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Martedì 29 Maggio 2012 12:07

Trapianti pediatrici: sempre più donatori viventi e organi artificiali

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In vista della Giornata nazionale per la donazione di organi, l'Ospedale Pediatrico Bambino Gesù ha presentato le innovazioni e gli incrementi sul fronte dei trapianti, frutto della sintesi tra organizzazione e lavoro in rete, competenze cliniche e avanguardia tecnologica.




L’impegno e l’articolazione clinica del Bambino Gesù si pongono in linea con la necessità di identificare nel Paese un centro nazionale di riferimento. L’Ospedale vanta infatti – ma è solo a titolo esemplificativo - la più alta percentuale nazionale di trapianti di rene da vivente (40% contro il 10% circa nel Paese), è l’unico Centro in Europa che ha un’offerta trapiantologica a 360° (organi, tessuti e cellule) e una capacità innovativa che l’ha portato, tra le altre eccellenze di attività, a impiantare  – primo al mondo – un cuore artificiale permanente in un ragazzo.


Considerando che più il bambino è piccolo tanto più sono rilevanti le difficoltà di trovare un donatore adeguato, l’organo artificiale assume un’importanza strategica poiché spesso rappresenta la sola possibilità di sopravvivenza. Sia che si tratti di soluzioni ponte in attesa di un trapianto, sia che costituisca una soluzione definitiva.


La velocità dell’innovazione tecnologica sanitaria, ambito nel quale il Bambino Gesù occupa una posizione di avanguardia nel panorama internazionale, ha reso possibile l’impianto permanente di organi artificiali nei bambini. E’ il caso del ragazzo - allora sedicenne - impiantato due anni fa con il primo cuore artificiale permanente al mondo.


Sempre al Bambino Gesù, il mese scorso, per la prima volta al mondo è stato impiantato il più piccolo cuore artificiale in un bambino di appena 16 mesi. L’apparecchio – mai utilizzato in precedenza – ha avuto bisogno di un apposito permesso per il suo primo impiego da parte della FDA (Food and Drug Administration) e del Ministero della Salute. L’intervento, unico nel suo genere, si è reso indispensabile a causa della gravità delle condizioni di salute del piccolo che non gli avrebbero consentito di sopravvivere in attesa del trapianto di cuore e che, per le condizioni generali non erano compatibili con soluzioni temporanee di circolazione extracorporea.


In chiave pediatrica assumono poi sempre maggiore importanza le donazioni da vivente (che integrano, ma non sostituiscono, quelle da donatore cadavere). Questo grazie anche alle innovative metodiche che permettono oggi di effettuare l’operazione con tecniche di prelievo mininvasive. Il trapianto da vivente è una valida alternativa che garantisce tra l’altro una maggiore sopravvivenza dell’organo prelevato e quindi una migliore qualità di vita per il piccolo paziente e per chi gli ha donato con generosità e amore un rene o una porzione di fegato.


Stimolare la donazione e i trapianti di organi, tessuti e cellule ha un alto valore simbolico, civile e sociale. Ancora di più in ambito pediatrico, perché rappresenta un importante investimento per e sul futuro. L’Ospedale Pediatrico Bambino Gesù è impegnato e sta contribuendo in maniera significativa a livello internazionale, anche nella ricerca, per ridurre sensibilmente tutti i rischi clinici di rigetto di un organo trapiantato o di complicanze immunologiche legate al trapianto di cellule.


