British scientists restored function in pigs with damaged esophagi by transplanting esophagi from other pigs. They left only the esophageal support matrix and replaced the cells with the recipient pig's stem cells, fundamentally blocking immune rejection. The team expects that pediatric patients born with a hole in the esophagus who cannot swallow food properly could be treated the same way.
Paolo De Coppi, a professor at University College London (UCL) Great Ormond Street Hospital, said, "We transplanted esophagi from other pigs into eight minipigs, and five survived without any problems for up to six months," in a paper published on the 20th (local time) in the journal Nature Biotechnology.
The team said the inter-pig esophageal transplant experiment is part of research to treat patients with congenital esophageal atresia. These pediatric patients cannot swallow food because of esophageal problems. Currently, treatment involves pulling the stomach up to the neck to connect it directly behind the neck, or transplanting part of the colon to bridge the gap.
◇ success in esophageal transplants between pigs
The researchers have sought a method to replace only the problematic section instead of performing major surgery that is hard for young patients to endure. The approach removes the damaged esophagus and transplants a donor esophagus composed of the patient's own cells. Although the scaffold of the esophagus comes from another individual, the cells are the patient's, preventing immune rejection.
The challenge is that pediatric patients rarely receive donated esophagi. The researchers decided to use animal esophagi. Previously, they cultured mouse cells on the esophagus of a larger rat and transplanted it into mice. They also transplanted a porcine esophageal scaffold into rabbits. Concluding that the Göttingen minipig, which weighs about 10 kilograms and is similar in size to a baby, would be suitable, they first demonstrated feasibility with pig-to-pig esophageal transplant surgery.
First, they collected muscle cells from the abdomen of the recipient pig. From these, they extracted two types of stem cells capable of developing into myovascular and connective tissue. Next came securing the esophagi for transplantation. They harvested esophagi from 16 minipigs, removed the cells, and left only the supporting scaffold. They then seeded and cultured the recipient pig's stem cells onto these scaffolds.
The team removed a 2.5-centimeter section of esophagus from eight recipient pigs and replaced it with an esophagus from another pig that had been cultured for two months. Of the eight pigs that received the transplant, five survived for six months. The researchers said the esophageal muscles, nerves, and blood vessels functioned normally without immune rejection. Genes activated in the transplanted esophagi were similar to those in natural esophagi.
Andrew Barbour, a surgeon at the University of Queensland, said, "This is an impressive result showing generation of an esophagus with all components that functions normally," adding, "While some scar tissue that can cause swallowing problems formed in the transplanted esophagus, the fact that it decreased over time is also encouraging."
◇ expected to apply to pediatric patients within five years
De Coppi's team said it is investigating whether it can culture esophagi up to 10–15 centimeters long. If successful, they expect to apply the method to pediatric patients within five years. Co-author Marco Pellegrini said, "We should be able to create a new esophagus by combining cells from pediatric patients with a porcine scaffold," adding, "The transplanted esophagus contains the patient's muscle progenitor cells, so it can grow over time with the child without immune rejection."
In fact, the minipigs that received transplanted esophagi gained weight like other pigs over six months, and their esophageal structure gradually became more similar to that of natural esophagi. The researchers said this suggests the esophagus continued to grow and mature after transplantation. But some scientists were cautious, saying definitive evidence is still lacking.
Dusko Ilic, a professor at King's College London (KCL), said, "This study shows significant progress in engineering functional replacements for hollow, complex organs," but added, "Claims that this approach offers a solution for children born without an esophagus are premature."
For children in a rapid growth phase, transplanted organs must grow with them, and it is still hard to conclude that the transplanted esophagi grew. Ilic said normal weight gain in pigs should not be interpreted as esophageal growth. "To prove esophageal growth, long-term studies are needed that directly measure the transplanted esophagus and identify autologous regenerative progenitor cells that support tissue development," he noted.
References
Nature Biotechnology (2026), DOI: https://doi.org/10.1038/s41587-026-03043-1