Single-Stage, Long-Segment Human Tracheal Transplantation Achieved in Novel Procedure

by Linda Kossoff •

Is it possible to achieve single-staged human vascularized long-segment tracheal transplantation by employing a rigid structure that can biologically integrate and that has functional ciliated epithelium?

BOTTOM LINE

Using a novel vascular supply construct, surgeons can successfully achieve tracheal revascularization and human transplant in a patient with extensive airway defects.

BACKGROUND: Long-segment tracheal defects are associated with significant morbidity and mortality. Scientific dogma has dictated that single-staged tracheal transplantation in these patients is not possible due to inability to restore blood flow. Numerous staged reconstructive techniques have been employed to manage extensive airway defects, but there have been complications.

STUDY DESIGN: Novel procedure.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, N.Y.

SYNOPSIS: For this novel procedure, a 56-year-old female with long-segment cricotracheal stenosis elected to undergo tracheal transplantation. The organ procurement and transplant were performed in side-by-side operating rooms to limit ischemic time. For implantation, surgeons placed the allograft into the recipient bed; the patient was ventilated through the inferior tracheal stoma. The inferior posterior and superior posterior membranous trachea were reconstructed using absorbable suture. After reinitiating vascular flow, there was brisk perfusion of the distal tracheal cartilage and membranous portions of the trachea. The superior tracheal anastomosis was left open to accommodate the endotracheal tube and as a port for postoperative monitoring via bronchoscopy. In twice-daily checks, the tracheal mucosa remained well-vascularized. Six months post-transplant, the trachea was functional, and the patient did not require a tracheostomy or stent. Authors note that a rigid structure able to biologically integrate and tolerate negative inspiratory pressures is required for successful long-segment tracheal reconstruction. They caution that, although this novel procedure foretells a new field of research/techniques for patients with life-threatening airway defects, future application of the procedure must be carefully considered.

CITATION: Genden EM, Miles BA, Harkin TJ, et al. Single-stage long-segment tracheal transplantation. Am J Transplant. 2021;21:3421–3427.