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June 5, 2018

Has Reconstruction of the Central Airways Been Transformed?From Aorta to Trachea

Author Affiliations
  • 1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA. 2018;319(21):2177-2178. doi:10.1001/jama.2018.4652

In this issue of JAMA, Martinod and colleagues1 report the results of a prospective, single-institution safety and feasibility trial of airway transplantation to reconstruct long-segment defects of the trachea and central bronchi. Over 6.5 years, 13 of 20 patients with end-stage tracheal lesions or proximal lung tumors requiring a pneumonectomy were enrolled in the study and underwent airway reconstruction with cryopreserved aortic allografts following definitive resection. Custom-made stents to support the allografts were used initially to prevent airway collapse but were removed at a postoperative mean duration of 18 months. A single patient undergoing carinal transplantation died postoperatively. With a median follow-up of nearly 4 years, 76.9% (10 of 13) of patients were alive and 80% (8 of 10) were breathing normally. Histological and molecular analysis of follow-up endobronchial biopsies showed regeneration of respiratory epithelium and de novo generation of cartilage within the aortic allografts from recipient cells.