Surgeons in New York City performed the first tracheal transplant in the US, which gave a new trachea to a woman who had severe asthma, the tube that carries air from the mouth to the lungs.
Doctors say such surgeries could help Covid-19 patients who severely damage breathing machines.
“We’ve been talking for 100 years about just inserting a new trachea,” said Dr. Albert Merati, a surgeon at the University of Washington who had no role in the recent transplant. But linking a donor’s trachea to a recipient’s blood supply is challenging and will only be considered as a last resort, experts say.
“It’s technically just extremely difficult,” said Dr. David Klassen, medical director of the United Network for Organ Sharing, or Unos, which oversees the U.S. transplant system. “It was a very difficult thing to break.”
Social worker 56-year-old Sonia Sein, a patient, said she had been “trying to create every breath at every moment” for six years after treatment for severe asthma damaged her trachea. She breathed a sigh of relief after the operation at Mount Sinai Hospital in New York.
According to experts, it is too early to regard Sein’s transplant, which according to Unos is the first of its kind in the US, as a total success. Signal must use powerful drugs to prevent organ rejection, but doctors hope to wean her in a few years. Less than three months after surgery, there were no complications or signs of rejection.
“If it were a failure, we would already know. It is very promising, ”said Dr. Alec Patterson, a transplant surgeon at Washington University in St. Louis who was not involved in the operation. “This is an important step forward.”
Signal’s ordeal began in 2014 when doctors put a tube in her throat to help her breathe during a severe asthma attack. It saved her life, but damaged her trachea. Several surgeries to reconstruct her trachea did not help. So far, doctors have had few good options for treating severe trachea damage.
The trachea is much more than a simple tube.
“Every breath we take must be expertly transferred from the tip of the nose to the last air sac in the lungs,” Merati said.
Doctors can remove damaged parts of the trachea or replace it with prosthetics, laboratory-supplied tissue, or self-supporting tissue from the patient’s skin and rib cartilage. But these techniques may not restore the full function of the organ, which uses small hairs to move mucus around and has the perfect flexibility to expand and collapse as we breathe, swallow and cough.
Where a patient’s entire trachea is damaged, a transplant may be their only hope, says Dr. Eric Genden, a surgeon on Mount Sinai who led the team.
“Right now, we are not talking much about the patients because there is no option for them,” Genden said. “We hope that this procedure … will help not only the patients who are faltering in a disaster, but also the patients who are currently considered hopeless.”
In an 18-hour operation, a team of more than 50 specialists transplanted a donor trachea and reconnected it to a complex web of small blood vessels.
“When we saw the organ come to life, we knew we had jumped the first hurdle,” Genden said.
According to doctors, the procedure can help others with birth defects of the trachea, untreatable respiratory diseases or major damage by ventilators.
“It can help care for Covid-19 patients,” Merati said. ‘Without a doubt, we are already seeing an impact’ of patients using breathing machines.