A baby called Easton is believed to be the first person to ever receive a combined heart and thymus transplant, which aims at revolutionizing the organ transplant system by helping the recipient’s body to accept the donor organ. The surgery appears to have been a resounding success and Easton is now doing extremely well months later. 

“This has the potential to change the face of solid organ transplantation in the future,” said Joseph W. Turek, M.D., Ph.D., chief of pediatric cardiac surgery at Duke University Hospital and one of the surgeons involved in the procedure, in a statement. 

Heart transplants are an extremely complex procedure and, even if successful, run the risk of the recipient’s immune system rejecting the foreign organ. In this event, the immune system begins targeting the organ tissue, ultimately attacking and destroying it. Organ rejection is a life-threatening condition. 

As a result, organ transplants are carefully matched between donor and recipient, and often accompanied by an array of immunosuppressive drugs to prevent rejection. These drugs are moderately toxic and given in two stages that can last for a long period (or even their entire lives), leaving the patient susceptible to opportunistic pathogens – during the ongoing COVID-19 pandemic, concerns for immunosuppressed people have been heightened. Alongside this, the lifespan of a transplanted organ is just 10-15 years due to the constant toxicity of the drugs. 

Instead, researchers from Duke University turned to an alternative. Baby Easton required a heart transplant as he was born with a weak heart and had a problem in his thymus gland, a critical part of the immune system that creates T-cells. This combination of conditions made Easton a rare candidate for two separate procedures, both transplanting a new donor heart and implanting thymus tissue. If the thymus was transplanted successfully, the immune system may recognize the donor heart as if it were his own and Easton may not require the cocktail of drugs needed to keep the immune system at bay. 

Following FDA approval for the procedure, Easton received a new heart and thymus in August 2021 at six months old. Using technology developed by Duke, the thymus was cultured and processed to treat the specific condition Easton had. 

The procedure was a success, and tests show that almost six months later, Easton’s thymus is producing T-cells characteristic of a healthy immune system. He remains on immunosuppressive drugs currently, but the team believe he may soon no longer require them. 

Such an achievement has resounding implications for not just solid organ transplants, but other conditions as well. 

“The team performed the transplant and implant in a patient who lacked significant thymus function, providing an excellent opportunity to examine how allogeneic processed thymus tissue can shape a person’s immune system to be more receptive to a donor organ,” said Allan D. Kirk, M.D., Ph.D., chair of the Department of Surgery at Duke University School of Medicine.

“If this can be extrapolated to patients who already have a functioning thymus, it could potentially allow them to restructure their immune systems to accept transplanted organs with substantially less dependence on anti-rejection medication. The processing method used for the thymus tissue seems to be critical and is of great interest.”