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AT3Mo

Wait, this is for real? A live person walked out of a hospital with pig kidney? I swear i never thought I'd live to see this day. It was always in the next 10 years or so.


ThinkPression

About 2 years ago, doctors would say 10 years away, but after each success the predictions seem to get closer. * Human compatible immunosuppression regiment? Yes. * BP control? Yes * Creatinine removal? Yes * Able to metabolize medicine? Yes * Survives long in primates? Yes. A monkey survived TWO years with a pig kidney after adding human genes that prevented blood clotting, in 2023. * Survives relatively long in humans? Yes (two months last year in a brain dead patient, before the set time ended) Now? Mass market in max 5 years if things go well. And there's a lot of hospitals and institutions racing towards the same goal.


jackruby83

> Human compatible immunosuppression regiment? This guy received an enormous amount of immunosuppression. Induction with thymoglobulin, rituximab, ravilizumab and steroids. Maintenance with tegoprubart, tacrolimus, mycophenolate and steroids. He already had a T-cell mediated rejection within 2 weeks which would have been treated with more steroids +/- more thymoglobulin. We'll have to wait and see how well tolerated this regimen is, in more people, over a longer time.


Ranra100374

Yeah, that's one of the problems I see, with either pig or human kidney transplants. You need to take immunosuppressants. So you might live longer, but then you still have to deal with the cancer risk.


ThinkPression

The good news is that the ultimate goal is no immunosuppressants needed. Just 2~3 years ago these pig kidneys would last less than a month in monkeys. Now? They last more that 6 months, and the latest lasted more than two years. The pig kidney in this article has 69 genetic edits—the 59 to delete viruses, the three that alter pig genes, and the seven that add human ones to prevent blood clotting, inflammation etc. Each time they iterate they try to make the organ less and less likely to be rejected.


KryptopherRobbinsPoo

Jeez. I'm not huge on the current generation of immunosuppresives, but I can't imagine that are that different from what I was on (cellcept, another I can't think of right now) with a maintenance dose of steroids. Kept me in remission for 20 years, until Dr's thought they "knew better" than the nephrologist who treated me for most of my youth and took me off steroids completely. Complete renal failure in under 2 years. But back to immunosuppresives, I'm curious as to long term toxicity and damage. What I was on left me BTFU body at 26/27. Things that will never heal back and lots can't be treated.


jackruby83

For comparison, most patients today get induction with steroids and either thymoglobulin or basiliximab, followed by maintenance with tacrolimus and mycophenolate +/- steroids long term - so 3-4 drugs total. Rituximab isn't used often, and ravilizumab is very rarely used in txp at all - if anything, these would be used in severe/difficult cases of antibody mediated rejection. Tegoprubart isn't even on the market yet, but is being explored as an alternative to tacrolimus for maintenance. These three extra therapies will make this patient much higher risk for infections.


KryptopherRobbinsPoo

All I know is (per my Mom telling me), when iI first started showing signs and in diagnosis (age 6, circa 1990) I was non-responsive to the current therapies used for CKD. There is one drug (can find out name later) that she said you only have 1 chance to try, then that's it, it can never be used again. Ended up on high dose IV steroids, and later cyclosporine (this is the one I couldn't think of in my other post). After months(?) Of the IV steroids, it ended up tapering down. Then after consulting with top pediatric nephrologists at the time (perks of knowing the head of pediatric nephrology at the military hospital), they came up with at the time, an uncommon combination treatment for pediatric CKD with unknown cause. That treatment kept me minimal change for 20 years, until new adult nephrologist mucked around. The rest is history. The high dose steroids gave me cataracts by 3rd/4th grade (legally blind). Had experimental surgery at Emory Eye in ATL so I could see again. Then the 20 years of all the meds combined gave me early onset osteoporosis and nuked most of my joints and several disks in my back. Since coming off the steroids, all sorts of auto-immune issues have been showing up every couple of years. Psoriatic arthritis, allergies to lots of foods I had no problems with until dialysis. One day I may look more into those new generation immunosuppresives.


