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Surgeons hail windpipe transplant

Surgeons who performed the world's first transplant of a laboratory-grown windpipe say life is still good for their patient five years after her pioneering operation.

Colombian mother-of-two Claudia Costello was given the bio-engineered airway in 2008 at the age of 30 after contracting tuberculosis.

An international team led by Professor Paolo Macchiarini, from the Karolinska Institute in Stockholm, Sweden, fashioned the organ in a laboratory "bioreactor" using stem cells taken from Ms Costello's bone marrow.

She was the first patient to undergo such a procedure, previously only tested on pigs.

The transplant was hailed as a medical milestone but the researchers could not predict its long-term success.

Now a follow up study in The Lancet journal has shown, five years on, that Ms Costello continues to enjoy a good quality of life. Her lungs are working well and she has not experienced any adverse immune reactions.

Scarring that led to a narrowing of one area was overcome by holding the airway open with a stent, or scaffold.

Prof Macchiarini said: "These results confirm what we - and many patients - hoped at the time of the original operation: that tissue engineered transplants are safe and effective in the long term.

"However, the scarring which occurred in this patient shows that long-term biomechanical stability can be improved, something which is currently under active pre-clinical investigation. The results of a first-in-man active clinical trial will soon provide the definitive evidence that is needed before this stem call-based tissue engineering technology can be translated into routine clinical practice."

The aim of the procedure, performed when Prof Macchiarini was working at the Hospital Clinic of Barcelona in Spain, was to repair the left side of the trachea, or windpipe, after it splits to enter the lungs.

First, the scientists first took a 7cm length of donor airway from a dead patient and washed away its cells with chemicals.

All that remained was a "skeleton" made of fibrous collagen. This was repopulated with cartilage cells derived from bone marrow stem cells, and cells lining a healthy part of Ms Costello's windpipe.

The graft was placed in a rotating "bioreactor" where the cells were allowed to mature and grow over a period of four days. Finally, it was transplanted into Ms Costello's body.

Ten days after the operation, Ms Costello was allowed home. Four months later, the airway was functioning normally and not producing a harmful immune reaction, a major obstacle in most transplants.


From Belfast Telegraph