Surgeons in the US have performed the third known larynx transplant in the US – and the first known case performed on a patient with active cancer.
Patient Marty Kedian made medical history as part of a clinical trial.
The landmark surgery that took place at Mayo Clinic offers new hope to thousands who have lost their voice and the ability to swallow and breathe on their own due to laryngeal dysfunction or total loss of their larynx.
This procedure, the third known larynx transplant in the U.S. and the first performed on a patient with active cancer marks a significant milestone.
Conducted by a multidisciplinary team of six surgeons, it was led by Dr David Lott, chair of the Department of Otolaryngology (ENT) – Head and Neck Surgery/Audiology at Mayo Clinic in Arizona, and leader of Mayo Clinic's Larynx and Trachea Transplant Program.
Experts emphasised the significance of this operation as a scientifically proven, safe and effective option.
The 21-hour transplant surgery, conducted by a multidisciplinary team, has yielded remarkable results. Four months post-surgery, Marty has regained his voice and his ability to swallow and breathe independently, surpassing the transplant team’s expectations.
In 2013, Marty was having difficulty swallowing, which led to a diagnosis of chondrosarcoma, a rare form of laryngeal cancer.
Despite numerous surgeries over a decade that reduced his voice to a whisper and necessitated a tracheostomy tube for breathing, Marty declined a total laryngectomy, seeking a way to restore his quality of life.
His quest led him to Dr Lott, a laryngeal restoration and transplantation research pioneer.
His Mayo Clinic program received approval in 2016 to conduct the first US clinical trial on laryngeal transplantation.
This trial aims to rigorously investigate the safety and efficacy of laryngeal transplantation, transforming it from an experimental procedure to a viable option for patients.
One of the significant challenges in advancing laryngeal transplantation for cancer patients has been the risk associated with immunosuppressive therapy. Marty's case, already on immunosuppressives due to a prior kidney transplant, allowed the team to perform the transplant without additional risks safely.
Dr Lott explains: ‘Having a patient with active cancer who already has his immune suppression allowed us to do the transplant safely without introducing additional risk in a way that has rarely if ever, been done before.’
The surgical team first removed Marty’s cancerous larynx before proceeding with the transplant. In addition to the larynx, they transplanted the pharynx, upper trachea, upper oesophagus, thyroid and parathyroid glands, blood vessels, and nerves. The procedure was a success.
Marty has regained 60% of his voice four months after the transplant, and further improvement is expected. He can also swallow and breathe independently.
Through regenerative sciences, Dr Lott and his team are also investigating ways a person’s tissue could be used as a natural therapeutic to integrate a donor larynx into the body with less risk of rejection.
Researchers at the Head and Neck Regenerative Medicine Lab are exploring decellularisation, which removes all cells from donor tissues and organs.
The resulting laryngeal organ structure has demonstrated potential in attracting new cells and promoting the tissue growth necessary to integrate the new organ into the body's systems.
You can watch a video about Marty’s journey here.
