Transplant medicine has made amazing progress in the last 50 years, with new research and surgical techniques saving thousands of lives worldwide. In 2017, a record number of more than 34,000 transplant surgeries were performed in the U.S. I have worked in the Transplant Center at Mayo Clinic's campus in Rochester, Minnesota, for nearly 20 years. Just during the time that I have been with Mayo, processes and procedures have changed the way we care for patients and have allowed us to perform more transplants than ever before.
In 1963, Mayo Clinic officially entered the field of transplantation with a bone marrow and kidney transplant. Today Mayo is the largest integrated transplant provider in the U.S. performing more than 2,000 transplants each year. While some innovations are still in clinical trials, some of these transplants were made possible by innovative transplant procedures, research and medical advances pioneered by Mayo Clinic. Here are just a few transplant-related innovations that have occurred in the last few years at Mayo Clinic.
Dr. David Lott came to Mayo Clinic's campus in Phoenix, Arizona in 2011 on a mission – to start a laryngotracheal transplant program – the first in the U.S. Dr. Lott is embarking on a five-year clinical trial of 10 laryngotracheal transplant patients. “We have a handful of patients waiting for the trial to commence,” he says. “Mayo wants to be at the forefront of transplant medicine, and this will be the world’s first full-fledged laryngotracheal transplant program. We’re excited to change the lives of these patients.” In addition to the laryngotracheal transplant program, which will use cadaver larynges, Dr. Lott and his team are working on a bioengineered larynx program. They’ll use a patient’s own stem cells to create tissue to replace the damaged areas of the larynx and trachea. Over several weeks of special treatment, the stem cells will grow new tissue on a patient-specific scaffold made on a 3-D printer in a new cell therapy laboratory at Mayo Clinic.
Due to a nationwide organ shortage and never-ending quest to find the best answers, medical science can provide, Mayo Clinic researchers are studying alternatives to transplant including using stem cells to repair, replace or regenerate diseased cells. Researchers study and test how reprogrammed stem cells may be turned into specialized cells that can repair or regenerate cells in the heart, blood, nerves and other parts of the body. These stem cells have the potential to treat many conditions and could eliminate many of the long waits on the transplant waiting lists.
Liver Ex Vivo Perfusion
When a liver is removed from a donor for transplant, surgeons typically have less than 12 hours to transplant that liver into the recipient. Current practice is to place the liver in cold storage in a preservation solution at 4 degrees Celsius. Dr. Andrew Singer of Mayo Clinic's campus in Phoenix, Arizona is the principal investigator for a clinical trial to increase that preservation time for as long as 24 hours, using a perfusion system that keeps the liver at a temperature that simulates the human body. Dr. Singer believes this new system will give surgeons longer time to transport livers over longer distances – which could minimize deaths on the waiting list by allowing the sickest patients to have those organs regardless of where they are located around the country.
We talked above a little bit about regenerative medicine, but what if liver disease could be cured by using a patient’s own cells to correct their liver disease? Dr. Scott Nyberg of Mayo Clinic's campus in Rochester, Minnesota has spent his professional life perfecting such a system. Dr. Nyberg is trained as a transplant surgeon and biomedical engineer, and his vision for the future is to engineer livers to address the organ shortage. Sometimes livers are donated that are not able to be used for transplant. Dr. Nyberg uses these livers in his research. He removes all the cells from the liver and replaces those cells with cells from a patient, creating a whole new organ. He and his colleagues hope to someday help eradicate the waiting list and eliminate the need for more deceased organ donors for patients with liver failure.
Even with the high transplant volumes, the rising number of organ donors, and the medical and surgical innovations that continue to be discovered, twenty people in the U.S. still die each day waiting for an organ. There’s more work for us all to do – more medical and surgical innovations to research, more opportunities to promote organ donation and more advances to put to use for our patients.
What do you think will be the next big transplant innovation?