Vein transplantation saved the girl's life
Swedish doctors performed a unique operation to bypass the portal vein of the liver
Doctors of Sahlgrenska University Hospital, Sweden, successfully performed surgery to bypass the portal vein of the liver of a 10-year-old girl. The graft vein was allogeneic, i.e. donor, but with the help of bioengineering, the girl's own stem cells were planted to it. A detailed description of the operation can be found in The Lancet magazine.
The patient was admitted to the hospital with an obstruction of the portal vein of the liver. Using the girl's umbilical vein as a transplant and other ways to save her life, including liver transplantation, were not suitable for doctors, as they would require long-term immunosuppressive therapy. As a result, the doctors decided to perform an operation, during which it was necessary to organize a communication between the upper mesenteric vein and the left branch of the portal vein of the liver. A 9-centimeter segment of the donor's iliac vein was chosen as a shunt for communicating these veins. Endothelial and smooth muscle cells grown from the stem cells of the bone marrow of the girl herself were attached to this segment.
The transplant instantly provided the girl with a full blood flow, confirmed by measurements during the operation and later by ultrasound examination. The blood flow rate in the portal vein was 25-30 cm/sec. For 9 months after the operation, the patient felt well. However, 1 year after the operation, the blood flow slowed down. The examination showed that the shunt remained passable, but was mechanically compressed by the mesentery of the colon, and the pressure in the portal vein increased to 20 mm Hg. The subsequent operation freed the graft from compression, the blood flow in it resumed, and the pressure decreased to 13 mm Hg. With the restoration of hepatic blood flow, the girl's physical and mental development improved markedly. Currently, the patient does not take any immunosuppressive drugs and, at the same time, she does not have the formation of any antibodies to the transplant.
Obstruction of the portal vein of the liver is an extremely dangerous condition that threatens the life of patients. It leads to varicose veins and increases the risk of bleeding from them, including from the upper gastrointestinal tract.
From The Lancet, Early Online Publication, 14 June 2012
Olausson et al., Transplantation of an allogeneic vein bioengineered with autologous stem cells: a proof-of-concept studyUsing autologous stem cells to populate a donor vein
Introduction
Extrahepatic obstruction of the portal vein can have serious health consequences. Varicose bleeding associated with this disorder leads to bleeding in the upper gastrointestinal tract, which, in turn, is the cause of high morbidity and mortality. This publication describes the procedure of clinical transplantation of the iliac vein from a dead donor with autologous stem cells of the recipient transplanted into it to a patient with extrahepatic portal vein obstruction.
Methods
A 10-year-old patient with extrahepatic portal vein obstruction was admitted to the Salgrenska Hospital at the University of Gothenburg in Sweden for bypass surgery between the superior mesenteric vein and the left intrahepatic branch of the portal vein (mesoportal bypass). To obtain an allogeneic transplant, a 9-centimeter segment of the donor's iliac vein was decellularized, after which it was populated with endothelial and smooth muscle cells grown from the recipient's bone marrow stem cells. This method was applied due to the impossibility of using the umbilical vein of the patient herself, as well as because other methods of treatment (for example, liver transplantation) would require lifelong use of immunosuppressants.
ResultsVein transplantation allowed the recipient to immediately provide the necessary blood supply (the blood flow rate of 25-30 cm/s in the portal vein and 40 ml/s in the arterial bed was measured during the operation and confirmed by ultrasound).
Normal values of laboratory parameters were observed in the patient for 9 months. However, after 1 year, the blood flow rate decreased. The examination showed that the shunt was passable, but too narrow due to a mechanical obstacle created by the mesentery tissue of the colon. After removal of the tissue causing compression, the diameter of the venous graft increased. Then a second venous graft populated with stem cells was used to lengthen the first one. After the second operation, the pressure in the portal vein decreased from 20 to 13 mmHg, and the blood flow rate in the portal vein was 25-40 cm/s. As a result of the restoration of portal circulation, the patient's physical and mental functions, as well as growth indicators, improved significantly. The patient has no antibodies to endothelial cells, and she does not take immunosuppressants.
Conclusions
Transplantation of a decellularized and autologous stem cell-populated venous transplant recipient from a dead donor can be used in cases where venous bypass surgery is required and further use of immunosuppressants is avoided.
Portal "Eternal youth" http://vechnayamolodost.ru22.06.2012