Bottom Line: An early study suggests it may be feasible to use human aortic grafts preserved by freezing to rebuild windpipe and airway sections removed because of disease.
Why The Research Is Interesting: Airway replacement could potentially benefit many patients with lung cancer and be an option for patients with end-stage tracheobronchial disease.
Who and When: 20 patients with lung tumors or tracheal lesions, of which 13 patients had diseased airway sections removed and underwent airway transplantation (5 tracheal, 7 bronchial and 1 carinal, which is where the trachea divides into the bronchi of the lungs); study conducted from October 2009 through February 2017, with final patient follow-up in November 2017
What (Study Measures): Airway transplantation using a cryopreserved aortic graft and custom-made stent inserted into the graft to keep the airway from collapsing but was later removed (exposure); 90-day morality (primary outcome)
How (Study Design): This was a cohort study where people were followed over time.
Authors: Emmanuel Martinod, M.D., Ph.D., Assistance Publique-Hopitaux de Paris, Bobigny, France, and coauthors
Results:
- Overall 90-day mortality among initial 20 patients was 5% because one patient who underwent carinal transplantation died
- No deaths after 90 days among patients who underwent tracheal or bronchial reconstruction
- 10 of 13 patients who underwent transplantation alive after nearly four years
- 8 of 10 breathing normally through newly formed airways after stent removal
- New generation of cartilage was observed in transplanted areas
Study Limitations: Limited number of patients in this feasibility study at a single center without a comparison group; larger studies needed to further assess effectiveness and safety
Study Conclusions: This study demonstrated the feasibility for complex tracheal and bronchial reconstruction.
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(doi:10.1001/jama.2018.4653)
Editor’s Note: This study is being published to coincide with its presentation at the American Thoracic Society International Conference. Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.