En un hito para la medicina, cirujanos estadounidenses trasplantaron el corazón de un cerdo a un paciente humano en un último esfuerzo por salvarle la vida, y el hospital de Maryland donde se realizó el procedimiento señaló el lunes que el receptor se encuentra en buen estado tres días después de la cirugía experimental.
Si bien es demasiado pronto para saber si la operación funcionará en realidad, sí representa un hito en una cruzada de varias décadas por trasplantar algún día órganos de origen animal para salvar vidas humanas. Doctores del Centro Médico de la Universidad de Maryland señalaron que el trasplante demostró que el corazón de un animal genéticamente modificado puede funcionar en el cuerpo humano sin que se presente un rechazo inmediato.
El paciente, David Bennett, de 57 años, sabía que no había garantía alguna de que el experimento funcionara, pero se estaba muriendo, no era elegible para recibir un corazón humano y no tenía más opciones, comentó su hijo a The Associated Press.
“Era morir o someterme a este trasplante. Quiero vivir. Sé que las posibilidades son bajas, pero es mi última opción”, dijo Bennett un día antes de la cirugía, según el comunicado difundido por la Facultad de Medicina de la Universidad de Maryland.
El lunes, Bennett respiraba por sí solo, aunque seguía conectado a una bomba de derivación cardiopulmonar para ayudar a su nuevo corazón. Las próximas semanas serán cruciales: En ellas, el paciente irá recuperándose de la cirugía y los doctores monitorearán cuidadosamente el desempeño de su corazón.
Existe una enorme escasez de órganos humanos donados para trasplantes, lo que ha llevado a los científicos a intentar descifrar la manera de utilizar órganos de animales en su lugar. El año pasado se realizaron poco más de 3.800 trasplantes de corazón en Estados Unidos, una cifra récord, según la United Network for Organ Sharing (UNOS), organismo que supervisa al sistema nacional de trasplantes.
“Si esto funciona, habrá un suministro inagotable de estos órganos para pacientes que sufren”, dijo el doctor Muhammad Mohiuddin, director científico del programa de xenotrasplantes de la universidad.
Sin embargo, los intentos previos para realizar este tipo de trasplantes — conocidos como xenotrasplantes — han fracasado, en buena medida porque el cuerpo de los pacientes rechaza rápidamente los órganos animales. Uno de los casos más conocidos se registró en 1984, cuando la bebé Fae, una niña que agonizaba, sobrevivió 21 días con el corazón de un babuino.
La diferencia en esta ocasión es que los cirujanos de Maryland utilizaron el corazón de un cerdo que fue sometido a edición genómica para retirarle un azúcar de sus células que es responsable del rechazo casi inmediato de órganos. Varias compañías de biotecnología están desarrollando órganos porcinos para trasplantes a humanos. El que fue utilizado en la cirugía del viernes fue proporcionado por Revivicor, una subsidiaria de United Therapeutics.
“Supongo que se puede definir como un parteaguas”, dijo el doctor David Klassen, director de medicina de UNOS, al referirse al trasplante en Maryland.
De cualquier forma, Klassen advirtió que es apenas el primer paso tentativo para averiguar si los xenotrasplantes podrían funcionar finalmente.
La Administración de Alimentos y Medicamentos (FDA por sus iniciales en inglés), que supervisa los experimentos de xenotrasplantes, dio luz verde a la cirugía con una autorización de emergencia por “uso compasivo”, la cual se aplica cuando el paciente no tiene más opciones.
Será crucial compartir los datos que se recaben de este trasplante antes de poder ofrecer esta opción a otros pacientes, dijo Karen Maschke, investigadora experta en el Hastings Center, el cual está ayudando a desarrollar las recomendaciones éticas y de política para los primeros ensayos clínicos subvencionados por los Institutos Nacionales de la Salud.
“No sería recomendable apresurar los trasplantes de animales a humanos sin esta información”, subrayó Maschke.
Con el paso de los años, los científicos han pasado de los primates a los cerdos, alterando sus genes.
Apenas en septiembre pasado, investigadores de Nueva York realizaron un experimento que dejaba entrever que este tipo de cerdos podrían facilitar los trasplantes de animales a humanos. Los doctores conectaron temporalmente el riñón de un cerdo a un cadáver humano y vieron que comenzó a funcionar.
El trasplante realizado en Maryland llevó el experimento al siguiente nivel, dijo el doctor Robert Montgomery, quien encabezó el experimento previo en NYU Langone Health.
“Este es un avance en verdad notable”, indicó Montgomery en un comunicado. “Como receptor de un trasplante de corazón y al padecer de una afección cardiaca genética, estoy sumamente entusiasmado por esta noticia y por la esperanza que le da a mi familia y a los otros pacientes a los que este avance eventualmente les salvará la vida”.
La cirugía del viernes pasado en un hospital de Baltimore tomó siete horas. El doctor Bartley Griffith, quien llevó a cabo la operación, dijo que el problema de salud del paciente — insuficiencia cardíaca y arritmia — lo hacían inelegible a recibir un corazón humano o un dispositivo de asistencia ventricular.
Antes de ofrecerle la opción a Bennett, Griffith había trasplantado corazones de cerdos en unos 50 babuinos en un lapso de cinco años.
“Todos los días estamos aprendiendo mucho con este caballero”, dijo Griffith. “Y hasta ahora, estamos contentos con nuestra decisión de proceder. Y él también lo está: Hoy tenía una enorme sonrisa”.
Las válvulas cardíacas de cerdos también se han utilizado con éxito en humanos durante décadas, y el hijo de Bennett señaló que su padre ya había recibido una hace aproximadamente 10 años.
“Está consciente de la magnitud y la importancia de lo sucedido”, dijo David Bennett Jr. acerca de su padre. “Podría no sobrevivir, o podría vivir un día, o un par de días. O sea, en este momento estamos en terreno desconocido”.
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