Claudia Pole / Mount Sinai Health System
The New York City medical team says they made the first complete surgical transplant of the trachea.
You may find it easy to transplant because the trachea is basically a tube that carries air to and from the lungs. But that’s not the case. In fact, tracheal transplantation is one of the last major challenges in medicine in this area.
The recipient is Sonia Thane, a 56-year-old woman from the Bronx, New York. She was admitted to the hospital six years ago after a particularly troublesome asthma attack. To help her breathe, she says the doctor inserted a tube into her throat.
“The tracheal intubation was too long and the trachea was damaged, so I had surgery to repair the trachea after surgery,” she says.
Those operations failed. Finally, the doctor made a hole in her throat and put it through a tracheostomy tube. But Sain, a former social worker who now lives with her daughter and grandchildren, is getting tired of the tube. She thought there must be a better way of life.
“I studied tracheal transplants because I thought I was doing all the other transplants. There must be something in the trachea,” she says.She found it Researcher at Mount Sinai Hospital in New York City Certainly I was working on that concept.
She says she called them every other day, “I kept calling until someone called me and made an appointment,” she says. “I think they got tired of calling me!”
That was about four years ago. At that time, Surgeons at Mount Sinai were not ready to try this operation on humans. Sain says he was so depressed about the tracheostomy tube that he considered checking in to the hospice and having him remove it. This ends her life.
But she held up, and at the end of last year she heard a reply from Dr. Eric Genden, A surgeon at Mount Sinai and a researcher at Mount Sinai School of Medicine. He said he was finally ready to try it.
I have an operation Long history Disappointed.
Claudia Pole / Mount Sinai Health System
It looked like a tube at first glance, so it looked pretty easy, but it turned out to be a very complex organ system, “says Genden. Inside the trachea are small hair-like filaments called cilia. It beats synchronously and helps clear particles from the lungs.
However, the biggest challenge in transplantation is sending blood to the trachea. For decades, doctors believed that the blood supply was supported by a network of small blood vessels, which cannot be surgically reconnected. Genden says it was based on a research treatise published in the mid-1960s by Harvard’s influential scientists.
“This doctrine is at a standstill, and the literature begins with hundreds of articles.” Because it’s not transplantable, here’s how to reconstruct the trachea, “Genden says. ..
Synthetic tubes did not work as a long-term solution.
Some surgeons temporarily I tried transplanting the trachea into a human arm Develop a new network of blood vessels before moving to the throat.Another surgeon replaced the trachea With big blood vessels (Donner aorta).
In 2008, Italian surgeon Paolo Macchiarini received worldwide attention when he claimed to have transplanted a trachea that grew from stem cells and attached to a synthetic skeleton in the laboratory.
It rocked the entire field. Genden saw it as the future of tracheal transplantation. “The data from the stem cell lab was so impressive that we closed the basic sciences for all intents and purposes,” he said.
However, most of Macchiarini’s patients died, He was accused of research misconduct.. His efforts have been stopped. So Genden resumed his research.
What forced him to move forward was the realization that an original research treatise in this area on the complex blood supply to the trachea was completely wrong.
It was found that some of the arteries that pass through the thyroid gland also supply blood to the trachea. So are some of the blood vessels that connect to the esophagus.
“This wasn’t a discovery we made. It was a discovery that was documented throughout the 1800s,” Genden said. It was simply forgotten. He verified it by studying blood flow in both animals and humans.
He found that only a few blood vessels, about the diameter of spaghetti, could provide an adequate blood supply to the trachea.
In mid-January, he was finally ready to try the technique on humans, and Sonia Thane became a pioneer. It was an 18 hour operation. That time included hours of surgery to remove the trachea from the donor, followed by hours of surgery to connect multiple veins and arteries to establish a blood supply to new organs. ..
“You never know this will work until you see as much research as you do doing blood flowing into that organ,” says Genden.
Thane tolerates the transplanted organ well, Genden says, and her own cells are now growing in it, replacing the donor’s cilia with her own.
“It’s like the Holy Grail of what we all wanted,” says Genden.
“It’s promising. I think it’s really exciting,” he says. Dr. G. Alexander “Alec” Dr. Patterson, A surgeon at Washington University in St. Louis and a former mentor at Genden’s. According to Patterson, it can take months or more to know if the surgery was completely successful.
And at this stage, I don’t think tracheal transplants will become routine.
“For example, I don’t think it’s a viable option for patients with tracheal tumors,” he says.
Cancer is a common reason why trachea needs repair. However, transplant patients need to be treated with drugs that suppress the immune system to prevent organ rejection, which is dangerous for cancer patients.
According to Patterson, the blood vessels that support the trachea are smaller than in adults, making surgery difficult even for newborns with tracheal defects.
However, people like Sonia Thane, whose trachea is damaged, are potentially good candidates. She looks forward to being released from the restrictions she lived in as she breathes through the neck tube. She still had a small hole in her throat and the doctor was passing it through a scope to examine the trachea. It’s no longer needed, but she’s so used to breathing that way, she says she’s not ready to sew it together.
“The first thing to do when it gets a little warm is to take a walk on the beach,” she says. “I haven’t done that for 6 years, so I’m going to walk the beach and just feel the sand through my toes.”
You can contact NPR Science Correspondent Richard Harris [email protected]..
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