A New Hampshire man fought for the chance at a pig kidney transplant, spending months getting into good enough shape to be part of a small pilot study of a highly experimental treatment.
His effort paid off: Tim Andrews, 66, is only the second person known to be living with a pig kidney. Andrews is free from dialysis, Massachusetts General Hospital announced Friday, and recovering so well from the Jan. 25 transplant that he left the hospital a week later.
“When I woke up in the recovery room, I was a new man,” Andrews told The Associated Press.
Andrews’ surgery comes at a turning point in the quest to tell if animal-to-human transplants could help ease the shortage of donated human organs. The first four pig organ transplants — two hearts and two kidneys — were short-lived. But the fifth xenotransplant recipient, an Alabama woman not nearly as sick as prior patients, boosted the field — thriving for now 2½ months after a pig kidney transplant at NYU Langone Health in November.
Doctors are moving from those one-off experiments to more formal studies. As they monitor Andrews’ recovery, doctors at Mass General Brigham have Food and Drug Administration permission to perform two additional transplants in their pilot study, using gene-edited pig kidneys supplied by biotech eGenesis.
And United Therapeutics, another developer of gene-edited pig organs, just won FDA approval for the world’s first clinical trial of xenotransplantation. Initially, six patients will receive pig kidneys — and if they fare well over six months, up to 50 additional patients will receive transplants.
“This is uncharted territory,” said Mass General’s Dr. Tatsuo Kawai, who led both Andrews’ surgery and the world’s first pig kidney transplant last year. But with lessons from animal research and the prior human attempts, he said, “I’m very optimistic. And hopefully we can get to survival, kidney survival, for over two years.”
Scientists are genetically altering pigs so their organs are more humanlike to address the transplant shortage. More than 100,000 people are on the U.S. transplant list, most who need a kidney, and thousands die waiting.
Andrews’ kidneys abruptly failed about two years ago, and the Concord, New Hampshire, grandfather struggled with fatigue and complications from dialysis. He’s on the transplant list but doctors warned it was a long shot. It can take seven years or more for people with Andrews’ blood type to find a matching kidney. Meanwhile, people slowly get sicker on dialysis — five-year survival is about 50% — and Andrews already had had a heart attack.
“I have seen my mortality and I was ready to fight,” Andrews said. So he asked Mass General if he could get a pig kidney instead. “I told them. ‘Anything, I’ll do anything. You give me a list of things you want me to do and I’ll do it.’”
Mass General transplant nephrologist Dr. Leonardo Riella said Andrews was weak and struggling with diabetes, including a slow-healing diabetic foot ulcer that hindered walking. He’d have to get more fit to be a candidate.
Andrews started physical therapy and returned six months later about 30 pounds lighter and “running down the hallway almost,” Riella recalled. “He was just, you know, a different person,” so they started checking if he’d qualify for the pilot study.
One big question was cardiac fitness: Mass General’s first pig kidney recipient had underlying heart disease that killed him. But Riella said intense exams showed Andrews’ “heart was in the best shape possible.”
Still, Andrews was a little nervous and sought advice from the only other person who knew what a pig kidney transplant was like — the NYU patient, Towana Looney.
“We just prayed together and talked about how it would be,” Andrews said of their phone calls before and after his transplant. He said Looney advised “to just stay strong and that’s what I’m doing.”
Doctors said Andrews’ pig kidney turned pink and quickly began producing urine in the operating room, and since then has cleared waste normally with no signs of rejection. Andrews spent the week after his discharge in a nearby Boston hotel for daily checkups but is expected to return home to New Hampshire soon.
NYU transplant surgeon Dr. Robert Montgomery said patients like those in Mass General’s pilot study could be “the sweet spot” for early xenotransplants — not yet too sick from years of dialysis but unlikely to survive long enough for a human transplant.
“Those are the patients where it really makes sense for them to try something else,” said Montgomery. His hospital is one of two that will be part of United Therapeutics’ clinical trial later this year, which will include similar patients.
It’s too early to know how Andrews will fare but if the pig kidney were to fail, Riella said he’d still qualify for a human transplant and, now deemed inactive on the transplant list, wouldn’t lose his “waiting time” that helps determine priority.
Andrews now wants to return to his old dialysis clinic and “tell these people there’s hope, because no hope is not a good thing,” he said.
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