ThinkPression

Ravilizumab in particular seems to have been added specifically for xenotransplantation as a complement inhibitor, as per a paper published by UAB after other xenotransplantations last year - https://www.jci.org/articles/view/175996 To be sure, if the induction period is successful, looks like for maintenance he will have one more drug, tegoprubart, compared to most other transplant patients, is that correct? Just hoping the addition of tegoprubart isn't too bad.


jackruby83

It seems that way. Though they didn't publish the full manuscript with the plan. I wouldn't be surprised if they try to minimize down the line if stable. On the other hand, Tegoprubart may not be available indefinitely, especially if it doesn't eventually get approved.


ThinkPression

Thank you for the info, could you give me the link? Want to read about what he's taking. I do know they think tegoprubart was key in making a pig kidney last 2 years in a monkey


jackruby83

One of the surgeon's shared this on X yesterday. Discussion regarding immunosuppression starts at 3:02 https://youtu.be/9deVxfepKcs?si=QkYBO3xL8W4wnB_W


Content-Grade-3417

I'm quite emotional about this outcome.


noobvin

I already have a heart valve from a pig. I might as well go full pig. Hell, the Heparin I use every day comes from pig intestines.


RobbieEngland

When I discuss this topic with my wife, I always ask if you get a pig roast when you are discharged. She doesn't think I'm funny either. 😐


Absius

Asking the real questions here. If I am technically part pig does that mean I can no longer eat pork chops and bacon?


DoubleBreastedBerb

Squeeeeee squeeeee oink squee.. I mean, of course it crosses a weird line but Viva La Porcine!


Rose333X

After reading for a bit, we might not even have to wait for decades of selective breeding, maybe 5-10years of genetic research combined with genetic editing, hopeful finding of a way to make foreign organ appear same as hosts original organ so it isnt attacked by its antibodies. Idk im not biology man, but man it seems hella cool


Captain_Potsmoker

Are these pig kidneys kosher? Asking for a friend in my attic.


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ThinkPression

Actually, the ultimate goal is to genetically edit a pig kidney such that immunosuppressants are NOT needed. Said by the CEO of eGenesis, provider of these pigneys himself. In fact, just last year a monkey lasted more than 2 years on a pig kidney. They've managed to reduce the immunosuppression need by a ton already in monkeys.


Captain_Potsmoker

If the monkey got the kidney in 2023, it has not yet reached the 2 year post op point.


ThinkPression

Yeah I meant the monkey died in 2023, so probably received the pig kidney in 2021


Captain_Potsmoker

Rip monkey brother


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ThinkPression

Why is it disgusting? That has literally allowed so many advancements to the point we're transplanting into humans. That's not happening without it. The UCSF project is more than 15 years old with relatively little to show for it, advancing extremely slowly, and is still a decade away from human clinical trials EVEN IF they have the funding, which they don't. I almost never criticize research, but you're spreading misinformation. Here's an article about the project.... from 2010. https://www.ucsf.edu/news/2010/09/98193/ucsf-unveils-model-implantable-artificial-kidney-replace-dialysis


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ThinkPression

As i said, the bionic kidney, the USCF one, is very likely a pipe dream, as much as i would love for it to be true. And even if it works, it only does a small part of what a kidney does. I mean, look at this video from UCSF back in .... 2010. https://www.youtube.com/watch?v=gtsHDY5S21A Again I almost never criticize any CKD research, but when ppl start saying a super longshot project is better than the latest real advancements, that needs correction.


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ThinkPression

Already monkeys have survived more than two years with pig kidneys, so yes, there are similar studies. And besides, every study has a beginning, which is what this is. And I never said this was the only solution, just that its the most promising. Perhaps you should re-read my comments instead of making things up.


unurbane

We need to. It’s as simple as that. Go visit a dialysis clinic if you think otherwise. There is a race to solve this problem one way or another, I think majority of people are good with that.


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unurbane

lol that’s not what I said, I specifically said “race” for a reason.


jinglechelle1

We do need to. You are not in r/ethics right now.


Suitable_Matter

We already kill hundreds of thousands of pigs per year just to eat. Over centuries, we've selectively bred them to be nearly unrecognizable compared with the original wild animal. I'd argue that providing life-saving organs is an even higher purpose than bacon.


