The first child stem cell-supported trachea transplant carried out in 2010 at Great Ormond Street Hospital (GOSH) is functioning well, according to a paper published in the Lancet today.
The follow-up of the procedure two years on shows that the new organ has strengthened and does not appear to have induced any signs of rejection. 13-year-old Ciaran Finn-Lynch continues to breathe normally, has grown 11 cm in height and has returned to school.
Ciaran underwent the transplant in March 2010 when his own trachea was removed and replaced by a donor windpipe laced with his own stem cells so it would not be rejected. Supporters of Great Ormond Street Hospital Children’s Charity are enabling vital further research to take place to refine this pioneering treatment, and roll it out to wider practice to help other children.
On the day he was born, Ciaran’s lungs collapsed and he was rushed to Great Ormond Street Hospital , where he was diagnosed with long segment tracheal stenosis, a condition which leaves those with it with a very narrow windpipe and difficulties breathing.
At six days old, Ciaran underwent major surgery to reconstruct his airways, remaining in intensive care for a further four months. When he was two-and-a-half, a metal stent began to erode into his aorta, again causing a severe bleed.
In March 2010 he underwent the pioneering transplant, just four weeks after a donor trachea was found in Italy. The donor organ was flown to the UK, while Professor Martin Elliot, Director of the National Service for Severe Tracheal Disease in Children at GOSH, and his team removed some of Ciaran’s bone marrow which contain the vital stem cells.
These cells were first mixed with chemicals in the laboratory to stimulate growth then injected into the donor windpipe. Finally the windpipe was transplanted to Ciaran. This procedure was Ciaran’s only option, and was the first to be performed in a child.
The two-year follow-up shows that the graft has not triggered any immune rejection response in the patient and has formed an adequate lining. The windpipe has not yet achieved normal rigidity but, nonetheless, is allowing Ciaran to lead the life of a normal teenager. The team expects that his body’s natural tissue repair mechanisms will continue to strengthen Ciaran’s trachea over time.
Professor Elliott says: “The ideal outcomes for tracheal transplants in children are normal airway and lung function, good general growth, a decent quality of life, and no further surgical interventions. So far we have achieved this, but we are at the edge of medicine and, similarly to first attempts of organ transplantation in the 1950s, many challenges remain.”
Paolo De Coppi, GOSHCC Clinical Senior Lecturer at the UCL Institute of Child Health, says: “For the moment we are limited to engineering relatively simple organs and tissues with these techniques; it will take longer for us to find ways of fully replacing the body’s more complex organs. However, we continue to make advances, such as our recent discovery that stem cells found in the amniotic fluid surrounding the foetus show good potential for tissue engineering.”
My hope is that soon we might build complex organs such as the heart, gullet or intestine; functional organs that can grow with children, eliminating any need for organ donors. We’ve got a patient population that really need these alternatives, urgently, if we’re to offer them long-term quality of life. Charitable support is crucial for us to advance this work.”
Watch our interview with Paolo De Coppi to discover more about the pioneering research he’s doing thanks to supporters of Great Ormond Street Hospital Children’s Charity:
By supporting pioneering research at Great Ormond Street Hospital and the UCL Institute of Child Healthyou can play a key part in helping further this work giving new hope to seriously ill children and their families. Find out how to support Dr Paolo De Coppi’s work.