The year 2024 was a remarkable one in the world of kidney transplants, with a record 27,759 operations performed nationwide. This was an increase of 1.6 percent over 2023, according to the Organ Procurement and Transplantation Network.
Kidney transplant surgeons at the University of Toledo Medical Center have been applauding that milestone achievement in 2024 and are working to create partnerships to bring last year’s biggest advancement into the new year: transplanting genetically modified pig kidneys into humans.
“We are discussing this with collaborators so we can be a part of this new wave and bring xenotransplants to Toledo,” said Dr. Obi Ekwenna, a UToledo Health transplant and urologic surgeon. “We are still in the early stages of figuring out all of the challenges and opportunities that are present with xenotransplantation.”
On April 24, UTMC will promote a living donor day.
In 2023, UTMC celebrated its 3,000th kidney transplant.
In 2022, robot-assisted surgeries became available at UTMC to make the procedure minimally invasive.
Meanwhile, UTMC recently garnered a number of 5 star ratings, the highest possible, from the Scientific Registry of Transplant Recipients. UT rates first in the country — at about six weeks — in speed of moving people from waitlists, according to Dr. Ekwenna. It also got 5 star ratings in one-year survival rates while on a waiting list and one-year organ survival rate after transplantation.
As University of Toledo researchers continue to lead studies on markers that might lead to organ rejection and on improved methods of matching patients to donors, the effort to boost successes in the field are taking place throughout the state and country.
The Ohio State University Wexner Medical Center Comprehensive Transplant Center completed its first 20-person chain of kidney transplants in December. The procedures involved a synchronized chain of 20 surgeries with five donors and five recipients on each of two days.
“This is one of the country's largest single institution living kidney donor transplant chains completed in one week,” said Dr. Kenneth Washburn, executive director of the Comprehensive Transplant Center and director of the Division of Transplantation Surgery at Ohio State University College of Medicine. “Big chains like this one allow us to help a large number of patients in a short period of time.”
Paired kidney donation happens when a person in need of a kidney has a living donor that's not a compatible blood or tissue match. But that living donor could be matched with a person who also has a donor who is not compatible and so a chain is formed. It is a Pay It Forward concept.
The transplant team began planning the chain in October.
“This kidney chain removed 10 patients from the transplant wait list, which will hopefully shorten the wait for others,” said Dr. Amer Rajab, who performed six of the surgeries. “People with kidney failure can live for a long time on dialysis, but the treatment can be hard on the body and limit quality of life.”
UTMC has also played a key role in forming such chains. In 2006, Dr. Michael Rees, a transplant surgeon at UT’s Medical Center, helped to found the Alliance for Paired Donation, Inc. In 2009, the Alliance was featured by People magazine’s Heroes Among Us Awards highlighting a kidney transplant chain which was initiated in Toledo and ultimately benefited 20 patients from all parts of the country in the longest chain at that time.
Today, there are about 90,500 people waiting for a kidney, with about 2,080 in Ohio, according to the Organ Procurement and Transplantation Network.
More advancements
At Northwestern Medicine Comprehensive Transplant Center in Chicago, the first kidney transplant was undertaken while the patient was awake and discharged home the next day, making the surgery an out-patient procedure.
Massachusetts General Hospital announced the world's first successful transplant of a genetically edited pig kidney into a 62-year-old man, who died months later.
The pig kidney was provided by eGenesis and was genetically edited to remove harmful pig genes and add certain human genes to improve compatibility. Additionally scientists inactivated any retro viruses from the pig donor to eliminate risk of infection to humans.
"I saw it not only as a way to help me, but a way to provide hope for the thousands of people who need a transplant to survive," Richard Slayman, of Weymouth, Mass., said in a statement issued at the time.
Meanwhile, an Alabama woman is free from dialysis and in better health after surgeons at NYU Langone Health performed a gene-edited pig kidney transplant in December. She is the third person in the United States to receive such a transplant. A fourth such transplant was completed successfully in January at Massachusetts General Hospital.
Organ donation shortages continue to drive new research and innovation, which has generated interest in zoonotic transplantation, according to Lauren Maziarz, an associate professor of public health at Bowling Green State University, noting that 17 people die each day waiting for an organ transplant.
Ms. Maziarz said the biggest concern to the public is the risk of infectious diseases being spread from animal to human.
“Until more clinical trials are complete, we won't know the full range of risks,” she said. “With the FDA recently approving genetically modified pig kidneys into patients, we will soon have a better understanding of how realistic large-scale xenotransplantation is.”
Dr. Ekwenna said these FDA-approved pig-to-human kidney transplant trials involve patients who are unlikely to live long enough to receive a human kidney.
There are still questions waiting to be answered. For instance, there are viruses unique to pigs. These are being genetically engineered out of the pigs prior to transplantation. Yet, it is something to watch, according to Dr. Ekwenna. Other outcomes to be learned through these trials is how long might a pig kidney last in a human, how long can rejection of the organ be kept at bay, and whether the kidney picks up tasks other than filtering waste and regulating fluids. Human kidneys have many functions, including hormone production to regulate blood pressure and red blood cells, activating vitamin D, and balancing electrolytes.
Promoting public health
Kidney disease remains a leading cause of death in the United States, according to Ms. Maziarz.
“Improving not only overall life expectancy, but also years of healthy, high-quality life, is a significant public health goal,” she said. “Because most people in kidney failure are treated with dialysis, which is costly and time intensive, focusing on ways to prevent chronic kidney disease, as well as better solutions that improve quality of life, are needed.”
Human-to-human transplants are the gold standard, according to Dr. Ekwenna, who said xenotransplantation augments possibilities for those on waiting lists.
"It is definitely an opportunity for patients who have organ failure that brings hope not too far in the future,” he said.
First Published March 9, 2025, 5:00 a.m.
