Doctors have transplanted a pig kidney into a New Jersey woman who was near death, as part of a dramatic operation that also stabilized her failing heart.
Lisa Pisano’s combination of heart and kidney failure left her too sick to qualify for a traditional transplant and out of options. Then doctors at NYU Langone Health came up with a new one-two punch: implanted a mechanical pump to keep her heart beating and days later transplanted a kidney from a genetically modified pig.
Pisano is recovering well, the NYU team announced on Wednesday. She is only the second patient ever to receive a pig kidney — following a groundbreaking transplant last month at Massachusetts General Hospital — and the latest in a series of efforts to make animal-to-human transplantation a reality.
This week, the 54-year-old grabbed a walker and took her first few steps.
“I was at the end of my rope,” Pisano told the Associated Press. “I just took an opportunity. And you know, worst case scenario, if it didn’t work for me, maybe it could have worked for someone else and it could have helped the next person.
Dr. Robert Montgomery, director of the NYU Langone Transplant Institute, reported cheers in the operating room as the organ immediately began producing urine.
“It’s had a transformative effect,” Montgomery said of the experiment’s initial results.
But “we’re not off the hook yet,” warned Dr. Nader Moazami, the NYU cardiac surgeon who implanted the heart pump.
Other transplant experts keep a close eye on how the patient is doing.
“I have to congratulate them,” said Dr. Tatsuo Kawai of Mass General, who noted that his own pig kidney patient was generally healthier before the surgery. “If heart function is poor, it is very difficult to perform a kidney transplant.”
More than 100,000 people are on the U.S. waiting list for transplants, most needing a kidney, and thousands are dying while they wait. Hoping to fill the shortage of donated organs, several biotech companies are genetically modifying pigs so that their organs become more human-like and less likely to be destroyed by patients’ immune systems.
NYU and other research teams have temporarily transplanted pig kidneys and hearts into brain-dead bodies, with promising results. Then the University of Maryland transplanted pig hearts into two men who had run out of other options, and both died within months.
Mass General’s pig kidney transplant last month sparked new hope. Kawai said Richard “Rick” Slayman experienced an early rejection scare but bounced back enough to go home earlier this month and is still doing well five weeks after the transplant. A recent biopsy showed no further problems.
Pisano is the first woman to receive a pig organ – and unlike previous xenotransplant experiments, both her heart and kidneys had failed. She went into cardiac arrest and had to be resuscitated before the experimental operations. She had become too weak to even play with her grandchildren. “I felt miserable,” said the woman from Cookstown, New Jersey.
A defective heart made her ineligible for a traditional kidney transplant. But while on dialysis, she also wasn’t a candidate for a heart pump, also called a left ventricular assist device, or LVAD.
“It’s like being in a maze and not being able to find a way out,” Montgomery explained, until surgeons decided to connect a heart pump to a pig kidney.
With emergency approval from the Food and Drug Administration, Montgomery chose a pig organ genetically engineered by United Therapeutics Corp so that the cells do not produce a certain sugar that is foreign to the human body and causes immediate organ rejection.
Plus a modification: The donor pig’s thymus, which trains the immune system, was attached to the donated kidney in the hope that it would help Pisano’s body tolerate the new organ.
Surgeons implanted an LVAD to supply power to Pisano’s heart on April 4, and on April 12 they transplanted the pig kidney. There is no way to predict her long-term outcome, but so far she is showing no signs of organ rejection, Montgomery said. And in adjusting the LVAD to work with her new kidney, Moazami said doctors have already learned lessons that could help guide the future care of heart and kidney patients.
Special compassionate use experiments teach doctors a lot, but rigorous studies will be needed to prove whether xenotransplants really work. What happens to Pisano and Mass General’s kidney recipient will undoubtedly influence the FDA’s decision to allow such studies. United Therapeutics said it hopes to start it next year.