Abstract:
Most tracheal lesions can be resected and primary reconstruction safely effected. But
reconstruction of long-segment tracheal defects requires a vascularized allograft. We report result our
experimental and anatomical studies and successful tracheal allotransplantation in a clinic. Our
method of tracheal transplantation uses the composite thyrotracheal allograft revascularized by both
inferior thyroid arteries and veins. The first step includes harvesting the trachea from a donor. For this
purpose the aortic arch cannulation was performed, and then it was ligated on the level of ascending
and descending branches, the superior vena cava was ligated and dissected above the ligated site.
Through the aortal catheter stream introduction of the preservative solution was performed.
Simultaneously a perfusion of shoulder-girdle, head, and neck and mediastinum organs (including the
trachea) was performed. This enabled quick removal of the donor complex together with muscles,
vessels and mediastinum cellular tissue. Further preparation of the graft was performed ex vivo. The
next step includes tracheal resection and thyrotracheal complex transplantation. The graft
revascularization was performed through the brachiocephalic trunk or carotid arteries of the recipient.
Venous drainage was restored by means of suturing the inferior thyroid vein of the grafted complex
with the left brachiocephalic vein of the recipient. Results: The findings of the experimental
anatomical study made it possible to conduct this operation in a clinical setting in a patient with
subtotal tracheal pathology. The thyrotracheal complex removal was completed using our protocol.
Organ perfusion was performed using the Custodiol solution (Dr Franz Kohler Chemia GMBH,
Germany). The trachea of the recipient was dissected at the level of the first intercartilaginous gap. In
the caudal segment, the trachea was resected from the right edge of the last cartilagenous tracheal
ring, and resection of the tracheobronchial triangle was performed on the left wall. After
revascularization of the graft, pulsation of the lower thyroid arteries was satisfactory, quick filling of
the lower thyroid vein was noted. Fibrotracheoscopy was confirmed restoration of the blood flow by
the changed coloring of the tracheal mucosa. To prevent postoperative complications the patient
received antibacterial, antimycotic, antiviral and immunosuppressing therapy. Since the discharge, the
patient has had no further episodes of dyspnoea .Three years after tracheal reconstruction, the patient
was satisfied with the outcome. Conclusion: Our experimental studies have paved the way for
transplantation of the trachea with adequate supportive blood flow in a clinical setting. The practical
experience supported the feasibility of the concept that tracheal transplantation is a viable option. This
method of treatment might help patients who are currently considered incurable.