A team of Mount Sinai surgeons has performed what the health system says is the world’s first human tracheal transplant, according to a news release.
Mount Sinai noted that the “achievement that has the potential to save the lives of thousands of patients around the world who have tracheal birth defects, untreatable airway diseases, burns, tumors, or severe tracheal damage from intubation, including those who had been hospitalized with COVID-19 and placed on a ventilator. Until now, no long-term treatments existed for these patients with long-segment tracheal damage, and thousands of adults and children died each year as a result.”
Before now, surgeons have been unable to transplant this organ in large part because of the complexity of providing blood flow to the donor trachea, leaving patients with long-segment tracheal disease no option for treatment. Mount Sinai said the procedure resulted from 30 years of research, much of it focused on how to revascularize, or provide blood flow to the trachea.
The 18-hour procedure took place on Wednesday, January 13, and was led by surgeon-scientist Eric M. Genden, MD, MHCA, FACS, the Isidore Friesner Professor and Chair of Otolaryngology – Head and Neck Surgery for Mount Sinai Health System and Professor of Neurosurgery, and Immunology, at the Icahn School of Medicine at Mount Sinai. The complex surgery involved a team of more than 50 specialists including surgeons, nurses, anesthesiologists, and residents.
The trachea transplant recipient is a 56-year-old female social worker from New York City. She had severe tracheal damage due to repeated intubation after an asthma attack; several failed surgical attempts to reconstruct her trachea led to even further damage. She breathed through a tracheostomy – a surgically created hole in her neck – and was at high risk of suffocation and death because of the progression of her airway disease and likelihood of her trachea collapsing. Being constantly worried she would go to sleep at night and never wake up was her main motivator to undergo the experimental procedure.
During the procedure, the Mount Sinai surgical team removed the trachea and the associated blood vessels from the donor. Then, the surgeons reconstructed the trachea in the recipient from the lungs to the larynx and performed a series of microvascular anastomoses, connecting the small blood vessels that nourish the donor trachea with the recipient’s blood vessels. Surgeons used a portion of the esophagus and thyroid gland to help provide blood supply to the trachea, which led to successful revascularization. Ultimately, this procedure allowed the removal of the recipient’s tracheostomy, giving her an opportunity to breathe through her mouth for the first time in six years.
The patient has had no complications or signs of organ rejection and doctors are monitoring her closely to assess her progress and reaction to antirejection therapy.
