Reacción a "A modified pig liver was transplanted into a living person for the first time"

This study marks a historic milestone, as it is the first time that a genetically modified pig liver has been transplanted into a living patient and has functioned for weeks, producing bile, albumin, and coagulation factors. The procedure was performed on a 71-year-old man with cirrhosis due to hepatitis B and a very large hepatocellular carcinoma in the right lobe, with no known metastases, which was resected during the same surgery. The xenotransplantation was not considered a curative cancer treatment, but rather a supportive strategy to prevent liver failure after tumour removal, as the remaining liver was insufficient. Overall, the article is very well documented, with detailed clinical, immunological, and histological follow-up, which gives it great scientific value and makes it a reference for the field.

Until now, porcine heart and kidney transplants in humans had been described, as well as liver transplants from brain-dead donors. This is the first time that a porcine liver has been shown to integrate temporarily and perform critical metabolic and synthetic functions in a living patient. The case shows that the most realistic strategy is to use it as a bridge therapy, allowing time for the native liver to recover or for a human donor to become available. In a context of enormous organ shortage, this advance has enormous potential.

There are several limitations to consider. This is a single case. The graft had to be removed on day 38 due to thrombotic microangiopathy associated with xenotransplantation, a serious coagulation complication that reflects the current limitations of this strategy. The patient ultimately died months later. In addition, the intense and prolonged immunosuppression used (tacrolimus, sirolimus, mycophenolate, corticosteroids, basiliximab, rituximab) could promote the growth of residual tumour cells, if any. The paper does not describe the performance of a post-mortem study (autopsy), which would have been very valuable in confirming the absence of tumour recurrence, assessing the condition of the native liver, better understanding the haemorrhagic complications, and studying the systemic immune response. Significant questions also remain regarding safety against porcine viruses, duration of function, and ethical and social acceptance.