New method of tracheal allotransplantation

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.