplant."
A quest for pig organs
With over 100,000 individuals on the US transplant waiting list, predominantly for kidneys, and thousands dying in wait, the quest for alternative solutions is critical. Biotech firms are genetically altering pigs to produce organs that are more compatible with human bodies and less likely to be rejected by our immune systems.
NYU, among other research groups, has conducted temporary transplants of pig kidneys and hearts into brain-dead patients, yielding promising outcomes. However, following the University of Maryland's pig heart transplants in two critically ill men, both patients passed away within months.
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Last month's pig kidney transplant at Massachusetts General sparked renewed optimism. Dr. Kawai shared that Richard "Rick" Slayman faced an initial rejection but has since recovered enough to return home earlier this month, continuing to do well five weeks after the transplant. Recent biopsies show no new complications.
A complex case
Pig heart and kidney recipient, Lisa Pisano, became the first woman to receive a pig organ. Unlike previous xenotransplant experiments, both her heart and kidneys had failed. She went into cardiac arrest and had to be resuscitated before the experimental surgeries. Her condition had deteriorated to the point where she was too weak to even play with her grandchildren.
"I was miserable," the Cookstown, New Jersey, woman said. A failed heart made her ineligible for a standard kidney transplant. While on dialysis, she also didn't qualify for a heart pump, called a left ventricular assist device or LVAD.
"It's like being in a maze and you can't find a way out," Dr Montgomery explained. That was until the surgeons decided to pair a heart pump with a pig kidney.
Two major surgeries in eight days
With emergency permission from the Food and Drug Administration, Dr Montgomery chose an organ from a pig genetically engineered by United Therapeutics Corp. so its cells don't produce a particular sugar that's foreign to the human body and triggers immediate organ rejection.
Plus, there was a tweak: The donor pig's thymus gland, which trains the immune system, was attached to the donated kidney in hopes that it would help Lisa's body tolerate the new organ. Surgeons fitted Lisa with the LVAD to power her heart on April 4, and she received the groundbreaking pig kidney transplant on April 12.
While it's impossible to predict her long-term prognosis, so far she has shown no signs of rejecting the organ, according to Dr Montgomery. Dr Moazami noted that in tweaking the LVAD to work alongside her new kidney, they've already gleaned insights that could benefit the future treatment of patients with both heart and kidney issues.
While special "compassionate use" experiments provide valuable knowledge for doctors, rigorous scientific studies are necessary to establish the efficacy of xenotransplants. The outcomes for Lisa and the kidney recipient at Massachusetts General will undoubtedly play a role in the FDA's decision-making process regarding the approval of such trials. United Therapeutics is aiming to launch one such study next year.