Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft.
OBJECTIVE
Transplantation of a human trachea has been reported only twice in the literature with limited documentation of the functional and structural properties of the allograft.


METHODS
A 57-year-old patient with chronic obstructive pulmonary disease with low segment tracheal stenosis was accepted for lung transplantation and 2-stage tracheal allotransplantation. Standard bilateral sequential lung transplantation was performed with the transfer of the donor trachea into the recipient's abdomen, which was wrapped in the greater omentum and sutured into the abdominal wall, similar to a stoma. The patient received immunosuppression consisting of cyclosporine A, mycophenolate mofetil, and cortisone. Sixty days later, the tracheal allograft presented with macroscopically normal appearance with maintained elasticity and rigidity. The patient underwent a cricotracheal resection 6 months after lung transplantation. However, reconstruction with direct end-to-end anastomosis was achievable. The tracheal allograft, therefore not needed for reconstruction, was harvested and underwent complete investigations.


RESULTS
Cross-section of the graft revealed a mechanically stable and macroscopically intact trachea. Hematoxylin-eosin staining demonstrated vital cartilage covered by respiratory epithelium. Angiography, followed by corrosion studies and electromicroscopy, demonstrated excellent vascularization of the tracheal wall.


CONCLUSIONS
The patient is alive 31 months posttransplantation and remains in bronchiolitis obliterans syndrome stage 0. Human trachea wrapped in omentum maintains its functional and structural integrity and may be used for 2-stage allotransplantation.
Department of Cardiothoracic Surgery, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. walter.klepetko@akh-wien.ac.at
Walter
W
Klepetko
Gabriel Mihai
GM
Marta
Wilfried
W
Wisser
Enrico
E
Melis
Alfred
A
Kocher
Gernot
G
Seebacher
Clemens
C
Aigner
Samy
S
Mazhar
D034861:Abdominal Wall / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D009852:Omentum / Q000601:surgery*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000601:surgery; D014132:Trachea / Q000098:blood supply / Q000637:transplantation*; D014135:Tracheal Stenosis / Q000150:complications / Q000601:surgery; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic