From the Editor

Xenotransplantation Reaches a Milestone

After decades of failed attempts at transplanting kidneys from one person to another, Joseph Murray, MD, a surgeon at the former Peter Bent Brigham Hospital in Boston, achieved success in 1954 when he transplanted a kidney between identical twin brothers. Reporting on their findings in Surgical Forum in 1955, Dr Murray and his coauthors noted that the recipient had good renal function persisting after 9 months.1 “The survival of the renal homograft for this period of time with continuing good function indicates the complete lack of a rejection response by the host and demonstrates that renal transplantation is a technically feasible procedure,” they concluded. Several years later, Dr Murray performed a successful kidney transplant between non-identical twin brothers.2 Since then, development and continued improvement of immunosuppressive medications, better donor-recipient matching criteria, and other advancements have made kidney transplantation routine. In 2021, 24,670 kidney transplant procedures took place in the United States, up from 22,817 in 2020, according to the Organ Procurement and Transplantation Network. Among the most formidable challenges today, however, is the lack of kidneys for transplantation. As a result, 100,000 people in the United States are waiting for a kidney transplant, according to the National Kidney Foundation.

Among the options being considered to ease the problem is xenotransplantation—the transplantation of organs or tissues from nonhuman animals into human beings. Numerous hurdles need to be resolved for this to work successfully, but investigators in 2022 reported an important milestone in the endeavor. Two separate teams—one at the NYU Langone Transplant Institute in New York City and another at the University of Alabama at Birmingham (UAB)—described how they transplanted kidneys from genetically modified pigs into brain-dead human beings with encouraging results. (See article on page 22.)

“Our results add significantly to the prior knowledge generated in non-human primate models and suggest that many barriers to xenotransplantation in humans have indeed been surmounted,” the UAB team wrote in a paper in the American Journal of Transplantation. 3 They also noted that “the decedent model has significant potential to propel not only the field of xenotransplantation forward but to answer a multitude of other scientific questions unique to the human condition.”

Kidney transplantation is considered the optimal treatment for endstage kidney disease, but the performance of the procedure is limited by a shortage of usable kidneys.The latest reports offer hope that this impediment could disappear or at least diminish in coming years.

Jody A. Charnow

Editor

1. Murray JE et al. Renal homotransplantation in identical twins. Surg Forum. 1955;6:432–436. 2. Murray JE, et al. Kidney transplantation in modified recipients. Ann Surg. 1962; 156:337–355. 3. Porrett PM, et al. First clinical-grade porcine kidney xenotransplant using a human decedent model.

Am J Transplant. 2022;22:1037-1053.

EDITORIAL ADVISORY BOARD

Medical Director, Urology

Robert G. Uzzo, MD, MBA, FACS

G. Willing “Wing” Pepper Chair in Cancer Research Professor and Chairman Department of Surgery Fox Chase Cancer Center Temple University School of Medicine Philadelphia Urologists

Christopher S. Cooper, MD

Director, Pediatric Urology Children’s Hospital of Iowa Iowa City

R. John Honey, MD

Head, Division of Urology, Endourology/Kidney Stone Diseases St. Michael’s Hospital University of Toronto

Stanton Honig, MD

Department of Urology Yale University School of Medicine New Haven, CT

J. Stephen Jones, MD

Chief Executive Officer Inova Health System Falls Church, VA Professor and Horvitz/Miller Distinguished Chair in Urologic Oncology (ret.) Cleveland Clinic Lerner College of Medicine Cleveland

Jaime Landman, MD

Professor of Urology and Radiology Chairman, Department of Urology UC Irvine School of Medicine Orange, CA

James M. McKiernan, MD

John K. Lattimer Professor of Urology Chair, Department of Urology Director, Urologic Oncology Columbia University College of Physicians and Surgeons New York

Kenneth Pace, MD, MSc

Assistant Professor, Division of Urology St. Michael’s Hospital University of Toronto Vancouver, Canada Medical Director, Nephrology

Kamyar Kalantar-Zadeh, MD, PhD, MPH

Professor & Chief, Division of Nephrology, Hypertension & Kidney Transplantation UC Irvine School of Medicine Orange, CA

