Surgery News - January 2009 - (Page 10) 10 THORACIC JANUARY 2009 • SURGERY NEWS Tissue-Engineered Trachea Transplanted in Woman Autologous cells with the right biomaterials might provide functional solutions for clinical disorders. B Y M I C H E L E G. S U L L I VA N Else vier Global Medical Ne ws woman in Barcelona has received the world’s first tissue-engineered tracheal transplant, which has functioned for more than 4 months without the need for immunosuppression. The graft was a decellularized cadaver trachea, which researchers seeded with the recipient’s own epithelial cells and stem cells differentiated into chondrocytes, Dr. Paulo Macchiarini and his colleagues reported an the online issue of the Lancet (doi:10.1016/S01406736(08)61598-6). The decellularization, combined with the recolonization with autologous cells, greatly reduced the likelihood of rejection, they said. “The results show that a cellular, tissueengineered airway can be produced with mechanical properties that allow normal functioning and which is free from the risks of rejection,” wrote Dr. Macchiarini, head thoracic surgeon at the Hospital Clinic Barcelona. “This patient provides new evidence that autologous cells combined with appropriate biomaterials might provide, in future, successful functional solutions for serious clinical disorders.” The patient, aged 30 years, with complications of tuberculous, received the transplant. She presented initially in 2004, with dysphonia and cough due to a tubercular infiltration of the cervical trachea and entire left main bronchus. Although the infection was successfully treated, she had a 3-cm stenosis of the left bronchus. Initially, a stent was implanted, but it was removed because of poor tolerance. By March 2008, severe dyspnea made it impossible for her to carry on normal daily activities. The left main bronchus SAVE THE DATES! T he American College of Surgeons is pleased to announce its continued collaboration with the Southeastern and Southwestern Surgical Congresses, to develop and implement educational programs in the spring. The College looks forward to sponsoring half-day symposia at these prestigious events. ews More N t a is jus ay! w click a THE AMERICAN COLLEGE OF SURGEONS AT THE THE AMERICAN COLLEGE OF SURGEONS AT THE SOUTHEASTERN SURGICAL CONGRESS Southeastern Surgical Congress FEBRUARY 7–10, 2009 Atlanta Marriott Marquis Atlanta, GA www.sesc.org SOUTHWESTERN SURGICAL CONGRESS Southwestern Surgical Congress MARCH 22–25, 2009 Hotel del Coronado San Diego, CA www.swscongress.org See the Exclusive Online Edition at www.facs.org Go to Periodicals, then Surgery News to learn about behavioral interventions that can improve OR teamwork. F O R M O R E I N F O R M AT I O N , contact Julie Tribe, MSEd, Senior Manager, Educational Programs, Division of Education, at jtribe@facs.org or 312/202-5433. FOR INFORMATION ON the ACS, visit www.facs.org or call 800/621-4111. HOSPITAL CLINIC UNIVERSITY OF BARCELONA A had a diameter of only 4 mm; her lung function was severely abnormal. The usual course of action would have been a left carinal total pneumonectomy, the researchers said. Because of the high rates of mortality and morbidity associated with the surgery, however, the team decided to replace the scarred bronchus with a tissue-engineered trachea. The trachea was harvested from a 51year-old woman who died of a cerebral hemorrhage. Over a 6-week period, the team removed all the graft’s immunologically active cells with 25 cycles of a detergent-based enzymatic solution. The researchers then harvested bronchial epithelial cells from the patient. The epithelial cells grew rapidly, and a population was soon ready for seeding the interior of the donor trachea. To secure chondrocytes for the outer trachea, the team harvested stem cells from bone marrow aspirate, and differentiated them into chondrocytes by a method developed at the University of Bristol, England, to treat osteoarthritis. The cells were then seeded onto the matrix, which had been placed in a small bioreactor specially designed for the procedure. The rectangular device suspended the trachea on a rotating spindle, which constantly alternated the graft between the bath of culture medium and air. Separate compartments for the interior and exterior of the trachea contained growth media designed to stimulate the different cell types. The surgery itself was uneventful. After a left posterolateral thoracotomy, surgeons removed the diseased left main bronchus, cut the graft to the required shape and length, and anastomosed it to existing tissue. The graft retained its na- tive flexibility, which eased implantation greatly, the researchers noted. Immediate ventilation of the lung occurred. After 2 days in the intensive care unit, the patient was moved to a general ward; she was discharged on postoperative day 10. By day 4, the graft was almost indistinguishable from adjacent normal bronchial mucosa, and laser Doppler readings confirmed an adjacent microvascular bed. At day 14, there was an adherent layer of mu- CT images (left) and virtual bronchoscopic images (right) cus on the graft’s sur- show before (top) and after (bottom) trachea grafting. face, and no inflammatory cells were detected cytologically. The experiment represents a major acBecause the new cells on the graft complishment in tissue engineering, Dr. were phenotypically identical to the Toshiko Sato and Dr. Tatsuo Nakamudonor’s native cells, however, “we cannot ra of Kyoto ( Japan) University wrote in say whether these cells originated from a commentary in Lancet (doi:10.1016/ those seeded or whether they grew in S0140-6736(08)61599-8). However, they from an adjacent healthy airway,” the re- were not ready to recommend the prosearchers said. cedure as a common one for airway reBy 1 month after transplant, the graft placement. was indistinguishable from native tra“Severe airway stenosis has been chea; local mucosal bleeding indicated well managed by tracheal resection, alfull revascularization. That rapid growth though lengthy resections are still assoof new blood vessels may be related to ciated with anastomotic complications. signaling by angiogenic cytokines that re- Almost half of the adult trachea can be mained in the graft after decellulariza- resected with a primary anastomosis, tion, the investigators hypothesized. which means that the demand for traAfter surgery, the patient rapidly re- cheal replacement is limited,” they said. gained normal lung function. Within 2 In addition, “some doubt remains months, her forced vital capacity had in- about whether their results should be recreased from 62% at baseline to 100%. garded as a fully tissue-engineered reSimilarly, her forced expiratory volume placement or an allotransplantation of increased from 55% to 100%. As of Oc- the trachea,” Dr. Sato and Dr. Nakatober 2008, she had no sign of rejection. mura noted. ■ http://www.facs.org http://www.facs.org http://www.sesc.org http://www.swscongress.org http://www.facs.org
Table of Contents Feed for the Digital Edition of Surgery News - January 2009 Surgery News - January 2009 Contents The 20/20 Vision Intent to Prevent News From the College: The Year Ahead Thoracic: Tracheal Triumph Practice Trends: Making the Grade Surgery News - January 2009 Surgery News - January 2009 - Contents (Page 1) Surgery News - January 2009 - Contents (Page 2) Surgery News - January 2009 - Contents (Page 3) Surgery News - January 2009 - Contents (Page 4) Surgery News - January 2009 - Contents (Page 5) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 6) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 7) Surgery News - January 2009 - News From the College: The Year Ahead (Page 8) Surgery News - January 2009 - News From the College: The Year Ahead (Page 9) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 10) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 11) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 12) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 13) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 14) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 15) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 16)
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