Laryngotracheal transplantation

Technical modifications and functional outcomes

D Gregory Farwell, Martin A. Birchall, Paolo Macchiarini, Quang C. Luu, Angelo M DeMattos, Brian J Gallay, Richard V Perez, Matthew Grow, Rajen Ramsamooj, Moses D. Salgado, Hilary A Brodie, Peter C Belafsky

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives/Hypothesis Laryngeal transplantation offers the potential for patients without a larynx to recover their voice, which is critical in our communication age. We report clinical and functional outcomes from a laryngotracheal transplant. Widespread adoption of this technique has been slowed due to the ethical concerns of life-long immunosuppression after a nonvital organ transplant. Our patient was already on immunosuppressive medication from prior kidney-pancreas transplantation, and therefore was not exposed to added long-term risk. We describe the unique technical advances, clinical course, and rehabilitation of this patient and the implications for future laryngeal transplantation. Study Design Case report. Methods A laryngotracheal transplantation was performed in a 51-year-old prior kidney-pancreas transplant recipient presenting with complete laryngotracheal stenosis. Surgical modifications were made in the previously described technique related to retrieval, vascular SUPPL.y, and reinnervation. This resulted in a robustly vascularized organ with well-perfused long-segment tracheal transplant and early return of motor reinnervation. Results A multidisciplinary approach resulted in a successful transplant without evidence of rejection to date. Postoperatively, the patient continues to rely on a tracheotomy but has had the return of an oral and nasal airway, vocalization, smell, and taste, all experienced for the first time in 11 years. Conclusions We have demonstrated that our methods may result in a successful laryngotracheal transplant. We describe the preparation, surgical technique, rehabilitation, and interventions employed in achieving optimal outcomes. This report contributes valuable information on this rarely performed composite transplant. Laryngoscope, 123:2502-2508, 2013

Original languageEnglish (US)
Pages (from-to)2502-2508
Number of pages7
JournalLaryngoscope
Volume123
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Transplantation
Transplants
Rehabilitation
Laryngoscopes
Pancreas Transplantation
Tracheotomy
Smell
Immunosuppressive Agents
Larynx
Nose
Kidney Transplantation
Immunosuppression
Blood Vessels
Pancreas
Pathologic Constriction
Communication
Kidney

Keywords

  • airway reconstruction
  • composite tissue allotransplantation
  • laryngotracheal transplant
  • Larynx
  • larynx stenosis
  • larynx transplant
  • trachea
  • tracheal stenosis
  • transplant

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Laryngotracheal transplantation : Technical modifications and functional outcomes. / Farwell, D Gregory; Birchall, Martin A.; Macchiarini, Paolo; Luu, Quang C.; DeMattos, Angelo M; Gallay, Brian J; Perez, Richard V; Grow, Matthew; Ramsamooj, Rajen; Salgado, Moses D.; Brodie, Hilary A; Belafsky, Peter C.

In: Laryngoscope, Vol. 123, No. 10, 10.2013, p. 2502-2508.

Research output: Contribution to journalArticle

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abstract = "Objectives/Hypothesis Laryngeal transplantation offers the potential for patients without a larynx to recover their voice, which is critical in our communication age. We report clinical and functional outcomes from a laryngotracheal transplant. Widespread adoption of this technique has been slowed due to the ethical concerns of life-long immunosuppression after a nonvital organ transplant. Our patient was already on immunosuppressive medication from prior kidney-pancreas transplantation, and therefore was not exposed to added long-term risk. We describe the unique technical advances, clinical course, and rehabilitation of this patient and the implications for future laryngeal transplantation. Study Design Case report. Methods A laryngotracheal transplantation was performed in a 51-year-old prior kidney-pancreas transplant recipient presenting with complete laryngotracheal stenosis. Surgical modifications were made in the previously described technique related to retrieval, vascular SUPPL.y, and reinnervation. This resulted in a robustly vascularized organ with well-perfused long-segment tracheal transplant and early return of motor reinnervation. Results A multidisciplinary approach resulted in a successful transplant without evidence of rejection to date. Postoperatively, the patient continues to rely on a tracheotomy but has had the return of an oral and nasal airway, vocalization, smell, and taste, all experienced for the first time in 11 years. Conclusions We have demonstrated that our methods may result in a successful laryngotracheal transplant. We describe the preparation, surgical technique, rehabilitation, and interventions employed in achieving optimal outcomes. This report contributes valuable information on this rarely performed composite transplant. Laryngoscope, 123:2502-2508, 2013",
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