What Happened Behind the ‘Revolutionary’ Pig at Human Kidney Transplant in New York

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New Delhi: For the first time in history, a medical team in the United States has successfully transplanted a pig kidney into a human patient.

The revolutionary procedure was performed by surgeons at NYU Langone Health, using a kidney that had been grown on a genetically modified pig. The patient who received the kidney was brain dead and was being kept on a ventilator, according to a report through The New York Times.

The kidney was attached to the blood vessels in the patient’s upper leg outside the abdomen. The NOW The report quoted Dr. Robert Montgomery, director of the NYU Langone Transplant Institute, as saying that the organ had “started to function normally, producing urine almost immediately.”

Xenotransplantation, that is, the transplantation of organs from one species to another, is not a new phenomenon.

Also in India, in 1997, a transplant surgeon from Assam, Dr Dhani Ram Baruah, as well as the surgeon from Hong Kong Dr Jonathan Go Kei-Shing had led pig-to-human heart and lung transplant in Guwahati. The surgery, however, plunged him into warm waters after the patient’s death.

Here is an overview of the history of xenotransplantation, the challenges and how the particular procedure in the United States was conducted.

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All about xenotransplantation

Humans have been intrigued by the idea of ​​transplanting organs from animals to humans for eons now, as evidenced by a multitude of mythological figures – from Ganesh in Hinduism to Daedelus in Greek mythology.

The first mention of xenotransplantation in scientific literature dates back to 1905 in France, when rabbit kidney slices were transplanted into a child with chronic renal failure.

A paper on Xenotransplantation: a historical perspective by Columbia University researcher Keith Reemtsma, noted that the immediate results had been excellent. By 1906, two more cases of transplants had been recorded, one from a pig and the other from a goat, although neither of the two transplants worked.

Since then, many cases of xenotransplantation have been performed around the world.

Indian Institute of Medical Sciences (AIIMS) nephrologist Sandeep Mahajan told ThePrint that previous cases involved organs from non-human primates like chimpanzees and baboons.

“So in the early 1910s, the 1960s, even the 1980s, it was. We had a heart transplant from a baboon… But now pigs are the easiest animals to transplant, they are the closest to us and are more abundant than primates, ”Mahajan told ThePrint.

In recent years, the notion has been gain momentum with many, including famous surgeon Terence English, advocating for the use of pig organs. Then, in 2018, a study published in the Nature journal has proven the viability of using genetically engineered pig hearts in baboons.

But, the procedure conducted this week was the first successful case where an entire organ was transplanted from a pig to a human.

The NOW The report cited Dr. Dorry Segev, professor of transplant surgery at Johns Hopkins University School of Medicine in the United States, who described it as a “big, big deal”.

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How NYU Doctors Did It

Pork kidney xenotransplantation by doctors at NYU Langone Health involved crossing a barrier.

“The basic barrier to xenotransplantation is the new antigens that animals have that humans do not have. So the body vigorously attacks the organs and rejects that organ very quickly, ”Mahajan explained.

This is what necessitated the genetic modification of the pig.

Human bodies tend to reject pig tissue because it carries a gene that codes for a sugar molecule called alpha-gal, which “can put the human immune system into a frenzy” and lead to the rejected organ.

So, Mahajan explained, “a normal pig has been genetically engineered not to express this gal system,” which means it lacks the sugar-producing gene.

“This is a unique experience in the sense that they transplanted the whole organ into a human … they kept it (the patient) for three days without the organ being rejected,” said added Mahajan.

A controversial case in India

India also saw a case of xenotransplantation 24 years ago, although this story came to a tragic end.

In January 1997, news emerged of an Assam heart surgeon, Dr Dhani Ram Baruah, transplanting pig organs into a 32-year-old man with terminal heart disease. Baruah is said to have performed the procedure on the patient as a last resort with the consent of his family.

A week after the transplant, the patient died of multiple infections, which led to Baruah being detained for 40 days for “Violate laws on human organ transplantation in India”.

More than two decades later, the doctor told ThePrint his career “was totally disrupted due to the number of restrictions imposed by the court” and that he ultimately had to shift his focus from xenotransplantation to genetic engineering. He now runs the Dr Dhaniram Heart Institute and Research Center in Sonapur, about 20 km from Guwahati.

Comparing the procedure he performed with that performed by American doctors, Baruah said his “procedure was quite different”.

“I did not make any genetic modification in the organ of the pig and instead proposed hyperacute anti-rejection therapy, which was administered to this organ of the pig so that it could be easily accepted by the human body.” , did he declare. “I did not use any immunosuppression and further removed the preformed antibodies from human blood so that it gave additional protection for acceptance.”

Mahajan said the human body was still likely to have been subject to many other rejections in the procedure Baruah performed. “Unless you could cleanse the body of these antibodies, the body would continue to form antibodies over and over again,” he said.

He added that while this week’s operation was a “proof of concept,” there is still a long way to go.

“It (xenotransplantation) would reduce our dependence on various organs which are obviously very rare…[but] there are obviously a lot of challenges – medical, ethical and religious, ”he said.

(Edited by Amit Upadhyaya)

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