The first child stem cell-supported trachea transplant is functioning well two years on, according to an Article published Online First in The Lancet today. The follow-up of the procedure, carried out in 2010 at Great Ormond Street Hospital (GOSH), shows that the new organ has strengthened and does not appear to have induced any signs of rejection. The 13-year-old boy who received the transplant continues to breathe normally, has grown 11 cm in height and has returned to school. He does not require any anti-rejection therapy.
Ciaran Finn-Lynch underwent the transplant in March 2010 at GOSH, when his own trachea was removed and replaced by a donor windpipe laced with Ciaran’s own stem cells so it would not be rejected.
The donated trachea was obtained from a deceased adult in Italy and was stripped of the donor’s cells, down to the inert collagen. Ciaran’s bone marrow stem cells were collected at GOSH, isolated at the Royal Free Hospital (RFH) and returned to GOSH the same day, where they were applied to the implanted trachea inside Ciaran’s body. Biopsies of epithelial tissues – the lining of the organ - were taken from the patient’s removed trachea during surgery and applied as the new graft was implanted in his body, to kick-start the gradual growth of a lining in the transplanted organ.
The graft was injected with additional cytokines – proteins that stimulate cell growth - to support the growth and differentiation of cells within the new trachea. Following the transplant, Ciaran was given further cell growth-inducing compounds known as granulocyte colony-stimulating factors or G-CSF. This is the first attempt to grow stem cells in vivo – within the body rather than in a laboratory - in a child in an operation of this kind.
The Lancet Article calls for more research in a number of areas, to speed up the recovery of structural rigidity within transplanted tracheas and to increase the availability of tracheal scaffolds by boosting the number of organ donors and exploring the use of animal tracheas and synthetic scaffolds.