On March 21, 2024, Massachusetts General Hospital (MGH) announced the world’s first successful transplant of a pig kidney into a 62-year-old man with end-stage kidney disease. The surgery took four hours on March 16, and it marks a major milestone in the goal to find organs that are more readily available to patients. MGH is a renowned leader in transplantation services and is recognized for providing advanced care and leading the academic community.
The pig kidney was provided by eGenesis, located in Cambridge, MA. The pig donor, where the kidney came from, was genetically edited using CRISPR-Cas 9 technology to remove any harmful pig genes and add human genes that would improve the compatibility of the organ in a human. The revisions involved eliminating three genes responsible for generating sugars on the surface of pig cells, which are targeted by the human immune system due to their association with foreign invaders. In their place, seven human genes were inserted to produce proteins that aid in preventing organ rejection. Sciences also inactivated any porcine (pig) endogenous retrovirus in the pig donor to prevent any risk of infection in human patients. By the end of the process, the pig kidney had undergone a record 69 genomic edits.
While this transplant was completed in a matter of hours, the research to make this surgery available has taken over five years to come to this point. MGH and eGenesis have conducted extensive research, and many of their finds published in Nature in 2023. Their research has led to this extraordinary development in xenotransplantation, the transplantation of organs or tissues from one species to another, and proves to be a potential solution to solve a worldwide problem. In fact, the United Network for Organ Sharing (UNOS) states that more than 100,000 people in the U.S. await an organ transplant, and 17 people die each day waiting for an organ. A kidney is the most common organ needed for transplant, and end-stage kidney disease rates are estimated to increase 29-68% in the U.S. by 2030.
“The success of this transplant is the culmination of efforts by thousands of scientists and physicians over several decades. We are privileged to have played a significant role in this milestone. Our hope is that this transplant approach will offer a lifeline to millions of patients worldwide who are suffering from kidney failure,” says Tatsuo Kawai, MD, PhD, Director of the Legorreta Center for Clinical Transplant Tolerance.
Mr. Richard Slayman, the recipient of the genetically engineered kidney transplant, is recovering well at MGH. He has lived with Type 2 diabetes and hypertension for an extended period and underwent a kidney transplant from a deceased human donor in December 2018, following seven years of dialysis. About five years post-transplant, signs of kidney failure emerged, leading Slayman to resume dialysis in May 2023. Since then, he has faced recurring complications with his dialysis vascular access, necessitating hospital visits every two weeks for clot removal and surgical adjustments. These issues have significantly impacted his quality of life, representing a common challenge among dialysis patients.
Slayman said in a statement, “My nephrologist, Dr. Winfred Williams, MD and the Transplant Center team suggested a pig kidney transplant, carefully explaining the pros and cons of this procedure. I saw it not only as a way to help me, but a way to provide hope for the thousands of people who need a transplant to survive. I want to thank everyone at MGH who has cared for me, especially Dr. Williams, Dr. Kawai, the surgeon who performed my first kidney transplant and now this one, and Dr. Riella, who has orchestrated the logistics behind this new transplant. They have supported me during every step of the journey, and I have faith they will continue to do so.”
This transplantation was completed under the guidance of Leonardo V. Riella, MD, Ph.D., Medical Director for Kidney Transplantation; Nahel Elias, MD, the Interim Chief of Transplant Surgery and Surgical Director for Kidney Transplantation; and Dr. Kawai.
