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.
Rusch VW. Has Reconstruction of the Central Airways Been Transformed? From Aorta to Trachea. JAMA. 2018;319(21):2177–2178. doi:10.1001/jama.2018.4652
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