April 22Featured ArticleIssue

UK Baby Undergoes World’s First Combination Heart Transplant-Thymus Procedure

The baby, who underwent the procedure at Duke University Hospital, appears to have gained the immune cells necessary to reduce or eliminate the need for prolonged use of toxic anti-rejection drugs

A baby named Easton, born with severe heart defects as well as thymic deficiency from an unknown cause, has received a combination heart transplant and allogeneic processed thymus tissue implantation at Duke University
Hospital. The baby appears to be gaining the immune cells necessary to reduce or eliminate the need for prolonged use of toxic anti-rejection drugs.

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The two procedures, under an expanded access application that was cleared by the FDA, represent a milestone in heart transplantation.

“This has the potential to change the face of solid organ transplantation in the future,” said Joseph W Turek, Chief of Paediatric Cardiac Surgery, Duke University Hospital, and a member of the surgical team that performed the landmark procedure.Turek added, “If this approach proves successful – and further validation is contemplated – it would mean transplant recipients would not reject the donated organ and they would also not need to undergo treatment with long-term immune-suppression medications, which can be highly toxic, particularly to the kidneys.”

The idea of using donated and processed thymus tissue during heart transplantation has been under study at
Duke and other sites for several years. Because the thymus gland stimulates the development of T-cells, which
fight foreign substances in the body, implanting the processed tissue is hoped to establish the donor’s immune system as the recipient’s, so the donated heart is recognised as “self.” The approach has shown promise in
animal experiments, including in Turek’s lab at Duke, but it had previously not been tried in a living organ recipient.Tests taken 172 days post-transplant/implantation indicate the processed thymus tissue is functioning, building the critical T-cells that are integral to a well-functioning immune system.

Easton’s care team at Duke continues to monitor progress; another milestone is possible in several months when
he could be tapered off anti-rejection drugs.

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