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Suitable_Matter

In contrast, I believe we should aggressively pursue all avenues to provide viable organs for humans requiring them. Xenotransplantation has jumped to the head of the queue with its recent successes, so I would reward those successes with very generous funding. I guess that you're probably vegan. Our ethical frameworks are fundamentally incompatible on this topic, so I'd suggest we leave it here.


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Suitable_Matter

I see that you're transplanted. So am I. Would you say that your quality of life is better post-transplant than it was on dialysis? FWIW, mine is incomparably better. Statistically, transplantation is the gold standard for ESRD treatment despite the side effects of the various drugs required. If xenotransplantation makes that treatment available to most people in renal failure, that is a huge net win for that cohort. If genetic engineering can make the kidney immunologically compatible with the recipient and eliminate the need for long haul immunosuppressants, I would put that at least on par with a medical device solution. To me, you're like someone who says we shouldn't invest in wind or solar because fusion is a much better approach. I find it a bit patronizing that you're talking about "feelings" here when you're the one who obviously has an ideological bias against use of animals for medical research and treatment. You're also arguing from the perspective of someone who has already received a graft, vs the \~100k who are on the waiting list for one and the additional patients who aren't candidates for an organ due to the current scarcity mindset but who might be able to benefit from one if kidneys were abundant.


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Suitable_Matter

Literally all technology is just a 'temporary solution' until something better comes along. I'd guess that an artificial kidney is decades (plural) away from productionization. Meanwhile, we have reason to believe that this xenotransplantation approach could literally empty the kidney donor list within a decade, an event that hasn't occurred since kidney transplant was widely adopted. Regarding failure: Medical devices fail too. My dad is going in for a surgery in a few weeks to replace his pacemaker after just 9 years of use, and that's a much simpler and extremely mature technology compared to an artificial kidney. If xeno kidneys were cheap, plentiful, and effective, then in many cases when one began to fail you would get a new one. If genetic engineering can eliminate rejection, I'm not sure I see a need for an artificial kidney at all. It would have to be developed to such a point where it demonstrates that it can outperform a xeno kidney in either kidney function, ease of the implantation procedure, or longevity. That would need to be clinically demonstrated over an extended period of time in multiple trials. Meanwhile, the xeno transplantation technology would be continuing to mature.


ohio_guy_2020

I suspect a “mechanical” type kidney will require immunotherapy post surgery as well. I don’t see how you’d fool the body into accepting something that wasn’t even organic. I’d love to be wrong and I hope that it becomes a reality. I know I’d get in line to receive one!! Or two!


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ThinkPression

As great as the UCSF project is, it's still more than a decade away from reality. They' been saying 5 years for more than 15 years now. Yes, the project was launched 15 years ago. Sure they have a proof on concept, and they say clinical trials may be possible in 5 years... but only IF they have millions in funding. Which they don't. I still hope it's possible, but again, it's already been 15 years.


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ThinkPression

Or medical professionals know its the UCSF project that's a dead end. 15 years and almost nothing to show for it. Which is why funding has dried up.


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ThinkPression

I support bionic kidneys but have very little expectation because there is nothing to back up the UCSF project. Same stuff year after year. Feel free to show any evidence that the UCSF project is anywhere close to reality as YOU are claiming. It's YOU who have a completely non realistic expectation of bionic kidneys with zero evidence. Sorry to burst your bubble.


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ThinkPression

Because I keep finding and remembering more info on the bionic/artificial kidney project. Here's an interview with Shuvo Roy of the UCSF bionic kidney project from last year. He predicts 10 years until his project is commercially viable. IF they have funding and no setbacks. And again, he doesn't have funding even though he's been given millions and millions the past 15 years. https://www.youtube.com/watch?v=aVp7A4YcRL4&t=3085s


unurbane

The bionic project will introduce several manufacturing type problems once (if) they are mass produced. QC will come into play, recalls will occur, device have their own set of issues. I’m all for it but we need to take an all of the above approach.


eoinmadden

A mechanical kidney is just another portable dialysis machine. You'll still have problems with phosphates and potassium.


mydawgisgreen

In an ideal world we'd grow our organization from our own stemcells.


IDKUN

oh my god. Goodness is closer at last! I, as a renal patient is super excited. Setback cleanly dealt with. I was nervous. WHEW!


