THE NEW YORK TIMES: Chinese surgeons perform first pig-to-human liver transplant

Surgeons in China have for the first time transplanted a section of liver extracted from a genetically modified pig into a human cancer patient, they reported on Thursday.

The surgeons, who described the procedure in a paper in The Journal of Hepatology, grafted the portion of pig liver onto the left lobe of a 71-year-old patient’s liver after removing the larger right lobe, where a tumour the size of a grapefruit had grown.

The lobe with the porcine transplant functioned, producing bile and synthesizing blood clotting factors, the surgeons reported. The patient’s body did not reject the organ graft, which enabled the remaining left lobe of the patient’s own liver to regenerate and grow, the scientists said.

The porcine liver lobe was removed 38 days after the transplant, when complications developed, the surgeons wrote in the report. The patient, who had advanced disease, died a little over 5 1/2 months later.

He would not have been eligible to receive a human donor organ in China because he had advanced cancer and hepatitis B-related cirrhosis, the authors wrote.

In a commentary accompanying the study, Dr Heiner Wedemeyer, a co-editor of the journal, hailed the procedure as a “breakthrough” and a “historical clinical milestone,” although he noted that this was only a single case and that much work remained to be done to prevent complications and excessive blood clotting.

“A new era of transplant hepatology has started,” he wrote.

Dr Heidi Yeh, an associate professor at Harvard Medical School and a transplant surgeon, said that the researchers had been brave to attempt such a procedure, as preliminary experimental work transplanting livers from gene-edited pigs into nonhuman primates had been unsuccessful, discouraging many scientists.

“I think this is a landmark development,” Yeh said. “They put a pig’s liver in a human for a month, and the human did fine.”

The Chinese undertaking underscores how swiftly and aggressively Chinese medical scientists are moving in their quest to advance the use of genetically modified pig organs to treat the country’s vast population.

They are especially eager to utilize kidneys from genetically modified pigs to help treat the more than 1.2 million patients in China who experience kidney failure.

Surgeons there recently reported that a 69-year-old woman had lived with a functioning kidney from a gene-edited pig for more than six months, a milestone approaching that of an American patient who is also still alive after receiving a gene-edited pig’s kidney in January.

Chinese surgeons also recently transplanted a pig’s lung into a brain-dead patient, a procedure that is also considered challenging and so has not been attempted elsewhere.

But liver disease is an acute public health problem in China, with more than 300,000 people each year experiencing liver failure and a severe shortage of human donor organs. In 2022, for example, only about 6,000 people in China received liver transplants from human donors.

Dr Beicheng Sun, a surgeon at Anhui Medical University in Anhui province and the lead author of the paper published Thursday, said the plan all along had been for the pig liver transplant to be temporary and for it to be removed from the patient after doctors had observed it for as long as possible.

“I never wanted that pig liver in the body for too long — I think that’s impossible,” Sun said in an interview. “My design is for it to serve and function as a bridge until the liver can regenerate or recover or a human donor liver can be located.”

“This shows good potential to get the liver to regenerate,” he said. “Until liver function has recovered, you need a kind of special situation to support the liver’s recovery.”

If a xenotransplanted liver — one from a nonhuman source — can function temporarily, “we may have enough time — one or two months or even three months — to get a human organ from a donor,” Sun said.

While American surgeons have in recent years transplanted hearts and kidneys from genetically modified pigs into a small number of living patients, they have shied away from liver xenotransplantation, which poses particularly complex challenges.

In experimental work transplanting livers from genetically modified pigs into nonhuman primates, most of the transplanted organs failed within a month.

Researchers have pivoted instead toward an approach more akin to dialysis, which involves circulating a liver patient’s blood through a genetically engineered pig liver that is outside the body.

A clinical trial of the treatment for critically ill patients with chronic liver failure who have had acute, life-threatening episodes of the disease was approved by the Food and Drug Administration and is expected to begin soon.

That procedure is also intended to serve as a “bridge” to a transplant for liver patients who have few other options for treatment and not as a permanent solution.

This article originally appeared in The New York Times.

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