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Single-Staged Vascularized Tracheal Transplantation for Tracheal Defects

by Linda Kossoff •

Twenty months after the first-in-human tracheal transplantation using a newly developed technique for vascularized single-staged tracheal transplantation, what is the status of the recipient?

BOTTOM LINE

The recipient’s trachea is functional, indicating viability of this technique in some cases of tracheal defects.

BACKGROUND: Long-segment tracheal defects affecting <40% of tracheal length may be reconstructed using existing surgical techniques, while defects affecting >60% of the trachea continue to challenge surgeons. Tracheal transplantation has been proposed as the solution, but the trachea’s segmental blood supply is not amenable to microvascular transplantation.

STUDY DESIGN: Case study.

SETTING: The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, N.Y.

SYNOPSIS: Based on researchers’ development of a single-staged vascularized tracheal transplantation technique, the first reported single-staged human tracheal transplantation for the management of the airway disease was performed. Twenty months later, the researchers conducted a follow-up on the status of the transplant and the viability of their technique. Prior to this surgery, the trachea recipient had presented with a 9.0-cm airway tracheal stenosis and complete cricoid stenosis and had failed six surgeries. The patient then underwent the surgical procedure, which employed the newly developed technique, and was closely monitored with endoscopic tracheoscopy, narrow-band imaging (NBI), free-cell DNA assessment, and histological and cytogenetic analysis of tracheal biopsies. The follow-up report revealed no evidence of acute or chronic rejection. Endoscopic assessment remained stable throughout the 20-month postoperative course, demonstrating well-vascularized mucosa, and the NBI has demonstrated consistent perfusion through the submucosal vascular arcade. Fluorescence in situ hybridization cytogenetics demonstrated that the donor trachea was repopulated with recipient epithelium, establishing a chimeric allograft. The patient has resumed a normal life without a stent or tracheostomy.

CITATION: Genden EM, Harkin T, Laitman BM, et al. Vascularized tracheal transplantation: a twenty month follow up. Laryngoscope. 2023;133:1839–1845.