[HN Gopher] Patient dies weeks after kidney transplant from gene...
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Patient dies weeks after kidney transplant from genetically
modified pig
Author : lxm
Score : 52 points
Date : 2024-05-12 18:07 UTC (4 hours ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| goles wrote:
| https://archive.is/XjlhQ
| sd9 wrote:
| > The hospital said it had "no indication" his death was related
| to the transplant.
|
| Additionally, the transplant happened in March, which is "weeks
| ago" but not 2 weeks ago, which is the timeframe I initially
| assumed from the headline.
| gexla wrote:
| Also, I'm guessing it's not actually the hospital's job to post
| the more detailed info which may be important related to
| learning from the transplant. I'm way out of my element here,
| but wouldn't the hospital just be the location and any
| important info sharing would be handled by someone else?
| AdamJacobMuller wrote:
| Technically anything (>14 days) could be considered "weeks ago"
|
| I was born more than 2000 weeks ago.
|
| That bit of the headline is just pointless.
| jraph wrote:
| Commonly, you would say weeks when months wouldn't apply,
| otherwise it would be misleading if not plain wrong. Usually.
| (such rules aren't set in stone, allowing humor to exist for
| instance ("I had a child" "Aw! A boy or a girl?" "Yes");
| context matters)
|
| Mathematically true isn't sufficient (and possibly sometimes
| not even relevant), "weeks ago" bears more meaning in common
| language than "there exists N such that N > 2 and N weeks
| passed".
|
| So you were born that many weeks ago, but not really weeks
| ago.
|
| What matters is how things are understood and it's not
| usually the interpretation of a formal version of the text
| (or it is, but a complex one that depends on the mood, the
| culture and the knowledge of the recipient, their
| understanding of the author, possibly on other factors as
| well, that most likely doesn't quite match a naive formal
| translation)
| RcouF1uZ4gsC wrote:
| > The hospital said it had "no indication that it was the result
| of his recent transplant."
|
| Sorry, the burden of proof goes backwards. When you are doing
| something this novel and the patient dies so soon afterwards, the
| null hypothesis is that it had something to do with the
| transplant and you have to show evidence that it was not due to
| the transplant.
| pocketarc wrote:
| It is entirely possible that the hospital knows what happened
| and why the person died, and are just not sharing it (maybe to
| respect the family's privacy, for example).
|
| Having said that, I do think you're right, the cause of death
| should absolutely be shared, otherwise it looks quite dodgy. If
| he was indeed discharged with "one of the cleanest bills of
| health I've had in a long time", then how could he die so
| shortly after, and why would there not be more discussion
| around the specifics?
| everforward wrote:
| It's grim, but he had renal failure requiring an operation in
| 2018 and then back into renal failure causing congestive
| heart failure in 2023.
|
| It's very possible for him to have the cleanest bill of
| health he's had in 6 months or a couple of years, while still
| dying.
|
| I suspect that unwinding whether his death is related to the
| transplant or not is non-trivial. He had a few issues that
| would likely kill him soon. Figuring out which one did, and
| whether it was caused by the transplant, may be difficult.
| jorlow wrote:
| On the other hand, you have to be pretty sick to qualify for
| such extremely experimental procedures. And transplants are
| pretty intensive operations even when someone is otherwise
| healthy (and getting human organs). It doesn't seem farfetched
| for unrelated complications to indeed be the cause of death.
| Someone wrote:
| If alternative treatment with decent prognosis exists (in this
| case Hemodialysis is such an option), to get past the ethics
| committee, first operations like these typically have to be
| done on patients on their death bed. That doesn't make it
| likely the patients survive a long time.
|
| For example, here's what Wikipedia says this of the first
| receiver of a heart transplant
| (https://en.wikipedia.org/wiki/Louis_Washkansky):
|
| _"As a result of heart attacks in 1965, approximately only one
| third of his heart was still functioning. In late October, he
| went into a diabetic coma, but regained consciousness. Once,
| when he was swollen with fluid and in considerable pain, his
| wife Ann asked him in a whisper how he was doing. He managed a
| smile and whispered, "I'm on top of the world." He was also
| suffering from kidney and liver failure."_
|
| And that's a case where no good alternative treatment existed,
| at a time when ethics committees weren't as stringent as they
| are today, if they existed at all.
| bsder wrote:
| Someone who has end stage kidney disease practically by
| definition has a shitload of other problems--any of which can
| kill the patient.
|
| This is similar to AIDS. AIDS almost never kills directly. Some
| other disease like cancer or pneumonia does the actual killing.
| rediguanayum wrote:
| While article doesn't say the cause of death, the patient did
| suffer from congestive heart failure, as a prior condition.
