Laryngotracheal transplantation: technical modifications and functional outcomes

• Published in: The Laryngoscope Vol. 123; no. 10; pp. 2502 - 2508
• Main Authors: Farwell, D Gregory, Birchall, Martin A, Macchiarini, Paolo, Luu, Quang C, de Mattos, Angelo M, Gallay, Brian J, Perez, Richard V, Grow, Matthew P, Ramsamooj, Rajen, Salgado, Moses D, Brodie, Hilary A, Belafsky, Peter C
• Format: Journal Article
• Language: English
• Published: United States 01-10-2013
• Subjects: Composite Tissue Allografts; Female; Humans; Laryngoscopy; Laryngostenosis - surgery; Larynx - transplantation; Medicin och hälsovetenskap; Middle Aged; Phonation; Quality of Life; Trachea - transplantation; Treatment Outcome; airway reconstruction; composite tissue allotransplantation; trachea; larynx transplant; laryngotracheal transplant; transplant; Larynx; larynx stenosis; tracheal stenosis
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.24053

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.
Case report.
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 supply, and reinnervation. This resulted in a robustly vascularized organ with well-perfused long-segment tracheal transplant and early return of motor reinnervation.
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.
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.