Daijiworld Media Network – Beijing

Beijing, Nov 30: In a groundbreaking medical achievement, Chinese surgeons have successfully transplanted a 10-gene-edited pig liver into a living human, marking the world’s first auxiliary porcine liver xenotransplant capable of supporting human metabolism for several weeks. The procedure offered vital temporary liver support in a case where conventional treatment was impossible.

The recipient, a 71-year-old man suffering from hepatitis B–related cirrhosis and an extensive hepatocellular carcinoma, had no viable options for standard resection or human liver transplantation. With his condition rapidly worsening and no donor organ available, doctors proceeded with the xenotransplant under compassionate use on May 17, 2024, after removing the tumour-bearing right lobe of his liver.

10 gene edits for compatibility

The donor organ came from a Diannan miniature pig engineered with ten specific genetic modifications—three xenoantigen knockouts and seven human gene insertions—to enhance immune tolerance and improve coagulation compatibility. The graft began functioning immediately after reperfusion, producing bile and contributing to key metabolic tasks such as bile acid regulation, albumin production and coagulation factor synthesis.

Serial biopsies showed no hyperacute or acute rejection, and early liver and kidney functions remained stable.

Critical complication emerges

However, the case revealed a major clinical challenge. Nearly a month after surgery, the patient developed xenotransplantation-associated thrombotic microangiopathy (xTMA)—a severe condition marked by hemolysis, low platelet count, complement system activation and microvascular clotting.

Despite treatments including anticoagulation, plasma exchange and the complement inhibitor eculizumab, the team was forced to remove the pig liver graft on day 38. Fortunately, the patient’s remaining native liver had grown sufficiently to maintain metabolic function, and the xTMA resolved.

The patient later experienced recurrent variceal bleeding and died on postoperative day 171.

A milestone with more work ahead

Researchers say the success of the auxiliary xenotransplant demonstrates that a porcine liver can temporarily sustain human physiology. However, challenges such as xTMA, coagulation mismatch and complement activation continue to limit widespread clinical adoption.

They emphasised that further gene editing, improved immunosuppressive strategies and targeted prevention of xTMA are essential before pig-to-human liver support can become a practical option in hospitals worldwide.