Doctors perform a four-hour surgery to transplant a genetically-edited pig kidney into human patient Rick Slayman. Image courtesy of Massachusetts General Hospital
On Thursday, March 21, Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system, announced the very first successful transplant of a genetically altered pig kidney into a sixty-two-year-old male patient, Rick Slayman. Slayman, who was living with end-stage kidney disease (ESKD), underwent the four-hour-long surgery on Saturday, March 16.
Led by Kidney Transplantation Medical Director Leonardo V. Riella, M.D., PhD, Legorreta Center for Clinical Transplant Tolerance Director Tatsuo Kawai, M.D., PhD, and Transplant Surgery Interim Chief and Surgical Director for Kidney Transplantation Nahel Elias, M.D., the pig kidney with sixty-nine genomic edits was successfully transplanted into the living patient. Slayman is reportedly recovering well and is expecting to be discharged from the hospital soon.
“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,” said Kawai.
Kawai, who performed the surgery, described it as the “most beautiful kidney I have ever seen,” saying that it took to the recipient quickly after transplantation. The fifteen members of the transplant team burst into applause.
While doctors believe the kidney could last years, they acknowledge the many unknowns involved in such a novel procedure.
According to CNN, the need for organs outpaces those available with seventeen people in the United States dying every day as they wait for a transplant. 27,000 kidneys were transplanted in 2023; however, 89,000 people were on the waitlist for a kidney that same year.
Beyond the scientific excitement and potential to one day meet the demands for organ transplants, this new procedure could help achieve more equity in healthcare.
“It also could be a potential breakthrough in solving one of the more intractable problems in our field, that being an unequal access for ethnic minority patients to the opportunity for kidney transplantation,” said Mass General associate chief of the Department of Nephrology Dr. Winfred Williams.
Mass General Brigham has a history in organ transplantation innovation. The first successful human organ transplant, also a kidney, was performed at Brigham and Women’s Hospital in 1945. The nation’s first penile transplant was performed at MGH in 2016.
Nursing practice specialist Melissa Mattola-Kiatos removes the pig kidney from a box prior to surgery. Image courtesy of Massachusetts General Hospital
“Mass General Brigham researchers and clinicians are constantly pushing the boundaries of science to transform medicine and solve significant health issues facing our patients in their daily lives,” said Mass General Brigham President and CEO Anne Klibanski, M.D.
The pig kidney was provided by eGenesis from a pig donor who was genetically edited with CRISPR-Cas9 technology. These edits removed harmful pig genes and added human genes to improve compatibility with the human patient.
Scientists also took steps to deactivate porcine endogenous retroviruses (PERVs) to eliminate the risk of infecting humans. PERVs are viruses or virus remnants integrated in the cells of a pig.
There have been concerns in the past of potential infectious risk when using pig cells and tissue in xenotransplantation, (procedures that involve transplanting or infusing human recipients with live cells, tissues, or organs from a different animal, in this case, a pig).
Slayman also received an infusion of novel immunosuppressant drugs, tegoprubart, provided by Eledon Pharmaceuticals, and ravulizumab, provided by Alexion Pharmaceuticals.
This is the third transplant using pig organs. The previous two were both hearts. Both patients unfortunately died weeks after receiving those organs.
Slayman’s procedure was performed under a single Food and Drug Administration (FDA) Expanded Access Protocol (EAP), also known as compassionate use. This allows a single patient or group of patients with life-threatening conditions access to experimental treatments when no alternatives exist.
If pig-to-human kidney transplants prove effective, they could potentially make dialysis obsolete in addition to whittling down the numbers on transplant waitlists. At MGH there are over 1,400 patients on the waitlist for a kidney.
“This successful procedure heralds a new era in medicine in which we have the potential to eliminate organ supply as a barrier to transplantation and realize our vision that no patient dies waiting for an organ,” said eGenesis CEO Michael Curtis.
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