A team at Mayo Clinic in Arizona has achieved a significant milestone by performing its first larynx transplant. The 21-hour operation, involving six surgeons and 20 support staff members, represents only the third larynx transplant ever conducted in the U.S. Notably, this is the first total larynx transplant performed as part of a clinical trial on a patient with active cancer in the country.
The recipient was a 59-year-old patient diagnosed with chondrosarcoma in his larynx. Following 14 prior surgeries, the patient opted to participate in the clinical trial as an alternative to a laryngectomy. The primary objective of the transplant was to improve his ability to speak, swallow, and breathe, thereby significantly enhancing his quality of life.
The procedure, a composite neck transplant (vascular composite allograft), encompassed the transplantation of at least eight different tissue types. These included tissues from the larynx, upper trachea, upper esophagus, pharynx, thyroid glands, parathyroid glands, nerves, and blood vessels.
Complexities of Larynx Transplantation
Dr. David G. Lott, surgical director of the Larynx and Trachea Transplant Program at Mayo Clinic in Arizona, emphasized the complexities of this type of transplant. "All transplants are complex, but there are more tissue types and moving parts with laryngeal transplantation than with other transplants," he stated. The intricate nature of the larynx, involving numerous tissue types and the requirement for post-transplant mobility, presents unique challenges.
Identifying the appropriate post-surgery immunosuppressant drugs is also challenging due to the multitude of tissue types involved. Preclinical research was conducted to determine the optimal medication regimen. According to Dr. Lott, "Preclinical models helped us learn which medications could regulate the immune responses of the various different donor tissues with fewest potential side effects and still be powerful enough to prevent rejection."
Clinical Trial and Patient Progress
The surgery was conducted as part of the Laryngeal Allograft Transplantation study, a clinical trial designed to assess the safety and efficacy of larynx transplants. This study aims to gather evidence that could support the establishment of the first clinical service line dedicated to laryngeal transplantation.
Dr. Girish K. Mour, medical director, noted the unique circumstances that allowed for the transplant in a patient with active cancer. "Having a patient with an active cancer who already has his own immune suppression allowed us to do the transplant safely without introducing additional risk in a way that has rarely, if ever, been done before," said Dr. Mour.
Four months post-surgery, the patient has shown remarkable progress, regaining his ability to swallow and recovering 60% of his voice. Continued improvement is anticipated over time. Dr. Lott described the patient's progress as "remarkable."
The clinical trial currently focuses on patients whose voice boxes have been severely damaged by cancer or traumatic injury. The team hopes that the research findings from this trial will refine the surgical technique and broaden its applicability to a wider range of patients, including those who have already undergone a laryngectomy.
Multidisciplinary Approach
The larynx transplant team employs a multidisciplinary approach to preserve and restore throat function. This team includes surgical and medical directors, transplant coordinators, reconstructive surgeons, research scientists, and allied health professionals specializing in dietetics, nursing, pharmacy, psychology, social work, and speech-language pathology.
