Surgeons have performed the world’s first human windpipe transplant on a woman with severe damage to her trachea, according to an announcement from Mount Sinai Hospital in New York.
The 18-hour procedure took place back in January 2021. With the patient now undergoing recovery, the team has announced the operation as “the first successful tracheal transplant,” noting the breakthrough could hold promise for people with a range of conditions – from tracheal birth defects and burns even to patients who suffered tracheal damage while being hospitalized for COVID-19.
The recipient of the tracheal transplant was 56-year-old Sonia Sein, a social worker from the Bronx, who suffers from asthma. Following a severe asthma attack several years ago, she had to undergo repeated intubation, whereby doctors insert a tube through her mouth into her airways, causing severe damage to her trachea. Several failed surgical attempts to reconstruct her trachea then led to even further damage. This left her breathing through a surgically created hole in her neck, known as a tracheostomy, which put her at an extremely high risk of suffocation and death.
Speaking to NPR, Sein explains that she came aware of researchers at Mount Sinai working on a Tracheal Transplant Program. She approached the hospital for several years regarding her condition, but doctors were not yet ready to carry out the risky operation on a human just yet. Then, last year, surgeon-scientist Dr Eric Genden – Chair of Otolaryngology-Head and Neck Surgery for Mount Sinai Health System and Professor of Neurosurgery, and Immunology, at the Icahn School of Medicine – decided it was time to give it a shot.
The trachea is simply a cartilaginous tube that transports air to and from the lungs, but the operation is anything but straightforward. One of the biggest hurdles for the procedure has been knowing how to get blood to the donor trachea during and after the operation. To overcome this, the surgeons used a novel approach where they linked large blood vessels in the recipient's esophagus and thyroid gland to the donor trachea, providing vital blood flow.
By the surgeons’ accounts, the technique worked just as planned, and the trachea was successfully transplanted into the recipient.
"Eighteen hours later, it was clear we had accomplished what many said could not be done. Ultimately, everything went smoothly because we assembled a strong team with extensive surgical expertise in organ transplantation and tracheal reconstruction. Seeing the graft come alive and knowing that the organ was well vascularized was an amazing experience. Knowing that this procedure and 30 years of research will save countless lives was indescribable. It is why we do what we do, to make a difference," Dr Genden said in a statement.
The surgery allowed Sein to have her tracheostomy removed, breathing through her mouth again for the first time in six years.
Meanwhile, Genden and the team hope their work will pave the way towards more tracheal transplants from people with birth defects, untreatable airway diseases, burns, and tumors. The transplant could even hold some promise for patients who have been hospitalized for COVID-19 and sustained tracheal damage from intubation.
"It is particularly timely given the growing number of patients with extensive tracheal issues due to COVID-19 intubation. Because of both mechanical ventilation and the nature of the COVID-19-induced airway disease, tracheal airway disease is precipitously increasing, and now we have a treatment," adds Dr Genden.