Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft

Klepetko, Walter; Marta, Gabriel; Wisser, Wilfried; Melis, Enrico; Kocher, Alfred; Seebacher, Gernot; Aigner, Clemens; Mazhar, Samy

doi:10.1016/j.jtcvs.2003.07.050

Cited by 70 publications

(58 citation statements)

References 19 publications

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“…31 Klepetko et al already applied human tracheal allograft with omentum wrapping to patients and reported preservation of functional and structural integrity of a human trachea. 32 These authors showed that allogeneic tissue-engineered cartilage implants, synthesized in vitro, lead to repair of tracheal defects in rabbits. A low level of inflammatory cells was detected in a minority of defect sites that were treated with cartilage grafts.…”

Section: Discussionmentioning

confidence: 99%

Tissue‐engineered allograft tracheal cartilage using fibrin/hyaluronan composite gel and its in vivo implantation

et al. 2009

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Objectives/Hypothesis: Treatment and management of tracheal defects remain challenging in head and neck surgery. Various reconstruction techniques have been used, with no consensus on the best approach. The purpose of this study was to explore a novel strategy to fabricate tissue-engineered trachea by using fibrin/hyaluronic acid (HA) composite gel and evaluate the feasibility of creating tracheal cartilage.Study Design: A preliminary animal experiment.Methods: Chondrocytes from rabbit cartilage were expanded and seeded into a culture dish at high density to form mechanically stable allograft tracheal cartilage using fibrin/HA composite gel. After a longitudinal cervical skin incision, the trachea was exposed and a rectangular defect (1 Â 0.5 cm) was created on the cervical trachea by scalpel on six rabbits. Tissue-engineered cartilage using fibrin/HA composite was trimmed and fixed to defect boundaries with Tissucol (Baxter International, Deerfield, IL). Postoperatively, the site was evaluated endoscopically, histologically, radiologically, and functionally.Results: Postoperatively, rigid telescopic examination showed that the implanted scaffolds in all cases were completely covered with regenerated mucosa without granulation or stenosis. Histologic data showed ciliated epithelium regenerated at the operated site from 2 months postoperatively. Ciliary beat frequency of ciliated epithelium on implants was very similar to normal respiratory mucosa. Computed tomography images revealed fine luminal contour of the regenerated site. However, allograft cartilage implanted was found to be partially preserved on the postoperative specimen.Conclusions: The tracheal luminal contour and functional epithelial regeneration without graft rejection and inflammation were observed after repair of a tracheal resection using allogeneic implants with chondrocytes cultured with fibrin/HA.

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Section: Discussionmentioning

confidence: 99%

Tissue‐engineered allograft tracheal cartilage using fibrin/hyaluronan composite gel and its in vivo implantation

et al. 2009

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“…Klepetko et al reported preserved viability of a heterotopically revascularized allograft by wrapping it in the omentum of a patient who received a lung transplant from the same donor. Its viability was documented after 60 days (Klepetko et al, 2004).…”

Section: Reconstruction Of Long-segment Stenosis Of the Tracheamentioning

confidence: 99%

Head and Neck Reconstructive Surgery

Vranckx¹,

Delaere²

2012

Selected Topics in Plastic Reconstructive Surgery

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“…Clinical and experimental studies have suggested that tracheal allograft is a curative option for treating long-segment tracheal defects. [4][5][6] However, the tracheal allograft lacks an identifiable vascular pedicle that would allow direct vascular anastomosis to the blood vessels in the recipient's neck. Therefore, the safe restoration of the blood supply of the graft is a key factor to achieve successful outcomes of tracheal anastomoses.…”

Section: Introductionmentioning

confidence: 99%

“…8 In addition, a 57-year-old patient who had lowsegment tracheal stenosis was alive at 31 months and achieved stage 0 bronchiolitis obliterans syndrome after a 1-stage tracheal reconstruction with the use of human trachea wrapped in the greater omentum. 4 Therefore, we decided to reconstruct a long-segment tracheal defect > 5 cm with 2-stage surgery. The allograft was revascularized by heterotopic wrapping in the recipient's greater omentum.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Objectives: Human tracheal allotransplant is an option for treating long-segment tracheal defects, but no reliable and satisfactory tracheal transplant procedure has been developed. The purpose of this study is to review the results of 2-stage tracheal reconstruction in human tracheal allotransplant for tracheal defects > 5 cm with the use of greater omentum for revascularization. Materials and Methods: There were 3 patients who had tracheal allograft. In stage 1, a segment of donor trachea (6 cm) was excised and wrapped in the recipient greater omentum. In stage 2, at 3 to 5 weeks after stage 1, the tracheal allograft and omental pedicle were orthotopically transplanted to the cervical part of the trachea. All patients received immunosuppression with tacrolimus, mycophenolate mofetil, and methylprednisolone. Fiberoptic bronchoscopy was performed monthly during the 6 months after stage 2. Results: In all 3 patients, no major postoperative complication was observed. Transverse section of the donor trachea showed a mechanically stable chondral framework. Histologic sections stained with hematoxylin-eosin showed complete cartilage rings covered by intact respiratory epithelium. Conclusions: A 2-stage procedure for human tracheal transplant with greater omentum is a safe and effective technique for tracheal reconstruction.

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Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft

Abstract: The patient is alive 31 months posttransplantation and remains in bronchiolitis obliterans syndrome stage 0. Human trachea wrapped in omentum maintains its functional and structural integrity and may be used for 2-stage allotransplantation.

Cited by 70 publications

References 19 publications

Tissue‐engineered allograft tracheal cartilage using fibrin/hyaluronan composite gel and its in vivo implantation

Tissue‐engineered allograft tracheal cartilage using fibrin/hyaluronan composite gel and its in vivo implantation

Head and Neck Reconstructive Surgery

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