Kidney Transplant: The Pig Option


WORLD over, kidney disease is a major health issue. According to United Network for Organ Sharing, there are nearly 107,000 people presently waiting for organ transplants, including more than 90,000 on the queue for a kidney in the United States alone with wait times averaging three to five years.


In other words, one in every seven American adult, an equivalent of about 15 per cent of the population, is suffering from kidney disease with about 90% of the number unaware they are ill.


That’s compared to between 2. 5 per cent and 35 per cent in the elderly population in Nigeria, which totals about 17 million recorded to have different stages of kidney disease.


The development calls for concern particularly in developing countries like Nigeria where kidney disease is more of a death sentence.


There seems to be great news after all as news from the United States indicates that those in need of outright kidney transplant may not need to worry endlessly either about matching donors or matching organ.


According to Reuters reports, doctors at the New York University, Langone Health, United States, have successfully transplanted a pig’s kidney into human being, the first of its kind, without triggering any immediate rejection by the recipient’s immune system.
The feat is considered a major advance that could come in handy to alleviate a dire shortage of human organs for transplant.


The procedure was conducted on a brain-dead patient with signs of kidney dysfunction whose family consented to the experiment before she was due to be taken off of life support. It involves the use of a pig whose genes had been altered so that its tissues no longer contained a molecule known to trigger almost immediate rejection.
The new kidney was attached to her blood vessels, maintained outside her body for three days just so that researchers can have easy access to it.


The outcome was described as one that “looked pretty normal,” in terms of function, according to leader of the study group, Dr Robert Montgomery.


We observed a kidney that basically functioned like a human kidney transplant, that appeared to be compatible in as much as it did all the things that a normal human kidney would do.


It functioned normally, and did not appear to be undergoing rejection,” Montgomery surmised.


Importantly, the kidney, according to Montgomery, made “the amount of urine that you would expect” from a transplanted human kidney, without any evidence of the vigorous, early rejection seen when unmodified pig kidneys are transplanted into non-human primates.
Dr Montgomery also added that the recipient’s abnormal creatinine level, indicator of poor kidney function, returned to normal after the transplant.


The idea of possibly using animal organs for human transplant has been in the works for decades. However, such efforts have been hindered in part but mainly by immediate rejection by the human body. But to overcome the challenge, Montgomery’s team theorized that removing the pig’s gene, alpha-gal, a sugar molecule or glycine, which triggers rejection, would be of help.


Following the theory, a genetically altered pig, christened GalSafe, developed by US Therapautic Corp’s Revivicor unit and it came came handy as a true experimental guinea pig, having been approved by the US Food and Drug Administration in December 2020, for use as food for people with a meat allergy and as a potential source of human therapeutics.


FDA warned however, that all medical products developed from the pigs would still require its specific approval before being used in humans.
Going forward, other researchers are considering the possibility that GalSafe pigs could be a one-stop transplant shop for all other human organs, including heart valves and skin grafts.


Montgomery, himself a heart transplant recipient, described his team’s new kidney experiment as one that is expected to pave the way for trials in patients with end-stage kidney failure in just about a year or two, even though it could be a short-term solution for critically ill patients until a human kidney becomes available, or as a permanent graft.


There are barriers to overcome however. The new experiment involved a single transplant with the kidney left in place for only three days. The implication is that there is need for future trials to uncover and overcome new barriers as recipients will likely be real life patients with low odds of receiving a human kidney and a poor prognosis on dialysis.


“For a lot of those people, the mortality rate is as high as it is for some cancers, and we don’t think twice about using new drugs and doing new trials (in cancer patients) when it might give them a couple of months more of life,” Montgomery said

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