Progress in Xenotransplantation Opens Door to New Supply of Critically Needed Organs

NEW YORK, NY, OCTOBER 21, 2021 – The first investigational transplantation of a genetically engineered, nonhuman kidney to a human body was recently completed at NYU Langone Health—marking a major step forward in potentially utilizing an alternative supply of organs for people facing life-threatening disease.

Robert Montgomery

NYU Langone Health

Dr. Robert Montgomery, the H. Leon Pachter, MD, Professor and chair of the Department of Surgery at NYU Langone and director of its Transplant Institute, performs the first xenotransplantation of a genetically engineered nonhuman kidney to a human at NYU Langone Health. (Photo by Joe Carrotta for NYU Langone Health)

Known as xenotransplantation, the surgery was performed on Saturday, September 25, 2021, at NYU Langone’s campus in Manhattan. Robert Montgomery, MD, DPhil, the Leon H. Pachter, MD, Professor and chair of the Department of Surgery at NYU Langone and director of its Transplant Institute, led a surgical team during the two-hour operation. The kidney was obtained from a genetically engineered pig hundreds of miles away and transplanted into a deceased donor who was maintained on a ventilator, with the consent of the family, for 54 hours while the function and acceptance of the new kidney was studied.

The gene that encodes the glycan known as alpha-gal—which is responsible for a rapid antibody-mediated rejection of porcine organs by humans—was “knocked out” in the donor pig. Additionally, the pig’s thymus gland, which is responsible for “educating” the immune system, was transplanted with the kidney to stave off novel immune responses to the pig kidney.

The surgery was part of a larger study approved by a specially designated research ethics oversight board at NYU Langone, and was performed after consulting the New York State Department of Health. It is the latest step in a research protocol that calls for additional and similar procedures to be performed. Whole body donation after death for the purpose of breakthrough studies represents a new pathway that allows an individual’s altruism to be realized after brain death declaration in circumstances in which their organs or tissues are not suitable for transplantation.

The kidney was attached to the blood vessels in the upper leg, outside the abdomen, and covered with a protective shield for observation and kidney tissue sampling over the 54-hour period of study. Urine production and creatinine levels—key indicators of a properly functioning kidney—were normal and equivalent to what is seen from a human kidney transplant. Throughout the procedure and subsequent observation period, no signs of rejection were detected. The results of the study will be presented for peer review and subsequent publication.

NYU Langone Health
Oct 21, 2021, 11:00 ET


The First Transplantation Symposium in Kiev, Ukraine

The First Transplantation Symposium in Kiev, Ukraine - Takes Place with Resounding Success

In an effort to encourage further collaboration between Baskent University and the Bogomolets National Medical University, the first transplant symposium in the history of Ukraine was held in Kiev on October 15-16, 2021 with great success. Despite the existence of few organ transplant centers where kidney, liver and heart transplantations are being performed, the need for coordinating and cooperating transplant activities throughout the country necessitated the organization of such a meeting.

IPITA 2021

2 Days Down - 2 Days left to go!

Day 3 - Paul E. Lacy Memorial Award Lecture

Parallel and Oral Abstract Sessions

  • Islet Organoids from pluripotent and adult stem cells
  • State-of-the-Art Encapsulation and Xenotransplantation
  • Best Poster Showdown Session
  • Immunotherapy and beta cell transplantation
  • Biomarkers and Immunomonitoring of beta cell replacement therapies

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RECENT PUBLICATIONS IDENTIFIED
BY TTS EDUCATION COMMITTEE ON COVID-19

Articles this week reviewed by Dr. Enver Akalin

Differential Kinetics of Immune Responses Elicited by Covid-19 Vaccines

Collier AY et al.
N Engl J Med. 2021 Oct 15. doi: 10.1056/NEJMc2115596. PMID: 34648703

This study evaluated antibody and T-cell responses from peak immunity at 2 to 4 weeks after the second immunization in recipients of the messenger RNA (mRNA) vaccines or after the first immunization in recipients of the Ad26.COV2.S vaccine to 8 months. The BNT162b2 and mRNA-1273 vaccines were characterized by high peak antibody responses that declined sharply by 6 months; these responses declined further by 8 months.

Antibody titers in recipients of the mRNA-1273 vaccine were generally higher than those in recipients of the BNT162b2 vaccine. The Ad26.COV2.S vaccine induced lower initial antibody responses, but these responses were relatively stable over the 8-month follow-up period, with minimal-to-no evidence of decline. At 8 months, the median CD8+ T-cell responses were 0.016% with the BNT162b2 vaccine, 0.017% with the mRNA-1273 vaccine, and 0.12% with the Ad26.COV2.S vaccine. With all three vaccines, T-cell responses showed broad cross-reactivity against SARS-CoV-2 variants.

COVID-19 in Solid Organ Transplantation: Results of the National COVID Cohort Collaborative

Vinson AJ et al.
Transplant Direct. 2021 Oct 6;7(11):e775. doi: 10.1097/TXD.0000000000001234. PMID: 34646938

This study identified a cohort of solid organ transplant (SOT) recipients testing positive or negative for COVID-19 (COVID+ and COVID-, respectively) between January 1, 2020, and November 20, 2020. Of 18 121 SOT patients tested, 1925 were positive (10.6%). COVID+ SOT patients were more likely to have a kidney transplant and be non-White race.

Comorbidities were common in all SOT patients but significantly more common in those who were COVID+. Of COVID+ SOT, 42.9% required hospital admission. COVID+ status was the strongest predictor of acute kidney injury (AKI), rejection, and graft failure in the 90 d after testing. A total of 40.9% of COVID+ SOT experienced a major adverse renal or cardiac event, 16.3% experienced a major adverse cardiac event, 35.3% experienced AKI, and 1.5% experienced graft loss.

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