Thankfully, regenerative medicine has advanced enough to created an alternative. A big, collaborative effort between scientists at Yale and Duke and doctors in Poland and the U.S. has created a bioengineered blood vessel that is safe, effective, and more durable than the synthetic grafts.
The science and the techniques behind this creation are remarkable. The first step is isolating vascular cells from a human donor and growing them in tissue culture. The cells are then placed on a degradable scaffold in the shape of a blood vessel where they will grow and stretch and eventually acquire the physical properties of a real, functional blood vessel. This part of the process takes about 8 weeks. After the 8 week growing process, the scaffold disintegrates, leaving behind a blood vessel. You might think that this is where the process stops, but the researchers took it further. The final step in the process is to wash away all of the cellular, living components to leave behind a protein structure that is mostly collagen. This protein structure maintains the blood vessel shape and is ready for implantation.
The fact that this engineered blood vessel is acellular is crucial because it minimizes the risk of rejection by the patient. In the 60 patients who received the bioengineered blood vessels, there was no incidence of rejection. Because the blood vessels are acellular, the patient's’ cells actually repopulated the collagen scaffold after it was implanted. Durability 1 year after implantation was 90% for the bioengineered blood vessels compared to 60% for the synthetic grafts and the engineered blood vessel were just as safe.
This work will not only help those on dialysis who cannot have an AV fistula, but it also represents a huge step in the broader field of regenerative medicine. Nonliving bioengineered tissue has been implanted to becoming living tissue. This is a very cool advancement that can be applied to multiple areas.
Sources: EurekAlert, The Lancet, and NIDDK