New York City surgeons performed the first tracheal transplant in the United States, giving a woman who suffered from severe asthma a new trachea, the tube that carries air from her mouth to her lungs.
Doctors say such operations can help Covid-19 patients who have suffered severe tracheal damage from breathing machines.
“We talked for 100 years about just putting on a new windpipe,” said Dr. Albert Merati, a surgeon at the University of Washington who did not participate in the recent transplant. But connecting a donor’s trachea to a recipient’s blood supply is a challenge and would only be considered as a last resort, experts say.
“It is technically extremely difficult,” said Dr. David Klassen, medical director of the United Network for Organ Sharing, or Unos, who oversees the United States’ transplant system. “It has been a very difficult thing to decipher.”
The patient, 56-year-old social worker Sonia Sein, said she spent six years “trying to catch her breath every moment” after treatment for severe asthma damaged her windpipe. She is breathing freely again after the operation at New York’s Mount Sinai hospital.
Experts say it is too early to consider the Sein transplant, which Unos said was the first of its kind in the United States, a complete success. Sein must take powerful drugs to prevent organ rejection, but doctors hope to wean in a few years. Less than three months after the operation, 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. “It is a big step forward.”
Sein’s ordeal began in 2014, when doctors put a tube in her throat to help her breathe during a severe asthma attack. It saved his life, but it damaged his windpipe. Several surgeries to reconstruct his trachea did not help. Until now, doctors had few good options for treating serious tracheal damage.
The trachea is much more than just a tube.
“Every breath we take has to be transmitted skillfully from the tip of the nose to the last air pocket in the lungs,” said Merati.
Doctors can remove damaged sections of the trachea or repair or replace them with prostheses, tissue grown in the laboratory, or self-supplied tissue from the skin and cartilage of a patient’s ribs. But these techniques may not restore full organ function, which uses tiny threads to move mucus and has the perfect flexibility to expand and collapse as we breathe, swallow and cough.
When a patient’s entire trachea is damaged, a transplant may be their only hope, said Dr. Eric Genden, a Mount Sinai surgeon who led the team.
“At the moment, we don’t talk much about these patients because there is no option for them,” said Genden. “We hope that this procedure … will help not only patients who are on the verge of disaster, but also patients who are currently considered hopeless.”
In an 18-hour operation, a team of more than 50 specialists transplanted a donor’s trachea, carefully reconnecting it to a complex network of tiny blood vessels.
“When we saw the organ come to life, we knew we had overcome the first hurdle,” said Genden.
Doctors say the procedure can help others with birth defects of the trachea, intractable diseases of the airways or extensive damage to ventilators.
“This could help care for Covid-19 patients,” said Merati. “Without a doubt, we are already seeing some impact” from patients on breathing machines.