Lo scenario internazionale – sottolinea Giuseppe Profiti, Presidente dell’Ospedale Pediatrico Bambino Gesù - si sta orientando sempre più verso la concentrazione dell’eccellenza e delle attività cliniche altamente complesse in un’unica realtà. Questo sulla scorta dell’evidente riscontro sul piano della sicurezza per il paziente oltre che per una sempre più mirata finalizzazione delle risorse economiche. Investire nella cura di patologie fatali grazie alla soluzione offerta dai trapianti di organi, cellule e tessuti, promuovere la cultura della donazione come atto di solidarietà civile oltre che di amore verso il prossimo e impegnarsi nella ricerca di soluzioni scientifiche e tecnologiche innovative, è per chi si occupa di bambini un imperativo imprescindibile che non conosce flessioni. Il coordinamento del Centro Nazionale Trapianti, anche sul fronte complesso delle donazioni e dei trapianti in età pediatrica ha contribuito a fare di questo Paese un modello di efficienza. Consegnare alla collettività lo spunto di riflessione sull’importanza della donazione da vivente e alla comunità scientifica internazionale una soluzione terapeutica innovativa come il cuoricino artificiale, del peso di 5 monete da un centesimo ma dal valore inestimabile, è il nostro modo di partecipare alla celebrazione della Giornata nazionale della donazione di organi”.


Pochi dubbi che il trapianto di organo o cellule rappresenti una vera e propria rivoluzione della moderna medicina che ha largamente modificato la storia naturale di molte patologie pediatriche, congenite o acquisite, regalando prospettive di normale sopravvivenza a bambini altrimenti condannati ad assai breve vita - sostiene Franco Locatelli, Direttore del Dipartimento di Oncoematologia Pediatrica dell'Ospedale Bambino Gesù - Altrettanto indubitabilmente, trapianti d'organo o di cellule possono essere ottimalmente condotti solo in Istituzioni o Centri in cui, all'elevata qualificazione e competenza, si coniughino programmi specifici in grado di creare una massa critica di attività che si traduce in una capacità di gestire al meglio tutti gli aspetti di trattamenti così sofisticati e complessi. L'investimento scientifico e assistenziale realizzato dal Bambino Gesù si è concretizzato in una qualificata rete e infrastruttura, dove i diversi professionisti della salute si integrano, complementando al meglio le diverse competenze. Non a caso, oltre all'eccellenza di attività di trapianto di cuore, rene, fegato, polmone e intestino, presso l’Ospedale vengono realizzati più di 120 trapianti all'anno di cellule staminali, numero che rappresenta più del 20% dell'intera attività nazionale. E, nel prossimo futuro, la Cell Factory attualmente in via di costruzione permetterà di implementare terapie cellulari o con cellule geneticamente modificate in grado di ridurre al minimo i rischi infettivi (tipici della popolazione dei trapiantati) e di ottimizzare, nel caso di trapianti di cellule, l'attività antitumorale”.


Nello scorso mese di marzo presso l’Ospedale del Bambino Gesù di Roma è stato impiantato per la prima volta al mondo il più piccolo cuore artificiale esistente - spiega Antonio Amodeo Responsabile Unità di progetto Assistenza Meccanica del Bambino Gesù - Il dispositivo, una pompa al titanio di soli 11 grammi capace di sostenere una portata fino ad un 1,5 litri al minuto, è stato usato in urgenza su un piccolo di 16 mesi affetto da miocardiopatia dilatativa con una grave infezione del sistema di assistenza ventricolare precedentemente impiantato. Il cuore artificiale, prototipo di laboratorio sviluppato nell’ambito un programma di ricerca americano del National Institutes of Health, ha permesso il completamento dell’iter terapeutico del piccolo che è culminato con il trapianto cardiaco. Attualmente, ad oltre un mese dall’intervento, il bambino gode di buona salute”.


L’Ospedale Pediatrico Bambino Gesù rappresenta una delle principali realtà europee per il trapianto pediatrico - conclude Alessandro Nanni Costa, Direttore del Centro Nazionale trapianti - coniugando l’attività trapiantologica per tutti gli organi ad un impegno etico, di servizio e di grandissima  professionalità”.


Fonte: Ufficio stampa e Relazioni istituzionali Ospedale Pediatrico Bambino Gesù - IRCCS


(Newsletter inviata il 22 maggio 2012)

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