Doctors at NYU Langone Health have performed a groundbreaking series of surgeries on a New Jersey woman, Lisa Pisano, who was on the brink of death. Facing both heart and kidney failure, Pisano was too ill to be eligible for a standard transplant. In a creative approach, doctors first implanted a mechanical pump to support her failing heart. Subsequently, they transplanted a kidney from a genetically modified pig. This innovative procedure not only stabilized Pisano’s heart but also provided her with a new kidney, offering hope where options had seemed exhausted.
Pisano’s successful surgery is part of a series of attempts to make animal-to-human transplantation a viable option
The NYU team announced on Wednesday that Pisano is recovering well. Following a groundbreaking transplant last month at Massachusetts General Hospital, she is only the second patient ever to receive a pig kidney. Pisano’s successful surgery is part of a series of attempts to make animal-to-human transplantation a viable option.
“I was at the end of my rope,” Pisano told The Associated Press. “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, director of NYU Langone Transplant Institute, recounted cheers in the operating room as the organ immediately started making urine.
“It’s been transformative,” Montgomery said of the experiment’s early results. But “we’re not off the hook yet,” cautioned Dr. Nader Moazami, the NYU cardiac surgeon who implanted the heart pump.
“With this surgery I get to see my wife smile again,” Pisano’s husband Todd said Wednesday.
Other transplant experts are closely watching how the patient fares.
“I have to congratulate them,” said Dr. Tatsuo Kawai of Mass General, who noted that his own pig kidney patient was healthier overall going into his operation than NYU’s patient. “When the heart function is bad, it’s really difficult to do a kidney transplant.”
More than 100,000 people in the U.S. are currently on the waiting list
More than 100,000 people in the U.S. are currently on the transplant waiting list, with the majority in need of a kidney. Sadly, thousands die each year while waiting for a suitable organ. In an effort to address the shortage of donated organs, several biotech companies are genetically modifying pigs to make their organs more similar to human organs and less likely to be rejected by the recipient’s immune system.
Research teams, including those at NYU, have successfully transplanted pig kidneys and hearts into brain-dead paitents, showing promising results. However, the University of Maryland’s attempt to transplant pig hearts into two men, who had no other options, resulted in both men passing away within months.
The recent pig kidney transplant at Mass General has sparked new hope in the field. Rick Slayman, who received a pig kidney transplant at Mass General, experienced an early rejection scare but has since recovered well and returned home. A recent biopsy showed no further problems. Lisa Pisano, the recipient of a pig organ, is the first woman to undergo such a procedure. Unlike previous xenotransplant experiments, both her heart and kidneys had failed.
Before the experimental surgeries, she had gone into cardiac arrest and had to be resuscitated. Her condition had deteriorated to the point where she was too weak to play with her grandchildren. She was ineligible for a traditional kidney transplant due to her failing heart, and while on dialysis, she did not qualify for a heart pump known as a left ventricular assist device (LVAD). “It’s like being in a maze and you can’t find a way out,” Montgomery explained — until the surgeons decided to pair a heart pump with a pig kidney.
The surgery involved implanting the LVAD to assist Pisano’s heart on April 4, followed by the pig kidney transplant on April 12
With emergency authorization from the Food and Drug Administration (FDA), Montgomery opted for a kidney from a pig genetically modified by United Therapeutics Corp. This modification prevents the pig’s cells from producing a specific sugar that is foreign to the human body and triggers immediate organ rejection. Additionally, a unique approach was taken: the donor pig’s thymus gland, which plays a role in training the immune system, was attached to the donated kidney, in the hope that it would help Pisano’s body accept the new organ.
The surgery involved implanting the LVAD to assist Pisano’s heart on April 4, followed by the pig kidney transplant on April 12. While her long-term prognosis is uncertain, Pisano has not shown any signs of rejecting the organ thus far, according to Montgomery.
Adjusting the LVAD to accommodate her new kidney has already provided insights that could benefit future patients with both heart and kidney issues, Moazami noted. While “compassionate use” experiments offer valuable insights, rigorous studies are needed to establish the effectiveness of xenotransplants. The outcomes for Pisano and the other recipients at Mass General will likely influence the FDA’s decision regarding future trials. United Therapeutics aims to begin such a trial next year.