Behind the “breakthrough” porcine to human kidney transplant in New York

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

A groundbreaking procedure was performed by a NYU Langone Health surgeon using kidneys raised in transgenic pigs. The patient who received the kidney was brain dead and was on a respirator. report NS New York Times..

The kidneys were attached to blood vessels in the patient’s upper limbs outside the abdomen. NS now The report states that Dr. Robert Montgomery, director of the NYU Langone Transplant Institute, said the organs “begin to function normally and urinate almost immediately.”

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

In India, in 1997, Assam’s transplant surgeon Dr. Dhani Ram Baruah and Hong Kong surgeon Dr. Jonathan Go Kei-Shing implementation Pig-to-human heart and lung transplantation in Guwahati. However, the surgery soaked him in hot water after the patient’s death.

It shows the history of xenotransplantation, challenges, and how certain procedures were performed in the United States.

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All about xenotransplantation

Humans have now been intrigued by the idea of ​​transplanting organs from animals to humans, as evidenced by many mythological characters, from Hindu Ganesha to Greek mythology Deideras.

The first mention of xenotransplantation in the scientific literature appears in 1905 when a slice of a rabbit kidney was transplanted into a child suffering from chronic renal failure in France.

Papers on Xenotransplantation: Historical Perspective Keith Reemzma, a researcher at Columbia University, said the immediate results were excellent. In 1906, two other transplants were recorded. One was from a pig and the other was from a goat, but neither of the grafts worked.

Since then, there have been many cases of xenotransplantation taking place around the world.

Sandeep Mahajan, a nephrologist at the All Indian Institute of Medical Sciences (AIIMS), told The Print that early cases were associated with organs of non-human primates such as chimpanzees and baboons.

“That is, it was the same in the early 1910s, 1960s, and 1980s. We had a heart transplant from a baboon … but now pigs are the easiest animals to transplant and are closest to us, It’s more abundant than primates, “Mahjan told The Print.

Over the last few years, the concept has been Gain momentum Many people, including the renowned surgeon Terence English, advocate the use of porcine organs. So In 2018, Research published in Nature The journal has demonstrated the feasibility of using transgenic pig hearts in baboons.

However, this week’s procedure was the first successful transplant of an entire organ from a pig to a human.

NS now The report said Dr. Dolly Segev, a professor of transplant surgery at Johns Hopkins University School of Medicine in the United States, described it as “a big deal.”

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How did NYU doctors do it

Xenotransplantation of porcine kidneys by NYU Langone Health physicians included overcoming barriers.

“The basic barrier to xenotransplantation is a new antigen that animals have that humans don’t have, so the body attacks organs violently and rejects them very quickly,” explains Mahajan. bottom.

This was what required genetic modification of pigs.

The human body tends to reject porcine tissue because it has a gene that encodes a sugar molecule called alpha-gal. This “can upset the human immune system.” Lead For organs that have been rejected.

Mahajan clarified that “normal pigs have been genetically modified to not express this gal system.” This means that the gluconeogenic gene is missing.

“This is a unique experiment in a way. They transplanted the entire organ into a human … they kept him (patient) for 3 days and the organ was not rejected,” Mahajan added.

Controversial case in India

In India, a case of xenotransplantation was seen 24 years ago, but the story had a tragic ending.

In January 1997, there was news that Assam’s cardiac surgeon, Dr. Dhani Ram Baruah, transplanted a pig organ into a 32-year-old man with end-stage heart disease. Barua is said to have operated on the patient as a last resort with the consent of his family.

One week after the transplant procedure, the patient died of multiple infections and Barua was detained for 40 days. “Violation of Indian Organ Transplant Law”..

For over 20 years, doctors told ThePrint that his career was “totally confused by the number of limits imposed by the court,” and eventually had to shift the focus from xenotransplantation to genetic engineering. There wasn’t. He currently runs the Dr Dhaniram Heart Institute and Research Center in Sonapur, about 20 km from Guwahati.

Comparing the procedures he took with those performed by US doctors, Barua said his “procedures were quite different.”

“I did not genetically modify the pig’s organs and instead devised an anti-acute rejection therapy, which was given to the pig’s organs for easy acceptance by the human body.” He said. “I did not use immunosuppression and also removed preformed antibodies from human blood to give additional protection for acceptance.”

Mahajan said the human body is still more susceptible to rejection in the procedures Barua has taken. “Unless you can cleanse the body of those antibodies, the body will continue to form antibodies over and over again,” he said.

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

“It (xenotransplantation) will reduce dependence on various organs that are clearly very deficient …[but] Obviously there are many challenges — medical, ethical, and religious, “he said.

(Edited by Amit Upadhyaya)

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