First US trachea transplant offers hope to Covid patients with windpipe damage

Surgeons in New York City have performed the first windpipe transplant in the US, giving a woman who suffered severe asthma a new trachea, the tube that transports air from the mouth to the lungs.

Doctors say such operations could help Covid-19 patients left with serious windpipe damage from breathing machines.

“We’ve talked for 100 years about just putting in a new windpipe,” said Dr Albert Merati, a surgeon at the University of Washington who had no role in the recent transplant. But hooking up a trachea from a donor to a recipient’s blood supply is challenging and would only be considered as a last resort, experts say.

“It is just technically extremely difficult,” said Dr David Klassen, chief medical officer for the United Network for Organ Sharing, or Unos, which oversees the US transplant system. “It’s been a very difficult thing to crack.”

The patient, 56-year-old social worker Sonia Sein, said she had spent six years “trying to catch every breath at every moment” after treatment for severe asthma damaged her windpipe. She is breathing freely again after the operation at New York’s Mount Sinai hospital.

Experts say it’s too soon to deem Sein’s transplant, which Unos said is the first of its kind in the US, a total success. Sein must take powerful drugs to prevent organ rejection but doctors hope to wean her off in a few years. Less than three months after the operation, there have been no complications or signs of rejection.

“If it was going to be a failure, we would know by now. It’s quite promising,” said Dr Alec Patterson, a transplant surgeon at Washington University in St Louis who was not involved in the operation. “It’s a major step forward.”

Sein’s ordeal started in 2014 when doctors put a tube in her throat to help her breathe during a severe asthma attack. It saved her life but damaged her trachea. Several surgeries to reconstruct her windpipe didn’t help. Until now, doctors have had few good options to treat serious trachea damage.

The windpipe is much more than a simple tube.

“Every breath we take has to be expertly conveyed from the tip of the nose to the last air sac in the lungs,” Merati said.

Doctors can remove damaged sections of windpipe or fix or replace them with prosthetics, lab-grown tissue or self-supplied tissue from a patient’s skin and rib cartilage. But these techniques may not restore full function to the organ, which uses tiny hairs to move mucus around and has the perfect flexibility to expand and collapse as we breathe, swallow and cough.

Where a patient’s entire windpipe is damaged a transplant could be their only hope, said Dr Eric Genden, a Mount Sinai surgeon who led the team.

“Right now, we don’t talk much about those patients because there is no option for them,” Genden said. “We’re hoping that this procedure will … help not only the patients that are teetering on disaster, but also the patients that are currently kind of deemed hopeless.”

In an 18-hour operation, a team of more than 50 specialists transplanted a donor trachea, carefully reconnecting it to a complex web of tiny blood vessels.

“When we saw the organ come to life, we knew we had jumped the first hurdle,” Genden said.

Doctors say the procedure could help others with tracheal birth defects, untreatable airway diseases or extensive damage from ventilators.

“This could help care for Covid-19 patients,” Merati said. “Without a doubt we are already seeing some impact” from patients being on breathing machines.

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