A transplant patient had a huge rejection episode before leaving the hospital

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The world’s first recipient of a kidney transplant from a genetically modified pig experienced a rejection episode before recovering and leaving the hospital last week, a Massachusetts General Hospital doctor told STAT.
But in his first few days back at home in Weymouth, Mass., the patient — 62-year-old Richard Slayman — had shown no further signs of organ distress.
advertisement “We couldn’t have hoped for a better outcome,” Leonardo Riella, MGH’s medical director of kidney transplantation, said in an interview Friday.
Slayman had previously received a human kidney transplant, but it failed after five years, requiring him to resume kidney dialysis in 2023.
The pig kidney began producing urine almost as soon as it was surgically connected to Slayman’s circulatory system and it continued to function during his first week in the hospital.
Cellular rejection can happen any time, but especially within the first year of an organ transplant.
They’ll be looking for signs of rejection and for infections — which he’s more prone to acquiring while on medications that tamp down his immune system.
A second patient, who underwent the procedure last September, began to show signs of organ rejection a month post-surgery and died two weeks later.

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Before recuperating and leaving the hospital last week, the world’s first recipient of a kidney transplant from a genetically modified pig went through a rejection episode, a Massachusetts General Hospital physician told STAT. But during his first few days back in Weymouth, Massachusetts. Richard Slayman, the 62-year-old patient, had not displayed any more symptoms of organ distress.

Instead, he was engaging in activities that he hadn’t done in over a year, such as indulging in his cravings and having a long, hot shower.

The medical director of kidney transplants at Massachusetts General Hospital, Leonardo Riella, stated in a Friday interview, “We couldn’t have hoped for a better outcome.”.

Slayman had previously undergone a kidney transplant from a human, but the organ failed after five years, forcing him to start kidney dialysis again in 2023. He was admitted to the hospital every few weeks due to complications with blood clots and other vascular issues, and for the previous year, he had been hooked up to a kidney-filtering machine for four hours, three times a week. Showering was out of the question due to a chest catheter inserted to help with these problems.

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“He was having a lot of trouble,” Riella said. “It was one of those moments you kind of remember for the rest of your life, watching him leave the hospital after his dialysis. “.

An engineered pig kidney from Cambridge, Massachusetts was transplanted during the ground-breaking procedure on March 16. -based eGenesis. To address the critical organ shortage, the company uses CRISPR gene editing technology to make dozens of genome modifications in pigs that result in organs that are more compatible with human bodies. The positive results thus far indicate that formal trials of cross-species transplantation may not be far behind. This is the first in-human test of the technology, following encouraging primate studies that were published last year.

Almost immediately after being surgically attached to Slayman’s circulatory system, the pig kidney started to produce urine, and it kept up its production during his first week in the hospital. Tests on urine revealed the organ was removing toxins and maintaining the right ratio of minerals, especially potassium, in his blood.

But the kidney started to exhibit symptoms of difficulty on the eighth day. After doing a biopsy, the medical professionals saw that white blood cells had begun to invade the transplanted organ, resulting in swelling and inflammation. These are the classic symptoms of cellular rejection, which is the most prevalent kind of acute graft rejection. About 20 percent of patients receiving kidneys from human donors have it, according to transplant nephrologists like Riella. It can be treated with high doses of steroids and a medication that lowers the body’s T cell count.

After three anxious days, Slayman’s body started responding to treatment and the function of his new kidney improved. These medications were prescribed by his doctors. In order to prevent further rejection episodes, they also increased the immunosuppressive regimen he will be taking for the foreseeable future.

Cellular rejection can occur at any point after receiving an organ transplant, but it is more common during the first year. Riella suggested that it might be advantageous for it to occur at such a short notice. “Since it might go unnoticed for a few weeks, at which point it might be too late, I would rather get a rejection very early and get it treated and make adjustments,” he stated. “You want to put it out quickly before it gets out of control; it’s kind of like a wildfire.”. “.

Slayman will continue to be monitored by the MGH transplant team with three weekly blood and urine tests in addition to twice-weekly doctor visits. He is more likely to get infections when taking immune-suppressive medications, so they will be on the lookout for infections and indications of rejection.

It is advised that he not return to his position as manager at the Massachusetts Department of Transportation for the first two months. Meanwhile, they are using metagenomic sequencing technology to screen his blood once a week for any circulating pathogens, and this process detects DNA fragments.

According to Riella, “we’re doing this passive surveillance to look for things he might be picking up from the outside world, or transmission coming from the donor.”. The genomes of eGenesis pigs have been altered to eliminate the possibility that they could infect humans with porcine viruses, a worry that kept the xenotransplant industry closed for the majority of the 2000s.

Yet, authorities in the U.S. S. worry about the possibility, especially in light of the discovery that a pig virus may have been unintentionally transferred from a genetically modified pig heart manufactured by a different company, Revivicor, and that this may have contributed to the death of a xenotransplant patient in 2022, two months following the procedure at the University of Maryland Medical Center.

Slayman is doing better so far than the two patients at the University of Maryland who received Revivicor pig hearts; these two individuals are the only ones in the world who have had an organ from a genetically modified pig sewn inside of them. A month after the surgery, a second patient who had the procedure done in September of last year started to exhibit signs of organ rejection and passed away two weeks later.

Notwithstanding his patient’s improvement, Riella stated that it is premature to start talking to the FDA about doing another kidney transplant from a pig under the compassionate use program—the legal loophole that permitted Slayman to receive the organ outside of a clinical trial. Regarding starting a clinical trial, he said that the MGH transplant team and executives from eGenesis are currently in talks with the agency.

To accurately reflect Dr. Riella’s medical background, this story has been updated.

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