Larynx and trachea transplant

Overview

A larynx and trachea transplant is a procedure that replaces a damaged voice box (larynx) and windpipe (trachea) with a new one. Your larynx enables you to speak, breathe, and eat. Your trachea connects your larynx to your lungs.

This procedure is complex, but it may restore your ability to breathe and allow you to live a more active life.

Why it's done

When you have a damaged larynx or trachea, and other ways of treating it have not worked, you may need a trachea transplant.

Some of the reasons to have a trachea transplant include:

• Scarring of the larynx or trachea
• Severe injury and damage to your larynx or trachea
• Narrowing of your trachea since birth
• Growths in your larynx or trachea

Trachea transplant may be an option if these treatments have not helped you:

• An opening in your neck (tracheostomy)
• Previous surgery on your larynx or trachea
• A tube (stent) placed to open your trachea more

Risks

Risks can occur during or after your transplant. Some problems could happen right after your surgery, and some could happen later.

Risks are:

• Bleeding. Your care team will watch you carefully for blood loss.

• Rejection of the new trachea. After a transplant, your immune system sees that something foreign is inside you and attacks it.

  You will get medication to reduce the chance that your body rejects your new trachea. You may have side effects such as high blood sugar, kidney problems, swelling, infections, nausea and other conditions. If this happens, you will be treated right away.

• Infection. Infection can happen after any surgery and when you take anti-rejection medication. If you develop signs of an infection, such as chills, a high fever, fatigue that is new or body aches, call your care provider right away.

  It is also important to reduce your chances of getting an infection. Stay away from crowds and sick people, wash your hands frequently, and stay up to date on your vaccinations. Also, take safe care of your teeth, and do not share utensils with others.

How you prepare

If you are preparing for a larynx or trachea transplant, you have been on a long journey.

Taking the first steps

When you and your doctor have decided on a transplant, you will have to choose a transplant center. Doctors at this center will perform an exam to see if you are eligible for a transplant. Your care team will look at your health history and all your prior tests. The team will go over the benefits and risks of the transplant with you.

When you choose a center, look at how much experience the center has. Each center should have statistics that you can check and compare to other centers.

Ask if the transplant center provides other services you will need such as support groups, travel assistance and long-term follow-up.

What you can expect

During your transplant

You will be asleep during the transplant and will be given medication, so you do not feel pain. The surgeon will remove your damaged trachea and sew the new one in its place.

This procedure takes several hours, but you will not be aware of the time passing.

After your transplant

When you wake up, you will have tubes in place in your body to help your recovery. You will have oxygen, intravenous (IV) fluid, a breathing tube and a tube to drain your urine. You will receive medicine for pain.

You will move from the operating room to the intensive care unit (ICU) so you can be closely watched.

As time goes by, your team will remove the tubes and move you to a regular hospital bed.

The amount of time you spend in the hospital varies from person to person but is usually a few weeks.

When you leave the hospital, you will need close follow-up care by the transplant team. Since you will be on anti-rejection medication, you should follow directions carefully. You should also follow diet and exercise guidance from your care team.

Results

A larynx or tracheal transplant can improve your quality of life.

This procedure can restore functions that improve your health and comfort.

You will receive a follow-up appointment and the transplant team will help you with other resources such as support groups, exercise programs and speech therapy if needed. You may also receive help with meal planning and instruction about your medications.

What if your new transplant fails?

Not all transplants work. This surgery is challenging, but new techniques and results offer promise. If you have problems with your transplant, your health care provider will tell you what options you have.