What Mount Sinai’s Trachea Transplant Success Means for Patients in Need

A team of Mount Sinai surgeons in New York City earlier this year performed the world’s first human tracheal transplant surgery, the health system announced this week. News of the procedure’s success already has other patients taking note.

To date, surgeons have been unable to transplant the trachea — an organ essential for speaking, breathing, and normal lung function — because of the complexity of providing blood flow to the allograft, Mount Sinai said in announcing the procedure.

Patients with significant tracheal damage have had no option for treatment. However, the Jan. 13 procedure — the result of 30 years of research on how to provide blood flow to the trachea and understand the biology of the organ — has provided new hope.

The trachea transplant recipient is a 56-year-old woman from New York City, a social worker, who had severe tracheal damage due to repeated intubation after an asthma attack, and several failed attempts to reconstruct her trachea led to further damage, Mount Sinai said.

She breathed through a tracheostomy — a surgically created hole in her neck — and was at high risk of suffocation and death. Now, one of the things she reportedly enjoys most is being able to dance with her grandchildren.

The 18-hour procedure was led by surgeon-scientist Eric Genden, MD, professor and chair of otolaryngology–head and neck surgery for Mount Sinai Health System and professor of neurosurgery and immunology at the Icahn School of Medicine at Mount Sinai. The surgery involved more than 50 specialists, the health system said.

With the success of the inaugural procedure, Mount Sinai has launched a Tracheal Transplant Program for treating patients worldwide.

Sander Florman, MD, professor of surgery and director of the Recanati/Miller Transplantation Institute at Mount Sinai, told MedPage Today that Genden has already received at least a half dozen inquiries from other individuals who believe they may be candidates for the procedure.

Physicians who treat patients with tracheal damage can usually name one or two for whom all options for reconstruction have been exhausted, Florman noted. “This isn’t the first-line treatment for someone with a problem in their trachea.”

But reconstruction to fix very large defects isn’t always successful. There may be hundreds or even thousands of patients in need of another option. They may be individuals with direct trauma to their neck from car accidents or gunshot wounds, or who have endured prolonged intubations, Florman explained. The latter may be especially relevant as a result of the pandemic.

The procedure itself was revolutionary in terms of revascularization, Mount Sinai said. Surgeons connected the small blood vessels that supply the donor trachea with the recipient’s blood vessels, and then used a portion of the esophagus and thyroid gland to help provide blood supply to the trachea.

Following the procedure, the patient’s tracheostomy was no longer needed and she was able to breathe through her mouth for the first time in 6 years, Mount Sinai said.

As is typical with pioneering transplants, insurance didn’t cover the woman’s procedure, Florman said. Mount Sinai is absorbing the cost. The procedure itself is expensive, he noted, though he declined to provide a total dollar amount.

“We’re doing this because it’s the right thing for patients and is going to advance the field,” he said.

Mount Sinai worked with the organ procurement organization LiveOnNY to arrange the trachea donation.

Amy Friedman, MD, chief medical officer at LiveOnNY, told MedPage Today that the successful tracheal transplant surgery is “game-changing for patients in need.”