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J Thorac Cardiovasc Surg 2004;127:862-867
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft

^a Department of Cardiothoracic Surgery, University Hospital of Vienna, Vienna, Austria
^b Department of Thoracic Surgery, University of Rome "La Sapienza," Rome, Italy

Received for publication March 11, 2003; revisions received March 31, 2003; revisions received May 5, 2003; accepted for publication July 7, 2003.

^* Address for reprints: Walter Klepetko, MD, University Hospital of Vienna, Department of Cardio-Thoracic Surgery, Waehringer Guertel 18-20, 1090 Vienna , Austria
walter.klepetko{at}akh-wien.ac.at

OBJECTIVES: 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.

PATIENTS AND 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.

CONCLUSION: 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.