Child has windpipe transplant with stem cells

21st March 2010 - A 10-year-old British boy has become the first child to have a pioneering windpipe transplant operation in a procedure carried out in London by British and Italian doctors.

A donated trachea had the donor’s cells removed, leaving inert collagen. The child‘s bone marrow stem cells were collected, and added to the trachea to start the process of rebuilding it.

Similar operations have been performed on adults, but Great Ormond Street says this is the first time a child has had this procedure. It’s also the first time the whole length of the trachea has been transplanted.

Doctors hope the technique will greatly reduce the risk of rejection of the windpipe because it is coated with the boy’s own cells.

Why did he need the operation?

The child - who has not been named - suffered from a condition called long segment tracheal stenosis, in which the windpipe is small and will not grow.

The life threatening condition has been likened to having to breathe through a straw.

Medical history

The hospital says the boy had an initial operation on his trachea shortly after birth. Several years ago he had what was a more conventional trachea transplant. Last November his condition deteriorated and a metal stent, which had been placed in his trachea, began to erode, causing life threatening bleeding.

The medical team

Professor Paolo Macchiarini from the Careggi University Hospital Florence, is an honorary consultant at Great Ormond Street. He and colleagues in a pan-European team came up with the plan to use the child’s own body as a ‘bioreactor’, in which the stem cells would regenerate the donor trachea.

He worked with the Italian National Transplant Centre to deliver the donated trachea with the donor’s cells removed.

The operation in London was led by Professor Martin Elliott; he developed Europe’s first specialist tracheal surgery service for children. He also carried out the previous transplant on the boy.

Cardiac surgery was necessary to repair the child’s aorta, which had been damaged by the faulty stent.

Dr Mark Lowdell and colleagues at The Royal Free Hospital, UCL Medical School, received the donor organ from Italy and some bone marrow from the patient at the start of the surgery.
They prepared two different types of stem cells from the patient's own bone marrow, together with growth signalling chemicals, and returned them to Great Ormond Street with the donor trachea.

Macchiarini applied the cells and the growth factors to the trachea in the operating theatre.

He calls it a “bionic” process, in which cytokine medication is used to make the stem cells rebuild the trachea.

The team believes this new technique, whilst pioneering, is actually simpler than current procedures, and could be adopted in centres around the world.