P116. RECONSTRUCTION OF LONG TRACHEA DEFECTS BY TRACHEA ALLO-TRANSPLANTATION WITH CESSATION OF IMMUNOSUPPRESSION. LEARNING CURVE AFTER 10 CASES

Abstract

PURPOSE: The trachea is an enigmatic organ due to its complex morphology and definitive treatment of defects are challenging. Reconstructive options largely depend on the remaining structural cartilaginous support around the defect.For short tracheal defects, we moved from a 2-stage cartilage-prelaminated radial forearm flap, towards a 1-stage mucosa-laminated flap to restore the hollow mucosa-lined lumen. Alternatives are medial condylar flaps, or cartilage-loaded fascia flaps.For long airway defects there are no authentic autologous donor tissues available to restore the mucosa-lined elastic cartilaginous framework consistantly. When autologous options are not stable over time, the most promising approach for difficult-to-repair long airway defects is tracheal allotransplantation. METHODS: We treated 10 patients with long trachea defects, using a compatible donor allogenic trachea that was banked for prefabrication into the forearm of the recipient. We developed a strategy that creates a chimera of allogenic and autologous tissues which results in ‘tolerance’ of the vascularized trachea tube and allows for tapering and withdrawal of immunosuppressive therapy. RESULTS: Today all patients are alive. Further treatments may consist of laser removal of intraluminal scar tissue, bronchoscopy for broncho-lavage and stents. We report the outcomes and determining treatment factors of these 10 patients and define the hurdle stones and opportunities. CONCLUSION: Restoration of a long-segment circumferential tracheal defect remains an unmet challenge. Future reports on this subject should be required to provide thoroughly documented visual evidence of outcomes to reduce confusion surrounding tracheal replacement and to prevent future scandals like those seen previously in the tracheal regeneration story.