There's a first for everything
The most important news in healthcare: Friday, April 9th
Today we’re covering a story that’s rocked the field of transplant surgery — the first ever tracheal transplant.
Today’s Pulse is 800 words, or a 6 minute read.
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MEDICAL FIRSTSNY Woman Receives First Ever Tracheal Transplant
The pulse:
Surgeons at Mount Sinai have successfully transplanted a trachea for the first time in history.
Why would you need a tracheal transplant?
The recipient of the transplant was a 56-year-old woman named Sonia Sein. Six years ago, she suffered from a severe asthma attack that required her to be intubated for a long time. The extended intubation led to damage to her trachea and significant breathing difficulty. She ultimately needed a tracheostomy tube, which requires cutting a hole in the throat to place a new tube down the airway. Tracheostomy tubes can have a significant impact on quality of life, including making simple tasks such as swallowing and talking difficult. Understandably, Ms. Sein grew sick of her tracheostomy. She began looking into other options and discovered that researchers and surgeons at Mount Sinai were developing a plan for tracheal transplant, a first of its kind procedure.
We transplant other organs, so why is the trachea such a big deal?
One of the most important parts of any transplant surgery is ensuring the transplanted organ has a strong blood supply in the recipient. When a kidney is transplanted for example, surgeons take a few of the donor’s blood vessels with it to ensure they can reconnect the kidney to its blood supply in the recipient.
Unlike a kidney, the trachea has more than just a few blood vessels supplying it with nutrients. The trachea relies on a complicated network of micro-vessels. Reconnecting so many tiny vessels would be nearly impossible, so for a long time many people felt a synthetic tracheal construct was the only realistic solution. One of these people was Italian surgeon Paolo Macchiarini, who claimed in 2008 to have successfully transplanted a synthetic lab-grown trachea using the patient’s own stem cells.
A sinister “solution”
Dr. Macchiarini, a thoracic surgeon, was once considered a leader in the field of regenerative medicine. His team worked on both biological scaffolds (using tracheas from cadavers) as well as synthetic scaffolds that had been built in a lab. He claimed that by covering these scaffolds with stem cells harvested from the intended recipient, the trachea would have a better chance of successfully implanting. Stem cells are special cells that have the ability to develop into many different types of cells, including (theoretically) many of the cells found in the human trachea. Many scientists hailed his novel concept, and patients from all over the world flocked to benefit from his procedure.
Secretly, however, the operations were an alarming failure. Most of the 17 patients he operated on died shortly after. Dr. Macchiarini was accused of fabricating data and failing to conduct appropriate risk-benefit analyses prior to his operations. The disgraced surgeon was quickly shunned and his methods abandoned.
Dr. Eric Genden and his team in surgery during the tracheal transplant.
So if stem cells don’t work, what does?
Dr. Eric Genden, the Chair of Otolaryngology and Head and Neck Surgery at Mount Sinai, had been studying the possibility of tracheal transplant even before Dr. Macchiarini’s failed attempts. After studying blood flow to the trachea in both animals and humans, he wondered if some of the arteries that pass through the thyroid gland could be sufficient to supply the trachea. If so, a tracheal transplant could rely on re-connecting just a few blood vessels rather than requiring a reconstruction of a complex web of many small vessels.
The surgery:
In mid-January of this year, Dr. Genden felt ready to try this method on his first patient. Sonia Sein was eager to be that patient. The 18-hour surgery involved removing the trachea from the donor and connecting new veins and arteries to establish blood supply. Now, over two months later, Ms. Sein is doing well. She says:
The first thing I'm going to do when it gets a little warmer is take a walk on the beach. I haven't done it in six years. So, I'm going to walk down the beach and just feel the sand through my toes.
Bottom line it for me:
Once thought to be impossible, surgeons at Mount Sinai have pioneered the first ever successful tracheal transplant.
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