Nov. 09, 2024
Six surgeons and 20 support staff members completed the first larynx transplant at Mayo Clinic in an extraordinary 21-hour operation. It is only the third larynx transplant to be performed in the U.S. The surgery also marks a medical milestone as the first known total larynx transplant performed as part of a clinical trial in a patient with active cancer in the U.S.
The 59-year-old patient had a chondrosarcoma in his larynx. After 14 previous surgeries, he chose to participate in the clinical trial instead of having a laryngectomy. The goal of the transplant was to improve his ability to talk, swallow and breathe, which would greatly impact his quality of life.
The procedure was a composite neck transplant, also called a vascular composite allograft procedure. It included at least eight types of tissue, including tissue from the:
- Larynx.
- Upper trachea.
- Upper esophagus.
- Pharynx.
- Thyroid glands.
- Parathyroid glands.
- Nerves and blood vessels.
The Larynx and Trachea Transplant Program at Mayo Clinic in Arizona is led by David G. Lott, M.D., surgical director, and Girish K. Mour, M.B.B.S., medical director.
Methods
The larynx is challenging to transplant because it involves many tissue types and must be able to move after transplantation.
"All transplants are complex, but there are more tissue types and moving parts with laryngeal transplantation than with other transplants," says Dr. Lott.
The large number of tissue types also makes it challenging to identify the right postsurgery immunosuppressant drugs. To prepare, the team conducted research.
"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," says Dr. Lott.
While immunosuppression can increase the risk of cancer spreading, the patient was already on immunosuppressives because of a previous kidney transplant.
"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," says Dr. Mour.
Clinical trial to study larynx transplant
The surgery was part of a new clinical trial. The Laryngeal Allograft Transplantation study is researching the safety and efficacy of larynx transplants. Evidence collected during the study could support the first-ever clinical service line in laryngeal transplantation.
"Because this surgery is so rare, there are a lot of unknowns. We will continue our study of laryngeal transplantation in the patient's follow-up care to determine how well the new organ has restored his ability to talk, breathe and eat," says Dr. Lott. "Besides assessing the quality-of-life issues, we want to study how well the transplanted tissues are functioning over time."
Four months after surgery, the patient had regained his ability to swallow. He had also regained 60% of his voice, with continued improvement expected over time. Dr. Lott said his progress is remarkable.
Currently, the clinical trial supports patients whose voice boxes have been severely damaged by cancer or traumatic injury. The team hopes that research gathered in the trial will improve the surgery and make it possible for more patients, including those who have already had a laryngectomy.
A team-based approach
The larynx transplant team uses a multidisciplinary approach that helps preserve and restore throat function for patients. The team works together to coordinate and customize care. Team members involved in larynx transplant include:
- Surgical director, who is a laryngeal surgeon.
- Medical director, who is a transplant doctor.
- Transplant coordinator/operations manager.
- Head and neck reconstructive surgeon.
- Quality and compliance coordinator.
- Administrator.
- Research coordinator.
- Research scientist.
- Statistician.
The team also includes allied health professionals in:
- Dietetics.
- Nursing.
- Pharmacy.
- Psychology.
- Social work.
- Speech-language pathology.
After transplant, patients are often seen in the Swallowing Clinic, where board-certified speech-language pathologists help with speaking and swallowing.
For more information
Refer a patient to Mayo Clinic.