Claudia Paul / Mount Sinai Health System
A medical team in New York City said it performed the first complete tracheal transplant.
The trachea is the tube that carries air in and out of the lungs, so you might think it’s easy to transplant. But not so In fact, bronchial transplantation was one of the last great challenges in this field of medicine.
A 56-year-old from the Bronx, New York, named Sonia Sein, is the recipient. She ended up in hospital six years ago after a particularly nasty asthma attack. To help with breathing, she said doctors inserted a tube down her neck.
“I had a ventilator too long that it damaged my trachea,” she said, “so I had a post-operative operation to try and fix it.”
Those surgeries failed. Doctors eventually cut a hole in her neck and inserted a trachea tube, but Sein, a former social worker who now lives with her daughter and grandchildren, is fed up with the tubes. She thinks there has to be a better way to live.
“I was researching bronchial transplants because I thought they had a transplant for something else there should be something for the bronchi,” she said. She found that researchers at Mount Sinai Hospital in New York City were working on that idea.
She said she calls them every day. “And I kept calling back until someone called me back and made an appointment,” she said. “I thought they were bored of me calling!”
That was about four years ago. At the time, the surgeon at Mount Sinai was not ready to try this surgery on humans, Sein said she was very frustrated about the tracheostomy tubes she thought was examining at the hospice and having them removed, which would give her life. She ended
But she continued, and late last year, she was contacted by Dr. Eric Genden, a surgeon at Mount Sinai and a researcher at the Icahn School of Medicine, says he’s finally ready to give it a try.
The operation has long been a disappointment.
Claudia Paul / Mount Sinai Health System
Although it was fairly straightforward, at first sight it looked like a pipe. It turns out to be a very complex organ system, ”says Genden. For one thing, inside the trachea, there are tiny hairlike fibers called cilia, which bounce together and help sweep particles out of the lungs.
But the greatest challenge with transplantation is delivering blood to the trachea. For decades, doctors have thought that blood transfusions were supported by a network of small blood vessels that would never be able to reconnect with surgery, Genden said, based on research published in the middle of the decade. 1960 by influential scientists at Harvard.
“This belief stuck, and if you look at the literature, you’ll see hundreds of articles at the start. ‘This is how we rebuild the trachea because we can’t have a transplant,’ ‘Genden said.
Synthetic tubing is not a long-term solution.
Some surgeons have temporarily implanted trachea into people’s arms and let them develop new vascular networks before moving them to the throat. Another surgeon replaced the trachea with the aorta. (The aorta of the donor)
In 2008, Italian surgeon Paolo Macchiarini gained worldwide attention when he claimed to have transplanted the trachea he had grown from stem cells in the lab and attached to a synthetic skeleton.
As it shakes over the entire field, Genden sees the future of bronchial transplantation. “For all intents and purposes, we turned off fundamental science because the data coming out of the stem cell lab is very impressive,” he said.
But most of Macchiarini’s patients have died and he has come under fire for misconduct in the research. His efforts were halted, so Genden continued his research.
What forced him to move forward was that he realized that field semen research papers on complex blood supply to the trachea were unusual.
It turns out that some of the arteries passing through the thyroid gland supply blood to the trachea too. Therefore, some veins that connect the esophagus should be done.
“This is not a discovery that we have made, it is an ever-recorded discovery dating back to the 1800s,” Genden said. He validated it by studying blood flow in both animals and humans.
He realized that a few veins about the diameter of a spaghetti could supply enough blood to the trachea.
In mid-January, he was finally ready to try the technique alone, and Sonia Sein became a pioneer. It was an 18-hour surgery that included several hours of surgery to remove the trachea from the donor, followed by several hours of surgery to connect multiple veins and arteries to create the blood supply for new organs.
“As you’ve researched, you never know this will work until you see the blood flowing into that organ,” Genden said. “And behold, it comes to life.”
Sein was able to tolerate the transplanted organ well, Genden said, and now her own cells are growing internally, replacing the donor cilia by herself.
“It’s the holy grail of what we’ve all been,” said Genden.
“It’s a good trend, I think it’s really exciting,” said Dr. G. Alexander “Alex” Patterson, a surgeon at Washington University in St. Louis and a former consultant to Genden Patterson. It will take more than a few months to know if the operation is completely successful.
And at this stage, he doesn’t think a tracheal transplant becomes a routine.
“I don’t think it’s a viable option for patients with bronchial tumors,” he said.
Cancer is the most common cause for bronchial repair. But transplant patients need treatment with drugs that suppress the immune system to prevent organ rejection and are at risk in cancer patients.
Patterson said surgery could be challenging in newborns with bronchial defects because the blood vessels that support the bronchi are smaller than in adults.
But someone like Sonia Sein with a damaged trachea is a good choice. She looks forward to being free from the restrictions she lives when she breathes through the tubes on her neck. She also has a small hole in her throat that doctors use to thread the thread to examine her windpipe. No longer needed But she’s used to breathing like that so much, she says she’s not ready to get stitches.
“The first thing I do when the weather gets a little warmer is to take a walk on the beach,” she said. “I haven’t done it in six years. I’m going to walk along the beach and feel the sand on my toes.”
You can contact NPR Science Correspondent Richard Harris at firstname.lastname@example.org.