World's first windpipe transplant and regeneration in a child
19 March 2010
British and Italian doctors have achieved a world first in
transplanting a donated "stripped down" trachea into a boy and using his
own stem cells to rebuild the cellular structure in his body.
The boy had life-threatening condition affecting his trachea — long
segment tracheal stenosis — which resluts in a tiny windpipe that
will not grow. He also had serious damage to his aorta caused by a
metal stent previously implanted to repair the trachea.
The operation was carried out at the Great Ormond Street Hospital
(GOSH) in London last Monday. In preparing for the operation, the
donated trachea was stripped of the donor’s old cells, down to the
inert collagen. The boy's bone marrow stem cells were collected and
applied to the graft in the body, to rebuild the cellular component
of the trachea. Thus the child’s own cells will be used to make the
new airway sealed and effective.
This revolutionary procedure involved close working from a
Europe-ide team. Lab-based scientists and hospital-based clinicians
worked together to deliver this extraordinary treatment.
Professor Paolo Macchiarini, Careggi University Hospital
Florence, Honorary Consultant at GOSH and Honorary Prof at UCL,
along with Prof Bader, Director of Stem Cell Biology and Cell
Technology, from the University of Leipzig Germany, developed the
idea to use the child’s own body as ‘bioreactor’ and the stem cells
to regenerate the implanted trachea. Working with the Italian
National Transplant Centre, he prepared the de-celled trachea for
Surgery at Great Ormond Street was led by Professor Martin
Elliott, who developed Europe’s first specialist tracheal surgery
service for children, and who had carried out the previous tracheal
transplant on this child. Before replacing the trachea, complex
cardiac surgery was necessary to repair the aorta
Dr Mark Lowdell and colleagues (Maryam Sekhavat and Edward
Samuel) at The Royal Free Hospital, UCL Medical School, received the
donor trachea from Italy and some bone marrow from the patient at
the beginning of surgery. The team prepared two different types of
stem cells from the patient's own bone marrow together with some
growth signalling chemicals and returned them to GOSH with the donor
trachea for the surgery.
Prof Macchiarini applied the cells and the growth factors to the
trachea in the operating theatre so that the cells that would grow
inside the tissue to allow the trachea to becoming a working organ.
Professor Macchiarini calls this a ‘bionic’ process, using specific
cytokine drugs to make the stem cells differentiate and rebuild the
This is the first time that this has been performed in a child.
It is also the first time the entire length of the trachea has been
transplanted. The application of this technology should reduce
greatly the risk of rejection of the new trachea, as the use of the
boy's own stem cells to rebuild the cellular structure will not
generate any immune response.
A child with Long Segment Tracheal Stenosis has a tiny windpipe
that will not grow. It is like breathing through a straw and is a
life threatening condition. Working with European partners, Great
Ormond Street has developed both a trachea widening operation and a
‘conventional’ transplant programme, as part of a multi-disciplinary
team. Around ten UK patients and two European patients receive
surgery here a year, with average recovery time now being five
This boy had had a repair of long segment congenital tracheal
stenosis shortly after birth, and later required the then relatively
new conventional homograft trachea transplant, now several years
ago, The child deteriorated last November when a metal stent used in
his trachea began to erode into the aorta, a key artery, causing
severe bleeding. A new solution had to be arranged as the risk to
the child was severe.
successful transplantation of a synthetic windpipe seeded with
patient's own stem cells. 8 July 2011