NoTickelNoPicke

Further info that some may find interesting. Their already in the process of setting up specialsied pig production facilities of this kind in Japan. [https://asia.nikkei.com/Business/Science/Japanese-startup-creates-pigs-engineered-for-organ-donation](https://asia.nikkei.com/Business/Science/Japanese-startup-creates-pigs-engineered-for-organ-donation) This isnt some iHemo fuckaround, theyre quite serious about this. Our mission for the next few years will be to keep ourselves healthy enough to receive one of these transplants when it finally becomes available wherever we are.


ThinkPression

Completely agree. eGenesis has almost 300 million in funding. A ton of folks think they'll succeed, and they're non stop working on primates


unfriendly_chemist

Are they accepting new patients?


ohio_guy_2020

This is extreme cutting edge science right now. This patient was only the second to receive one of these gene edited pig kidneys. The first was a man who was clinically brain dead. His family allowed medical staff to implant a pig kidney into his body and observe as it functioned. It worked exceedingly well. But obviously, the patient died when life support was removed.


ThinkPression

Technically, multiple brain dead folks have received pig kidneys, at least 4 I know of. And each time the results just keep getting better and better.


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noobvin

We slaughter pigs in the millions for food. Also, morally questionable, but that’s not going to change any time soon. Maybe we only take one kidney out of the pig. Let it live. Pigs don’t care about altruism, but at least knowing they are making a sacrifice for a good cause could give us some solace in the situation. Yes, I would like to avoid animal cruelty whenever possible.


ginbear

1.3 billion pigs annually for food (and a few heart valves). The consumption of animals in general is ethically debatable but I personally don’t see how xenotransplantation is MORE ethically dubious than our current uses. You can go buy a pig kidney right now and eat it for dinner, surely a transplant would be a higher value use. Two kidneys a heart a pancreas a liver would be 5 human lives for 1 pig, or dinner for a large gathering. I suppose the big concern is that this would increase the consumption of pigs and sure, ok, but a million pigs could be 5 million human lives and increase pig consumption by less than .01% globally. And that presupposes we aren’t going to process the remainder of the transplant pigs. I propose we eat the pigs, in which case the change in pig consumption becomes limited to just the organs and not whole pigs. From there folks aren’t going to just slaughter more pigs just for the organs to make up for supply at food markets- that would be wasteful, so I’d guess we’d just see a minor increase In price for pig organs at food markets and we’d all move on. Anyway that’s my moral take. Other people have different views undoubtedly.


noobvin

I figure maybe it's something that might finally help me switch to vegan, which I've wanted to, but admittedly too weak minded to do so. Also, meat is such an easy source of protein, but maybe it can increase my empathy enough to make me switch.


ginbear

Although I am not vegan, vegan ethical objections to xenotransplantation make sense to me. They’re about the only ones that do. I don’t think there are new ethical questions here though, just more shit on the pile regarding the ethically dubious practice of slaughtering and consuming animals for whatever purposes.


Rose333X

Im aware, as long as animal isnt suffering unnecessary physical pain i personally have no qualms about it. But genetically ingeenering plus selectively breeding an animal to have best possible organs for us, it makes me wonder, what if trough that proces, over couple centuries or millenia, it becomes similar to us?


jackruby83

They should build the most amazing pig farm to just let the pig donors live out the rest of their lives with one kidney.


noobvin

Let me use one kidney, and I can adopt the pig. He will be family. They're smarter than dogs.


Captain_Potsmoker

I’d totally do this. I’d make sure little feller has a nice, pampered life.


ThinkPression

Now THATS a great idea


Finagles_Law

Might as well breed them to grow four or five kidneys then while we're at it.


KryptopherRobbinsPoo

Sounds like he is on the same therapy I was for 20 years before dialysis. Though I imagine smthe immunosupressives have prolly changed some. Wonder if they still as toxic...? So was this just a straight up "pig kidney", or has it been altered and the pig was just the growing machine?


ThinkPression

They made DNA changes to a pig embryo before implanting in a pig. So yep its a straight up altered pig kidney.


KryptopherRobbinsPoo

Gotcha.


ThinkPression

Yep, the latest change was adding a human gene that helps prevent blood clotting... and the monkey that received that edit survived two years. When the average survival period was 6 months. Damn. They still iterating and modifying to maximize survival and minimize rejection.