Wednesday, November 19, 2008

US teen lives 118 days without heart

By Jim Loney

MIAMI, Nov 19 (Reuters) - An American teen-ager survived for nearly four months without a heart, kept alive by a custom-built artificial blood-pumping device, until she was able to have a heart transplant, doctors in Miami said on Wednesday.

The doctors said they knew of another case in which an adult had been kept alive in Germany for nine months without a heart but said they believed this was the first time a child had survived in this manner for so long.

The patient, D'Zhana Simmons of South Carolina, said the experience of living for so long with a machine pumping her blood was "scary."

"You never knew when it would malfunction," she said, her voice barely above a whisper, at a news conference at the University of Miami/Jackson Memorial Medical Center.

"It was like I was a fake person, like I didn't really exist. I was just here," she said of living without a heart.

Simmons, 14, suffered from dilated cardiomyopathy, a condition in which the patient's heart becomes weakened and enlarged and does not pump blood efficiently.

She had a heart transplant on July 2 at Miami's Holtz Children's Hospital but the new heart failed to function properly and was quickly removed.

Two heart pumps made by Thoratec Corp (THOR.O: Quote, Profile, Research, Stock Buzz) of Pleasanton, California, were implanted to keep her blood flowing while she fought a host of ailments and recovered her strength. Doctors implanted another heart on Oct. 29.

"She essentially lived for 118 days without a heart, with her circulation supported only by the two blood pumps," said Dr. Marco Ricci, the hospital's director of pediatric cardiac surgery. During that time, Simmons was mobile but remained hospitalized.

When an artificial heart is used to sustain a patient, the patient's own heart is usually left in the body, doctors said.

In some cases, adult patients have been kept alive that way for more than a year, they said.

"This, we believe, is the first pediatric patient who has received such a device in this configuration without the heart, and possibly one of the youngest that has ... been bridged to transplantation without her native heart," Ricci said.

Simmons also suffered renal failure and had a kidney transplant the day after the second heart transplant.

Ricci said her prognosis was good. But doctors said there is a 50 percent chance that a heart transplant patient will need a new heart 12 or 13 years after the first surgery. (Editing by Cynthia Osterman)

Claudia Castillo gets windpipe tailor-made from her own stem cells

A woman has been given a new section of windpipe created from her own stem cells in an operation that could revolutionise surgery.

Claudia Castillo, 30, who lives in Barcelona, has become the first person to be given a whole organ tailor-made for her in laboratories across Europe.

A graft from a donor was used, but because it has been imbued with Ms Castillo’s own cells, there is no sign that her body will reject the organ. Researchers and surgeons from Britain, Italy and Spain collaborated to grow tissue from Ms Castillo’s own bone marrow stem cells, using them to fashion the new bronchus – a branch of the windpipe. They believe that one day the approach will be used to create engineered replacements for other damaged organs, such as the bowel or bladder. In five years they hope to begin clinical trials in which laboratory-made voice boxes are implanted into patients with cancer of the larynx.

Martin Birchall, of the University of Bristol, a British member of the team, said: “This is the first time a tissue-engineered whole organ has been transplanted into a patient. I reckon in 20 years’ time it will be the commonest operation – it will transform the way we think about surgery.”

Ms Castillo, who was born in Colombia, had suffered a tuberculosis infection that ravaged her airways, leaving her unable to do simple domestic tasks. Disease had caused her windpipe, or trachea, to collapse just at the point where it entered her lung. Without the pioneering operation in June, the lung would have been removed. Today she again has a normal life and is able to look after her two children. She can walk up stairs without getting breathless and has even been dancing.

The prospect of the patient needing powerful drugs to avoid rejection had been thought to outweigh any potential benefits of trachea transplants. Four months on, Ms Castillo’s doctors have seen no sign of her immune system rejecting the transplant, even though she has had no immunosuppres-sive drugs.

Details of the transplant, performed by Paolo Macchiarini, at the Hospital Clinic of Barcelona, are published online today by The Lancet.

First a section of trachea was taken from a donor and stripped of cells that could cause an immune reaction, leaving a grey trunk of connective tissue. Stem cells were then taken from Ms Castillo’s bone marrow and grown in Professor Birchall’s laboratory. Stem cells can develop into different kinds of tissue, given the right chemical instructions, enabling researchers to cultivate cartilage and epithelial cells to cover the 7cm graft. It was then “seeded” with the new cells using a process developed in Milan. Finally the trachea, covered in cartilage and lined with epithelial cells, was cut to shape and fitted.

Professor Macchiarini said: “The probability that this lady will have rejection is almost zero. She is enjoying a normal life, which for us clinicians is the most beautiful gift.”

The researchers said that the surgery could help some patients in Britain but admitted that the procedure was too expensive to be widely available. They are seeking EU funding and commercial sponsors for trials to create and transplant a larynx, an operation that could be more cost-effective.

Ms Castillo said: “I was scared at the beginning because I was the first patient – but trusted the doctors. I am now enjoying life and am very happy that my illness has been cured.”