Written by By Ilya Ehrenberg, CNN
Dr. Martha Grabovnik, a nephrologist at Johns Hopkins University, is the lead author of a paper describing her clinical trial of pig kidneys transplanted on a deceased patient who was suffering from end-stage renal disease. The results could potentially offer new hope for end-stage renal disease patients, as kidneys removed from living donors often don’t result in a life-long replacement.
Dr. Martha Grabovnik (credit: John Hopkins University)
Experts said that while the study, published in the American Journal of Nephrology , wasn’t unique in its approach, the ability to transplant both the transplant recipient and the donor kidneys simultaneously was revolutionary in itself.
But more important, the success achieved at Johns Hopkins poses a compelling question: how can the same techniques that are used to transplant the kidneys of healthy donors be deployed to live donor patients to maximize their chances of success?
“If we’re going to transplant animal organs into living donors, there needs to be a way to produce more healthy organs,” Grabovnik said. “Pigs have the chance of being very fertile and endowing the country with some very good donor organs.”
Both kidneys came from donor pigs after the human patient who was undergoing nephrectomy, or kidney removal, went into septic shock due to an infection. The source of this infection was unknown at the time of the operation. Both kidneys were scheduled to be removed, but stopped working. The patient was then intubated and breathing on her own, which stopped functioning and proved fatal.
It was then that the nephrologist realized that the patient would not have a realistic option for a donor kidney because current donor regulation prohibited removal of healthy organs from live donors.
The transplant was performed to add life support for the patient.
(Credit: John Hopkins University)
“If someone was waiting for a donor kidney, and you had to wait for a live donor to arrive, the rate of that receiving a donor kidney could be less than one in 1,000,” said Grabovnik. “The likelihood of dying before receiving a transplant could be 80 percent. That’s pretty devastating.”
Both women were transplanting kidneys from dead donors. They had other options available to them, such as liquid nitrogen dissection, where kidney material is removed and frozen, or perfusion – giving the kidneys a straight flush of saline and drug infusions to put them back into the body.
“It was very important that we perform this procedure to preserve that patient’s life,” Grabovnik said. “The donor organs didn’t feel anything or remember anything and they were just disconnected from the donor patient. But, it was very important to do.”
Prior to this project, the only way to obtain healthy donor organs from live donors was to use the organs of deceased animals. In the United States, rules prevent any living donor organ from being transferred, even when live donors are willing to donate to their loved ones, if their organ is potentially unfit for transplantation into someone else.
The pig kidneys in this case were removed and reinserted from a pig within the living donor’s body. Since pigs don’t have large immune systems, the transplant was untested, but successful. If the procedure was successful, the technique could also make transplants from living donors possible in the future.
“At Johns Hopkins, we are exploring several possible protocols that might allow kidneys to be used from an adult who was previously deceased,” Grabovnik said. “Patients could have their kidneys removed, not transplanted, in order to make sure the organs are healthy. Another method might involve using human cells taken from their own blood and attaching them to their kidneys.”