| Further congestive heart failure can cause all sorts of
| complications, meaning that the patient was pretty sick at
| baseline. According to the article, patient had an earlier
| human kidney transplant in 2018 that failed in 2023 leading to
| the congestive heart failure, and thus made patient a candidate
| for the xeno-kidney transplant. Patient was a pioneer- rest in
| peace.
| andrelaszlo wrote:
| This is why there are concepts like relative survival. Maybe
| new procedures are evaluated using similar methods?
|
| https://en.m.wikipedia.org/wiki/Relative_survival
| hombre_fatal wrote:
| Not when the intervention is done on someone already about to
| die.
| torstenvl wrote:
| No. When a very ill patient with several terminal comorbidities
| dies, the null hypothesis is that he died from one of those
| conditions. Your prior is to be skeptical of new medical
| interventions, and that's fine, but it is your responsibility
| to distinguish between your biases and the most likely a priori
| cause.
| choilive wrote:
| The patient had a host of other conditions that put their
| mortality risk already extraordinarily high, which is likely
| why this experiment treatment got approved in the first place.
| Kidney function might now be fine but it could have just have
| easily been one of the other comorbidities that did them in. I
| am sure they are doing more research on this.
| adamredwoods wrote:
| So he also had congestive heart failure from the previous kidney
| failure. Also other articles state "type 2 diabetes and
| hypertension". Dialysis was becoming a burden.
|
| He was very brave. A decision like this is immense.
| ceejayoz wrote:
| Yeah, early trials of something like this will be offered to
| someone who likely wouldn't benefit all that much from a real
| human kidney either, so as not to waste it.
| nxobject wrote:
| I am reminded of Barney Clark, the recipient of the Jarvik-7 - he
| lived for 112 days, but brushed up against the limits of his
| transplanted mechanical heart as time went on and on.
| zaptheimpaler wrote:
| > The hospital said it had "no indication" his death was related
| to the transplant.
|
| I think the transplant team likely did have tons of evidence
| showing the kidney was fine - monitoring things heavily is just
| normal procedure after any transplant, even more so after this
| kind of transplant. He would have had daily or weekly labs
| showing Creatinine/eGFR, ultrasounds, blood tests, urine tests,
| regular appointments talking about symptoms and lots more.
|
| Its possible that the pig kidney caused the death in some way
| that isn't clearly understood yet though. Maybe some proteins in
| the kidney went into the bloodstream and affected another organ,
| maybe they exacerbate congested blood vessels somehow etc. Maybe
| an autopsy will reveal more.
|
| But yeah if you read the history of transplants or any risky new
| medical procedure, they are very fragile and can be set back
| decades or stopped when they go bad or mistakes are made. There
| are incentives for people to cover up the reason's things failed
| and history of hospitals lying out of their teeth to cover their
| asses (see Charles Cullen in The Good Nurse).
|
| I guess I'm saying there is plenty of evidence on both sides of
| the answer to the question of "why did he die".. either way he
| did something heroic.
| Laaas wrote:
| "Patient given modified pig kidney dies two months later" would
| be more apt.
|
| Very editorialized title.
| maerF0x0 wrote:
| "Patient dies of congestive heart failure, not due to pig
| kidney transplant" Also would be more apt.
| dyauspitr wrote:
| That would be misleading too in the other direction, we don't
| know if it played a role.
|
| "Patient given modified pig kidney dies two months later,
| cause not confirmed to be kidney" or something along those
| lines would be the best headline.
| kQq9oHeAz6wLLS wrote:
| Both your headline and OPs would not have met the first
| requirement for a headline, which is to draw the reader in
| so they have to read the article to get the whole picture.
|
| Sadly, the article's headline does just that.
| mrybczyn wrote:
| "Patient sick enough to need a kidney transplant, dies"
| maerF0x0 wrote:
| First of all.. RIP Pioneer. Thank you for your service to
| humanity.
|
| > The hospital said it had "no indication that it was the result
| of his recent transplant."
|
| A major issue, at least in Canada, is that the system will let
| you get too sick to recover before helping you. There are times
| when a healthy person enters the queue, and doesn't get fast-
| tracked / called upon until their health begins to fail severely.
| morkalork wrote:
| The cases in Canada are mind bogglingly frustrating, such as a
| woman ending up with an amputation after getting extreme bed
| sores while in care. If you think rugular movement and care
| from nurses to prevent that was too expensive, how does that
| compare to a whole operation and following recovery? Talk about
| penny wise and pound foolish.
| sealeck wrote:
| This is an extremely general problem which I think comes down
| to temporal biases in the human mind and a kind of
| survivorship bias.
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