By Denise Mann
THURSDAY, June 14 (HealthDay News) -- In what is being reported as a scientific first, Swedish doctors were able pair the groin vein of a dead donor with stem cells from a young girl and implant the healthy vein into the girl, improving both blood flow in her lower body and her quality of life.
The 10-year-old had a rare condition where her portal vein, which is located in the abdomen and tasked with carrying blood from the bowels and other abdominal organs to the liver, was blocked. If this vein is blocked, liver disease, heart failure and certain cancers may develop. The relatively rare condition may also cause weight loss, nausea and pain.
Details of the feat are published online June 14 in The Lancet.
U.S experts were quick to caution that the procedure has only been accomplished in one patient, but they agreed that it could be a game-changer with applications that go far beyond this particular condition.
In the procedure, the transplant team from the University of Gothenburg in Sweden first took a segment of the groin vein from a dead donor, and stripped it of all living cells. They then injected stem cells taken from the girl's own bone marrow into the remaining vein. Two weeks after this seeding, the newly grown graft was implanted in the girl.
There were no complications, and the procedure immediately restored normal blood flow. In the year following the operation, the girl grew taller and gained weight. Her blood flow later decreased, and she underwent a second vein replacement surgery a year after the first. Her quality of life has improved since the procedures, and she is now able to take increasingly long walks and participate in light gymnastics. Importantly, she is showing no sign of rejecting the new vein even though she is not taking any immunosuppressive drugs.
"The new stem cells-derived graft resulted not only in good blood flow rates and normal laboratory test values but also, in strikingly improved quality of life for the patient," wrote the team led by Dr. Michael Olausson, of Sahlgrenska University Hospital in Gothenburg. "The work also establishes the feasibility and safety of a novel paradigm for treatment, in cases of venous insufficiency, obstructed veins or inadequate autologous [from the patient] veins."
Today, surgeons may approach such cases by harvesting veins from a patient's neck or leg to re-route around a blockage elsewhere. This can be traumatic and is associated with its own set of risks and complications. In addition, not everyone has healthy veins that can be used in this manner. This is where the new stem cell vein grafting procedure could play an important role.
"This is an interesting article and an exciting first step," said Dr. Scott Pilgrim, an attending pediatric cardiologist at Steven and Alexandra Cohen Children's Medical Center of New York, in New Hyde Park. "If this outcome turns out to be reproducible and is studied in a larger, defined population with a well-designed, controlled trial, I feel this advance could be a watershed moment in developing new, novel strategies for vascular and cardiothoracic surgeons."
The implications are far reaching in that new veins and arteries could be 'grown' ahead of time for an anticipated surgery, he said. "It would be interesting to see if these vessels are capable of continued growth in a child, as this is often the reason for re-operation in congenital heart disease." The grow-your-own approach may one day replace the need for mechanical heart valves and the use of blood-thinning drugs.
Donna Arnett, incoming president of the American Heart Association and chair of epidemiology at the University of Alabama at Birmingham, agreed that its potential is exponential.
"When you have to use an artificial graft, you worry about rejection and need to use immunosuppressant drugs," she said, and these drugs increase risk of developing infections. "This could be useful for people who don't have a vein to use from their own body, and it avoids the use of immunosuppressants."
They may also build on the concept and attempt to engineer arteries, which could be useful for people who require coronary artery bypass grafts to treat heart disease.
"A lot of lead time would be needed so this would not work in the situation where you need something acutely," Arnett said.
Find out more about coronary artery bypass grafting at the U.S. National Heart, Lung, and Blood Institute.
SOURCES: Scott M. Pilgrim, M.D., attending pediatric cardiologist, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park; Donna Arnett, Ph.D., incoming president, American Heart Association, and chair, epidemiology, University of Alabama at Birmingham: June 15, 2012, The Lancet
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