Pranav Garimella, MBBS, MPH, is chief medical officer of the American Kidney Fund.

Pranav Garimella, MBBS, MPH

Crisis Point: Unmet Needs and New Horizons in Kidney Transplantation

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

From Unmet Needs to New Possibilities: The Evolving Future of Kidney Transplantation

For many patients, kidney transplantation offers a chance not just at prolonged survival, but at a life free from the burdens of dialysis. Despite decades of progress, the field continues to grapple with a constellation of unmet needs, including the shortage of available donor kidneys, geographic inequities in access, risks of rejection, and long-term graft attrition, all of which place lasting burdens on both patients and healthcare systems.

Recent years, however, have seen growing momentum and progress. Improvements in diagnostics are enabling more precise prediction of rejection risk and the tailoring of immunosuppression regimens. Evolving perfusion techniques like continuous hypothermic machine perfusion can better preserve organ quality and potentially extend the viable window between donation and transplantation. The safe use of HCV-positive donor kidneys and the emergent promise of xenotransplantation are also expanding the donor pool in ways once considered unlikely.

To fully realize the impact of these advancements, the system must evolve: policies must be modernized, regulatory pathways harmonized, infrastructure expanded, and equity prioritized so that advances reach the patients who need them most. Only through coordinated, system-level change can the promise of these breakthroughs translate into real-world benefit.

With sustained investment in innovation, equitable deployment of new technologies, and collaboration across stakeholders, the future of kidney transplantation looks bright.

Brief descriptions of the speakers featured in this project are provided below:

, chief medical officer of the American Kidney Fund

, senior medical director of transplant diagnostics at Thermo Fisher Scientific Transplant Diagnostics, former director of renal and pancreas transplantation at Houston Methodist J.C. Walter Jr. Transplant Center and surgical director of kidney and pancreas transplantation in the Department of Surgery

, surgical director of kidney and pancreas transplantation at Piedmont Healthcare

, a patient advocate and 3-time kidney transplant recipient, the most recent of which was with an HCV-positive donor kidney

 to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

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A trio of experts and a patient advocate discuss unmet needs and recent innovations in kidney transplantation, from xenotransplantation to continuous hypothermic machine perfusion.

Xenotransplantation: A New Frontier in Kidney Transplantation, With Pranav Garimella, MBBS, MPH

Renal xenotransplantation has taken remarkable strides in 2025, transforming a long-theoretical concept into a tangible clinical reality with recent advances in genetically modified pig kidneys yielding improved compatibility, stronger early outcomes, and extended graft function.

These milestones, including the launch of the first US Food and Drug Administration (FDA)-approved clinical trials, signal a turning point that could reshape the future of kidney transplantation, potentially easing organ shortages and offering new hope to patients who cannot access a human donor kidney.

“Xenotransplantation is perhaps the most exciting frontier in kidney transplant that we've seen, and although it's not new, it's been around for a long time, this is the first time we've seen substantial improvements in patient outcomes and substantial longevity in these xenotransplanted kidneys,” Pranav Garimella, MBBS, MPH, Chief Medical Officer of the American Kidney Fund and an associate professor of medicine at UC San Diego, told 

According to data from the Organ Procurement and Transplantation Network, more than 100,000 people in the US are currently on the national transplant waitlist, with another person added every 8 minutes. In 2023, more than 27,000 kidney transplants were performed, and nearly 90,000 people are still seeking a kidney transplant as of September 2024. With the number of patients seeking a transplant far exceeding the number of donor kidneys available, the US currently faces a major public health crisis.

On February 3, 2025, the FDA made history when it cleared United Therapeutics’ Investigational New Drug application to initiate a clinical study of the company’s investigational UKidney™ derived from a 10 gene-edited source pig, representing the first-ever clinical trial of a xenokidney.

Most recently, the Agency cleared an Investigational New Drug application from eGenesis to initiate a clinical trial evaluating EGEN-2784, a genetically engineered porcine-derived kidney, in patients with end-stage kidney disease who are ≥ 50 years of age, dialysis-dependent, and on the kidney transplant waitlist.

On January 25, 2025, Tim Andrews, 67, received an EGEN-2784 kidney at Massachusetts General Hospital in the institution’s second successful transplant of a genetically edited pig kidney into a living recipient. He has now surpassed 7 months post-transplant, making him the world’s longest-living recipient of a genetically engineered porcine-derived organ.

“I still think xenotransplantation is a bridge,” Garimella said, citing a current lack of knowledge about how long these kidneys will last and what risks might come with the use of these genetically modified organs. “I'm really hopeful. A lot of patients are unable to get kidneys from humans. They can't wait that long, and this would be a fantastic opportunity to get them off dialysis, which significantly impairs quality of life and their ability to do things that they would want.”

