TRACHEAL TRANSPLANTATION

TRACHEAL TRANSPLANTATION

Scientists and surgeons have led a revolutionary operation to transplant a new trachea into a child, using the child's own stem cells to rebuild the airway in the body. The operation -- a world first -- involved laboratory-based scientists and hospital-based clinicians working in partnership with colleagues in Europe to treat a 10-year-old British boy.

The boy, who has not been named, is recovering from surgery but his condition is stable and he is breathing unaided. He was born with a rare condition called Long Segment Tracheal Stenosis -- a tiny windpipe that does not grow and restricts breathing.

Shortly after birth, he underwent a conventional trachea transplant at Great Ormond Street Hospital for Children (GOSH), but his condition deteriorated last November when a metal stent implanted in that operation began to erode into the aorta, a key artery, causing severe bleeding.

Scientists and surgeons at UCL, GOSH, the Royal Free Hampstead NHS Trust, and the Careggi University Hospital in Florence, Italy, developed a new technique to treat the life-threatening condition. They stripped cells from a donated trachea, used it to replace the entire length of the damaged airway, and then used the child's own bone marrow stem cells to seal the airway in the body.

Dr Mark Lowdell, Director of Cellular Therapy at Royal Free Hospital and a senior lecturer at UCL Medical School, received the donor trachea from Italy and some bone marrow from the patient at the beginning of surgery. He and his colleagues prepared two different types of stem cells from the bone marrow together with some growth signalling chemicals and returned them to GOSH with the donor trachea.

Professor Paolo Macchiarini, from Careggi University Hospital, who is an Honorary Consultant at GOSH and Honorary Professor at UCL, applied the cells and the growth factors to the trachea in the operating theatre.

Martin Elliot, Professor of Cardiothoracic Surgery at UCL and Director of the Tracheal Service at GOSH, led the operation to repair the damaged aorta and implant the new trachea. The application of this technology -- which has never been used on a child before -- should reduce greatly the risk of rejection of the new trachea, as the child's stem cells will not generate any immune response.

Professor Martin Birchall, UCL lead for translational regenerative medicine, who is also a head and neck surgeon specialising in airways and voice, led on ethics and regulatory approvals.

Professor Birchall and Professor Macchiarini achieved the world's first stem cell-based organ transplant on an adult patient in 2008.

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Written by Dr Martin Harris, Doctor and Mohel for Jewish Circumcision Clinic in London Bris Mila Brit Milah.
www.circumcisionlondon.co.uk

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Contact Dr Martin Harris