A new kind of gene-edited pig kidney
was just transplanted into a person
A New Jersey woman is
the second living recipient of a pig kidney.
A month ago, Richard Slayman became the first living person to receive a kidney transplant from a gene-edited pig. Now, a team of researchers from NYU Langone Health reports that Lisa Pisano, a 54-year-old woman from New Jersey, has become the second. Her new kidney has just a single genetic modification—an approach that researchers hope could make scaling up the production of pig organs simpler.
Pisano, who had heart failure and end-stage kidney disease,
underwent two operations, one to fit her with a heart pump to improve her
circulation and the second to perform the kidney transplant. She is still in
the hospital, but doing well. “Her kidney function 12 days out from the
transplant is perfect, and she has no signs of rejection,” said Robert
Montgomery, director of the NYU Langone Transplant Institute, who led the
transplant surgery, at a press conference on Wednesday.
“I feel fantastic,” said Pisano, who joined the press
conference by video from her hospital bed.
Pisano is the fourth living person to receive a pig organ.
Two men who received heart transplants at the University of Maryland Medical
Center in 2022 and 2023 both died within
a couple of months after receiving the organ. Slayman, the first pig kidney
recipient, is still doing well, says Leonardo Riella, medical director for
kidney transplantation at Massachusetts General Hospital, where Slayman
received the transplant.
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“It’s an awfully exciting time,” says Andrew Cameron, a
transplant surgeon at Johns Hopkins Medicine in Baltimore. “There is a bright
future in which all 100,000 patients on the kidney transplant wait list, and
maybe even the 500,000 Americans on dialysis, are more routinely offered a pig
kidney as one of their options,” Cameron adds.
All the living patients who have received pig hearts and
kidneys have accessed the organs under the FDA’s expanded access program, which
allows patients with life-threatening conditions to receive investigational
therapies outside of clinical trials. But patients may soon have another
option. Both Johns Hopkins and NYU are aiming to start clinical trials in
2025.
In the coming weeks, doctors will be monitoring Pisano
closely for signs of organ rejection, which occurs when the recipient’s immune
system identifies the new tissue as foreign and begins to attack it. That’s a
concern even with human kidney transplants, but it’s an even greater risk when
the tissue comes from another species, a procedure known as
xenotransplantation.
To prevent rejection, the companies that produce these pigs
have introduced genetic modifications to make their tissue appear less foreign
and reduce the chance that it will spark an immune attack. But it’s not yet
clear just how many genetic alterations are necessary to prevent rejection.
Slayman’s kidney came from a pig developed by eGenesis, a company based in
Cambridge, Massachusetts; it has 69 modifications. The vast majority of those
modifications focus on inactivating viral DNA in the pig’s genome to make sure
those viruses can’t be transmitted to the patient. But 10 were employed to help
prevent the immune system from rejecting the organ.
Pisano’s kidney came from pigs that carry just a single
genetic alteration—to eliminate a specific sugar called alpha-gal, which can
trigger immediate organ rejection, from the surface of its cells. “We believe
that less is more, and that the main gene edit that has been introduced into
the pigs and the organs that we’ve been using is the fundamental problem,”
Montgomery says. “Most of those other edits can be replaced by medications that
are available to humans.”
There’s one major advantage to using a pig with a single
genetic modification. “The simpler it is, in theory, the easier it’s going to
be to breed and raise these animals,” says Jayme Locke, a transplant surgeon at
the University of Alabama at Birmingham. Pigs with a single genetic change can
be bred, but pigs with many alterations require cloning, Montgomery says.
“These pigs could be rapidly expanded, and more quickly and completely solve
the organ supply crisis.”
But Cameron isn’t sure that a single alteration will be
enough to prevent rejection. “I think most people are worried that one knockout
might not be enough, but we’re hopeful,” he says.
So is Pisano, who is working to get strong enough to leave
the hospital. “I just want to spend time with my grandkids and play with them
and be able to go shopping,” she says.
of technology and business elite.
JOE CARROTTA/NYU LANGONE HEALTH
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