Xenotransplantation: A Successful Recent Procedure May Change the Game for HF Patients

DocWire News talks with Andrew Sauer, MD, an associate professor of medicine and medical director of the Center for Advanced Heart Failure and Heart Transplantation at the University of Kansas/KU Medical Center, about the implications of the recent procedural success of the first pig-to-human heart transplant. Dr. Sauer expounds on what he thinks the results of an operation like this could mean for the quality of life (and length of life) for heart failure patients. Dr. Sauer is also a member of the DocWire News Editorial Board.

Read the transcript below.

Could you explain why this event has been described as a breakthrough for heart failure patients?

We had really exciting news this month. On January 10th at the University of Maryland, and or the first time in its current fashion, we saw a surgeon and a team identify a patient for whom a transplant was performed involving a pig heart going into a human recipient. What’s really exciting about this news is we historically have not been able to overcome the species barrier. This is called xenotransplantation, and while we have had xenotransplantation happen in humans in the past (for example, transplanting a baboon heart into a human, which happened in the 1980s), these heart transplant procedures have never been shown to actually be able to sustain life in terms of a patient recovering from surgery and potentially going home.

Where does research go from here?

In the bigger picture of transplantation, this is really exciting because we have a crossroads right now where we have a growing epidemic of heart failure. By 2030, it’s expected that there will be eight million patients in the United States with a diagnosis of heart failure. It’s been said many times to anticipate that a patient will be treated for heart failure with a heart transplant is like saying we’ll treat poverty with the lottery. Generally, we don’t really think about transplant as being a mainstay treatment for heart failure because we try to ultimately recover patients from heart failure, but when patients have lost all other options and we ultimately take out the old heart and put in a new one, it’s a scarce resource.

Ultimately, in the United States, we see about two to 3,000 transplants per year. And that has been growing above 3,000 recently. However, there’s only so many hearts out there. A lot of patients are unable to get access to the scarce resource, so there is a lot of interesting emerging technology in not only in xenotransplantation, but also in mechanical circulatory support, LVADs, as well as in donations after cardiovascular death. All of these really exciting innovations are happening at the same time. Obviously, with xenotransplantation, we have to figure out how to manipulate these non-human hearts, using knockout, genetic editing, and CRISPR technology (which is really an exciting thing for treating cancer and treating genetic diseases). However, ultimately, being able to re-engineer a pig heart to go into a human and sustain life for more than six months is really going to be potentially competitive with mechanical circulatory support or total artificial heart technologies. It’s really an unusual, exciting time in heart transplantation to be able to think about all the different converging options that we have other than traditional donation after neurologic death for heart transplantation.

What can practitioners take away from this achievement?

The take home message here, as it relates to the exciting events of xenotransplantation, is we all want to see how this gentleman does. We’re now 18 days out, and we ultimately want to see that this patient, this human being, has a nice extended life, and ultimately is able to go home and do some [living]. There are a lot of unanswered questions about the ethics and the complexity of how this fits in with other technologies, but can we do it again? Can we continue to see these hearts genetically engineered to ultimately take into the human body the opportunity to promote life as an alternative to traditional transplant? So this is a really exciting time, and I look forward to seeing what comes next.

See more from Dr. Sauer here.