Editors’ note: Garimella has relevant disclosures with Otsuka and the PKD Foundation.

HRSA. Organ Donation Statistics. October 2024. Accessed September 11, 2025. 

https://www.organdonor.gov/learn/organ-donation-statistics

Brooks A. FDA Clears First Xenotransplant Trial for Gene-Edited Kidneys. HCPLive. February 3, 2025. Accessed September 11, 2025. 

https://www.hcplive.com/view/fda-clears-first-xenotransplant-trial-gene-edited-kidneys

Brooks A. FDA Clears IND Application for EGEN-2784, a Genetically Engineered Pig Kidney, for ESKD. HCPLive. September 8, 2025. Accessed September 11, 2025. 

https://www.hcplive.com/view/fda-clears-ind-application-for-egen-2784-a-genetically-engineered-pig-kidney-for-eskd

Garimella describes recent progress in renal xenotransplantation, uncertainties that still need to be addressed, and how he sees it impacting the field moving forward.

Crisis Point: Curbing the Chronic Kidney Disease Epidemic

CKD’s Emergence As A Public Health Crisis: Next Steps for Halting the Silent Spread

In recognition of National Kidney Month, this episode addresses the growing burden of 

 and its emergence as the biggest public health crisis of our time.

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. In many patients, the disease progresses silently and goes undetected until it reaches advanced stages when symptoms appear but treatment options are limited. While there has been no single cause of the CKD crisis, the growing prevalence of risk factors like diabetes, hypertension, and obesity has intensified the threat posed by CKD, setting the stage for a surge in cases that could overwhelm healthcare systems and disrupt countless lives.

Current estimates suggest 9 out of 10 people with kidney disease are unaware they have it, and 1 in 3 of those with severely reduced kidney function but who are not yet on dialysis are unaware they have kidney disease.

In addition to the need for better public awareness to facilitate early detection and treatment of CKD, patient-focused multidisciplinary care is also essential for improving outcomes. The burden of CKD cannot fall on nephrologists alone. Addressing this crisis requires a collaborative effort across the entire health care system but must be tailored in a way that ensures complete, equitable care for the patient.

Be sure to check out part 1 of this episode, which delves into the complex challenges surrounding CKD, exploring the various factors contributing to its growth, the importance of early detection and intervention, and the need for heightened public awareness.

In part 2, the conversation shifts to the importance of collaborative, multidisciplinary care that maintains a focus on patients’ wants and needs as well as the future of CKD care.

, associate clinical professor of medicine in the division of nephrology at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation

, chief executive officer of Carna Health

, a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant

American Kidney Fund. Quick kidney disease facts and stats. Accessed March 5, 2025. 

https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

In part 2 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss strategies to address the CKD crisis.

Crisis Point: The Silent Rise and Growing Threat of Chronic Kidney Disease

CKD’s Emergence as A Public Health Crisis: How We Got Here and How to Turn the Tide

CKD is estimated to affect 35 million adults in the US alone, but despite its widespread impact, it often flies under the radar. For many patients, the disease progresses silently and goes undetected until it reaches advanced stages when symptoms appear but treatment options are limited.

While there has been no single cause of the CKD crisis, the growing prevalence of risk factors like diabetes, hypertension, and obesity has intensified the threat posed by CKD, setting the stage for a surge in cases that could overwhelm healthcare systems and disrupt countless lives.

Several changes will be necessary to change the trajectory of CKD and mitigate the public health crisis it poses. Among these is the need for heightened public awareness. Given the silent nature of CKD, early detection and treatment are difficult to obtain if patients are not aware of the disease and their risk for it.

Effective interventions for CKD are most effective when the disease is caught early, preventing the need for dialysis or transplantation. While kidney disease is not reversible, it is treatable. Most recently, the US Food and Drug Administration approved semaglutide (Ozempic) to reduce the risk of kidney disease worsening, kidney failure, and death due to cardiovascular disease in adults with 

Part 1 of this episode of Crisis Point delves into the complex challenges surrounding CKD, exploring the various factors contributing to its growth, the importance of early detection and intervention, and the need for heightened public awareness.

 chief medical officer of the American Kidney Fund

 associate clinical professor of medicine in the division of nephrology at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation

 a patient advocate who was diagnosed with CKD during pregnancy, eventually requiring dialysis and a kidney transplant

Brooks A. FDA Approves Semaglutide (Ozempic) for Type 2 Diabetes, Chronic Kidney Disease. 

. January 28, 2025. Accessed March 5, 2025. 

https://www.hcplive.com/view/fda-approves-semaglutide-ozempic-type-2-diabetes-chronic-kidney-disease

In part 1 of this episode of Crisis Point, 3 nephrology experts and a patient advocate discuss CKD’s emergence as a public health crisis.

Pranav Garimella, MBBS, MPH

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