Successfull one-step transplantation of the thoracic part of the trachea in a patient with idiopathic fibrosing mediastinitis and a marked fracheal stenosis

Abstract

One-step tracheal allotransplantation followed by omentopexy of the transplant and anastomotic lines was performed in a 24-year old patient suffering form idiopatic fibrotic mediastinitis and decompensated stenosis of the thoracic part of the trachea. Graft rejection reactions observed postoperatively were curbed by high doses of antithymocitic globulin and methylprednisolone. Associated viral-bacterial infection was suppressed by acyclovir and tienam. Two months after the operation, the-transplant remained viable, its lumen making about 10 mm.

The authors make a conclusion postulating the possibility of a successfull allotransplantation of trachea, namely, its major fragment (10 rings), being obviously antigenic and immunogenic. The effectiveness of such operations depends largely on an adequate matching of a donor and a recipient, provided the ischemic period of the donor’s trachea is minimal and theigreater omentum graft’s root is used for its revascularization. Careful monitoring of the patient for the first signs of rejection reaction and application of modem immunosuppressants is also important.