In unprecedented surgery, woman in the USA receives mechanical heart and porcine kidney | Health

NYU Langone Health, an academic hospital center in the United States, announced this Wednesday (24) the performance of an unprecedented surgery: doctors at the institution performed the first surgery using a mechanical heart pump and transplanting an edited pig kidney genetically in the same person.

Performed on a 54-year-old woman with terminal heart and kidney failure, the procedure can be considered a milestone in modern medicine. The surgery was separated into two stages, carried out nine days apart. In the first, the heart pump was implanted; then, xenotransplantation – the name given to organ transplantation between different species.

In the first surgery, the medical team placed a left ventricular assist device (LVAD), the heart pump, which works by unloading the left ventricle and directing blood to the aorta. The LVAD is typically used in patients awaiting a heart transplant or who are considered ineligible for one. It was placed on an emergency basis, as, without the device, Lisa’s life expectancy would be reduced by days.

The method was used because Lisa Pisano, the patient in question, did not meet the criteria to join the transplant list. Due to chronic conditions, the success statistics of the procedures were reduced. In this way, she became a candidate for this unprecedented medical feat.

Eight days later, the second surgery was performed. Surgeon Robert Montgomery, responsible for the procedure, approached United Therapeutics Corporation, a company in the field of biotechnology, and determined that an experimental gene-edited pig kidney was available and compatible. “Without the possibility of a kidney transplant, she would not have been eligible as a candidate for an LVAD due to the high mortality in dialysis patients with heart pumps,” Montgomery said in a statement.

A genetically modified porcine kidney was selected to “eliminate” the alpha-gal gene, responsible for sugar production. Its removal is a precaution to avoid an antibody reaction, generating rejection by the body of the new transplanted organ. Additionally, the donor pig’s thymus gland, responsible for regulating the immune system, was surgically placed under the covering of the kidney to further reduce the likelihood of a reaction.

This complex intervention marks the sixth human xenotransplant surgery performed by the NYU Langone Transplant Institute and orchestrated by Montgomery. The doctor was responsible for the world’s first gene-editing pig transplant surgery, on September 25, 2021.

To date, there is no record of LVAD patients who have received any type of transplant. This is only the second known transplant of a genetically modified pig kidney into a living person, the first being with the combined thymus.

“By using pigs with a single genetic modification, we can better understand the role that a stable, key change in the genome can play in making xenotransplantation a viable alternative,” says Montgomery. “Since these pigs can be bred and do not require cloning like more complex gene edits, this is a sustainable and scalable solution to the organ shortage. If we want to start saving more lives quickly, using fewer modifications and medications will be the answer.”