Transplantation of the human trachea remains an unsolved technical problem because the trachea lacks of a well-defined blood supply. Although a number of experimental approaches have been studied to solve this problem,22 only a few attempts to transplant the trachea in humans have been reported. In 1979, Rose et al. reported a heterotopic implantation by wrapping the trachea in the sternocleidomastoid muscle.23 Three weeks later, orthotopic implantation was performed, accompanied by a vascularized muscular section from the sternocleidomastoid. After 9 weeks, and without immunosuppression protocol, no signs of rejection or ischemia were apparent. However, no further information on the long-term results is available.
Levashov and colleagues reported the second case of human tracheal transplantation in 1993.24 A 24-year-old woman with idiopathic fibrosing mediastinitis affecting the thoracic segment of the trachea received an allograft replacement of the distal trachea wrapped with omentum. Although the patient was on cyclosporine A immunosuppression, early rejection after 10 days was treated by increasing the dose of immunosuppression. The functional outcome after 2 months of transplantation was good. However, progressive stenosis eventually required permanent stenting of the trachea.
In 2004, Klepetko et al. reported heterotopic tracheal transplantation with omentum wrapping in the abdomen.25 A 57-year-old patient with chronic obstructive pulmonary disease and low-segment tracheal stenosis was accepted for lung transplantation and 2-stage tracheal allotransplantation. During lung transplantation, the trachea was wrapped with omentum in the abdomen. Triple immunosuppressive therapy was started with intravenous cyclosporine A, MMF, and corticosteroids, and was maintained orally thereafter. Eight months after lung transplantation, 5 cm of tracheal segment was excised, and the defect was closed with no need for tracheal allograft transplantation. Therefore, the tracheal allograft was harvested and investigated completely. Hematoxylin-eosin staining revealed vital cartilage covered by respiratory epithelium. The tracheal wall was highly vascularized, indicating allograft viability without signs of rejection.
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