Nephrologists

Anthony J. Bleyer, MD, MS

Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, NC

David S. Goldfarb, MD

Professor, Department of Medicine Clinical Chief New York University Langone Medical Center Chief of Nephrology NY Harbor VA Medical Center

Csaba P. Kovesdy, MD

Chief of Nephrology Memphis VA Medical Center Fred Hatch Professor of Medicine University of Tennessee Health Science Center Memphis

Edgar V. Lerma, MD

Clinical Associate Professor of Medicine Section of Nephrology Department of Medicine University of Illinois at Chicago College of Medicine Chicago

Allen Nissenson, MD

Emeritus Professor of Medicine The David Geffen School of Medicine at UCLA Chief Medical Officer, DaVita Inc. Denver

Rulan Parekh, MD, MS

Associate Professor of Pediatrics and Medicine University of Toronto

Robert Provenzano, MD

Associate Professor of Medicine Wayne State University School of Medicine Detroit Vice President of Medical Affairs, DaVita Healthcare Denver

Renal & Urology News Staff

Editor Jody A. Charnow Web editor Natasha Persaud Production editor Kim Daigneau Group creative director Jennifer Dvoretz Production manager Brian Wask Vice president, sales operations and production Louise Morrin Boyle National accounts manager William Canning Editorial director, Haymarket Oncology Lauren Burke Vice president, content, medical communications Kathleen Walsh Tulley Chief commercial officer James Burke, RPh President, medical communications Michael Graziani Chairman & CEO, Haymarket Media Inc. Lee Maniscalco

Contents

SUMMER 2022 ■ VOLUME 21, ISSUE NUMBER 3

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this month at renalandurologynews.com

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Urology

11 AS Rate Increasing for Low-Risk PCa The proportion of men managed with active surveillance rose from 26.5% in 2014 to 59.6% in the rst half of 2021, data show.

12 Metastatic PCa Survival Improved in Wake of Treatment Advances Survival increased by 1 month for every year of diagnosis after 2011 compared with 0.02 months annually from 2000 to 2008, a study found.

12 COVID-19, OAB Link Reported Patients with COVID-19 infection are at increased risk for experiencing new or worsening overactive bladder symptoms, investigators reported.

21 Late Relapse Rare in Testicular Cancer In a study of patients in Norway, late relapse, de ned as disease recurrence more than 2 years after treatment, occurred in 1.9% of men with clinical stage I disease.

Nephrology

13 Fracture Risk With SGLT2 Inhibitors Not Higher vs Other Diabetes Drugs Fracture rates in patients with CKD did not differ signi cantly at 180 and 365 days.

13 Methylprednisolone Found to Slow IgAN Progression Treatment led to a 4.8% absolute annual decline in a composite outcome of a 40% decrease in eGFR, kidney failure, or death from kidney disease.

14 Uric Acid-Lowering Therapy May Increase CKD Risk Patients with serum uric acid levels of 8 mg/dL or less had a 24% increased risk for an eGFR less than 60 mL/min/1.73 m2 .

16 Deceased-Donor Kidneys Useful Despite Longer CIT Transplant outcomes not worse for carefully selected recipients who receive a kidney with a cold ischemia time of 36 hours or longer.

Survival among men with metastatic

prostate cancer has improved markedly with advances in medical therapy. CALENDAR

Editor’s note: The 2022 conference listings below include information provided by the sponsoring organizations on their websites as this issue went to press.

European Association of Urology

37th Annual Congress Amsterdam, The Netherlands July 1-4

International Continence Society

Annual Meeting Vienna, Austria September 7-10

Kidney Week 2022

Orlando, FL November 3-6

ASTRO

2022 Annual Meeting San Antonio, TX October 23-26

Large Urology Group Practice Association

(LUGPA) 2022 Annual Meeting Chicago, IL November 10-12

Society of Urologic Oncology

Annual Meeting San Diego November 30-December 2

24

Departments

6 From the Editor Kidney xenotransplantation hits a milestone

8 News in Brief Erectile dysfunction is a risk factor for MACE

23 Ethical Issues in Medicine Breaches of patient con dentiality are sometimes necessary

24 Practice Management Study reveals a growing problem with inappropriate polypharmacy