Lisa Pisano, 54, had heart failure and end-stage kidney disease that required regular dialysis. However, she did not qualify for a traditional combined heart and kidney transplant because she had several chronic conditions that made her an unsuitable candidate. The supply of human organs is limited, so in order to be eligible for multiple transplants, a person must meet certain criteria that lead to the assumption that the results of the operation will be good.
L. Pisano’s doctors began to consider the possibility of fitting her with a mechanical artificial heart, which could extend the patient’s life. However, implanting an artificial heart would be very risky if the woman continues to receive dialysis – so she would still need to secure a functioning kidney. Complicating matters was the fact that due to the antibodies circulating in Pisano’s blood, she could have had to wait years for a human kidney to “match” her immune system.
But she didn’t have that much time. “She only had a few weeks to live,” said Dr. Robert Montgomery.
Since a human kidney was not available, the surgical team sought organs from genetically edited pigs instead.
In two procedures over nine days in early April, Pisano received an artificial heart, then a pig kidney and thymus gland. The latter helps train the body’s immune cells, so its inclusion should help prevent a woman’s immune system from rejecting the kidney, according to doctors.
“No human or pig kidney has ever been transplanted into an artificial heart patient, so we didn’t know if it would work,” Montgomery said. “We have innovatively combined two miracles of modern medicine.”
When the team pitched the idea to patients, “she was all for it from the beginning,” said Pisano’s husband, Todd.
It is also the first time that a pig’s thymus gland and kidney have been transplanted into a living person/ Earlier, New York University tried a similar procedure on a brain-dead organ donor. In addition to reprogramming Pisano’s immune system, the thymus is expected to allow her to take lower doses of immune-suppressing drugs than she would normally need. The thymus itself was inserted into the transplanted kidney.
The pig from which both organs were harvested had been genetically edited to lack a certain type of sugar in its tissues. This sugar, known as alpha-gal, triggers an immune response in humans that would have caused the organ to be rejected.
This type of genetically edited kidney is relatively simple — compared to the kind that was recently transplanted to a man in Massachusetts. In that case, the new kidney was obtained from a pig from which three pig genes had been removed and seven human genes had been added. Montgomery said that because of the differences in how each pig is raised, it is likely that these simpler kidneys could be put into widespread use more quickly.
Now, 12 days after the transplant, Pisano’s kidney function “is perfect and she has no signs of rejection,” says Dr. R. Montgomery. He added that the woman will need time to fully recover before being released to a rehabilitation facility.
Like Todd, Lisa hopes that more people will be able to benefit from this dual procedure in the future. “My goal was to make sure that I was made for someone else – that someone else would see what I went through and take the leap, take the risk,” Pisano said.
Adapted from Live Science.
