Successful transplantation of tissue-engineered vein in a child offers hope

The first biologically tissue-engineered vein grown from a patient's own stem cells has been successfully transplanted into a 10-year-old girl with portal vein obstruction, dramatically enhancing her quality of life. These pioneering results, published online first in the Lancet, could offer a potential new way for patients lacking healthy veins to undergo dialysis or heart bypass surgery without the problems of synthetic grafts (that are prone to clots and blockages) or the need for lifelong immunosuppressive drugs.

"The young girl in this report was spared the trauma of having veins harvested from the deep neck or leg with the associated risk of disorders, and avoided the need for a liver or multivisceral transplantation", explain Martin Birchall and George Hamilton from University College London, UK in a linked Comment.

The hepatic portal vein drains the blood from the intestines and spleen to the liver, and blockage can cause serious complications such as lethal variceal bleeding, enlarged spleen, developmental retardation, and even death. To date, attempts to restore portal using umbilical veins and artificial grafts to build a bridge around the blockage (meso Rex bypass) have had mixed success.

Here, a team from the University of Gothenburg took a 9cm segment of iliac (groin) vein from a deceased human donor and removed all living cells, leaving a tube consisting of just the protein scaffolding. This scaffolding was injected with stem cells obtained from the girl's own bone marrow. Two weeks after seeding, the graft was reimplanted during a meso Rex bypass procedure.

The recipient had no complications from the operation and the procedure immediately restored normal blood flow. In the year following the operation she increased in height from 137cm to 143cm and her weight rose from 30kg to 35kg.

A year after the first graft procedure, decreased portal blood flow was noted. A narrowing of the graft required a second stem cell-based graft to be done. The patient has remained well since and is able to take increasing long distance walks of 2 to 3 km and is also taking part in light gymnastics. Importantly, she has not developed anti-donor antibodies despite not taking .

The authors conclude: "The new derived resulted not only in good blood flow rates and normal laboratory test values but also, in strikingly improved quality of life for the patient. The work also establishes the feasibility and safety of a novel paradigm for treatment, in cases of venous insufficiency, obstructed veins or inadequate autologous veins. Furthermore our work opens interesting new areas of research, including trying to reproduce arteries for surgical use in patients with arteriovenous fistulas for dialysis [a type of vascular access for dialysis] or coronary bypass surgery."

"Olausson and colleagues' report suggests that tissue-engineered vascular grafts are promising, but one-off experiences such as the procedure they describe need to be converted into full clinical trials in key target populations, and delivered via straightforward, quality-controlled production processes if regenerative medicine solutions are to become widely used and accepted.", add the Comment authors.

More information: Study online: www.thelancet.com/journals/lan… (12)60633-3/abstract

add to favorites email to friend print save as pdf

Related Stories

Stem cell technology used in unique surgery

May 09, 2011

Surgeon and Professor Michael Olausson was able to create a new connection with the aid of this blood vessel between the liver and the intestines, necessary to cure the girl. The girl is now in good health, ...

Scientists grow blood vessels for human surgery

Feb 02, 2011

Scientists can grow blood vessels in a lab for use in coronary bypass or dialysis, a promising alternative to harvesting from the patient, said a study published on Wednesday.

Recommended for you

How Staph infections elude the immune system

Oct 27, 2014

A potentially lethal bacterium protects itself by causing immune tunnel vision, according to a study from scientists at The University of Chicago published in The Journal of Experimental Medicine. By tri ...

Research reveals how lymph nodes expand during disease

Oct 22, 2014

Cancer Research UK and UCL scientists have discovered that the same specialised immune cells that patrol the body and spot infections also trigger the expansion of immune organs called lymph nodes, according to a study published ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.