Home » In Rome, the world’s first trachea transplant on a post Covid patient

In Rome, the world’s first trachea transplant on a post Covid patient

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A few days after the first tracheal transplant in the world carried out on a 56-year-old woman at Mount Sinai hospital in New York, the news of another record arrives from Italy: the execution of a transplant for the first time in our country trachea performed with an innovative technique and the first in the world on a patient who fell ill with Covid. It was performed last March 2 in Rome, at the Thoracic Surgery of theSant’Andrea University Hospital, university polyclinic of the Sapienza network, on Giuseppe S. who, at the age of 50, risked losing his life first due to the Coronavirus and then due to complications due to invasive ventilation techniques that became necessary during the illness.

First trachea transplant in the world in New York


It was the team of Sapienza-Sant’Andrea who saved it, and in particular Cecilia Menna who, at the age of 35, performed this extraordinary operation that lasted more than four hours, restoring the patient’s breath and therefore life. TO Salute the thoracic surgeon, head of the “Tracheal Replacement” program of Sant’Andrea and mother of two children, tells the whole story, what the technique used consists of and how now Giuseppe is back on his bicycle, managing to pedal for 25 kilometers without breathing problems.

Young and sportsman in intensive care

Giuseppe S., a native of a small town near Catania, fell ill with Covid despite his age and lifestyle. He is 50 years old and a cyclist in excellent health, but one day, last November, he felt ill with the classic Covid symptoms: a general malaise, breathing difficulties and fever. After he passed out at work, he was taken to hospital in Catania where he had to be hospitalized in intensive care. There he spent a long time intubated. Then, as the practice dictates, if the patient does not improve in a few days, we move on to tracheostomy, that is, prolonged ventilatory assistance.

La tracheostomia

It is a technique that is carried out when the patient must be assisted for breathing: “A hole is made on the tracheal surface at the end of the neck to which a tube connected to a ventilator is attached – explains the surgeon Menna – it is a technique standard that guarantees the patient the right ventilation and therefore survival but can induce damage to the trachea. Generally, the damage is limited and can be treated with a surgical reconstruction or with endoscopic techniques ”. Unfortunately, however, in this case, the patient had suffered a very extensive damage to the trachea: “A complete destruction, both because of the disease and as a consequence of the ventilation technique used, essential to keep him alive”.

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In recent months, doctors have found themselves faced with numerous patients with the same problem even if with less extensive damage for which it was possible to intervene with the standard surgical technique, that is resection and surgical reconstruction of the trachea. “Surely in the coming months and years we will see an increase in these cases precisely because Covid involves damage to the trachea and airways and the use of artificial ventilation techniques has been more widespread, so it is easy for the trachea to suffer obstructive damage for large portions. The technique we used for this patient is indicated when the entire trachea is involved because until now there were no alternatives “.

What is the trachea for

The trachea is a unique and irreplaceable organ that starts from the vocal cords and reaches the lungs: “It is about 12 cm long and has several functions, the most important is to pass air from the mouth to the lungs and therefore allow both breathing and phonation ”, explains Menna. Its immune function is also fundamental: “The trachea is lined internally by an epithelium which, through brushes, cleanses all the bacteria we breathe”. In short, it is a fundamental organ for life. That’s why when it gets damaged it’s trouble.

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And this is exactly what happened to Giuseppe S. who, even after recovering from Covid, had to deal with very heavy damage: “He had multiple obstructions that no longer let air pass along the entire extension of the trachea, from the vocal cords to the lungs with extremely inflamed tissues close to the organ ”, says the surgeon. Which means that even when he tested negative for the swab, Giuseppe was still unable to breathe and speak due to this closure. At first, the doctors of the Catania hospital tried to treat the patient but in this case the traditional surgery, i.e. the resection of 5-6 cm of the trachea, was not useful because the patient had a diseased 10 cm stretch. . For this, they turned to Sant’Andrea which is a national reference center for these pathologies.

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Longform

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It was then that the doctors in Rome decided to resort to the complete replacement of the trachea by performing the so-called ‘tracheal replacement’, a program that involves the replacement of the entire trachea. The news comes just days after the world‘s first trachea transplant. Are there any similarities? “In reality none – clarifies Menna – the trachea has always been considered very difficult to transplant due to the complexity of the blood vessels that run through it, but in the United States they performed their own technique by taking the trachea from the donor’s corpse and reconstructing it in the recipient. We, on the other hand, have performed another technique already adopted, but only in a few cases, which concern very small tracts of the trachea ”.

How the intervention took place

The innovativeness of this Italian transplant lies in the fact that the medical team replaced the entire trachea with another type of tissue, completely reconstructing it. The medical staff of the thoracic surgery of Sant’Andrea, directed by Erino Rendina, turned to the Treviso tissue bank and identified a cryopreserved thoracic aorta donated by a corpse. “Our technique – explains Menna – is extremely innovative because it was a long segment: we had to reconstruct the entire trachea, we covered and fed it with tissue taken from the abdomen and we made it more rigid by introducing the inside the aorta is cryopreserved a silicone cylinder to give the rigidity that characterizes the ‘tube’ of the trachea to allow the air to pass “.

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It is the first time in Italy that this technique is used for transplantation and it is the first time in the world on a post Covid patient. The operation, which lasted 4 hours and 40 minutes with 5 operators, was conducted with sophisticated anesthesia techniques, which made it possible not to resort to extracorporeal circulation. The diseased trachea was removed in its entirety and subsequently the delicate phase of reconstruction began.

The awakening of Joseph

The patient, immediately awakened and immediately able to breathe and speak independently, did not need hospitalization in intensive care or a tracheostomy and was transferred directly to the thoracic surgery ward where he resumed speaking and eating normally. His post-operative course was regular and three weeks after the operation, he was discharged. “It was not even necessary to administer immunosuppressive therapy, as is the case for other cadaveric organ transplants – explains the surgeon – therapy that serves to keep the recipient’s immune system at bay to avoid the risk of rejection but can cause problems because the patient is not defended. In our surgery, immunosuppressive therapy is not needed thanks to the very low immunogenicity of the implanted aortic tissue “.

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Back on the bike

One month after the reconstruction of the trachea, Giuseppe returned to his bicycle: “Just yesterday – says Menna happily – he sent me a whatsapp with a photo on his bicycle telling me that he had traveled 25 kilometers without experiencing any respiratory problems. Of course we continue to monitor it remotely. The goal is to remove in two years the silicone cylinder that he has inside his via area and which must remain there so that the implanted aortic segment transforms and becomes rigid as a real trachea must be ”. Now Joseph enjoys his freedom, he breathes deeply. In connection from Catania, today Giuseppe said in a strong, clear but excited voice: “I’m fine, I breathe much better, I speak without problems and I eat too much. I’m back on my bicycle and I live again. Thank you all”.

Center for Tracheal Surgery

The reconstruction surgery of the trachea was presented today in the great hall of Sapienza by the medical staff of the thoracic surgery of Sapienza-Sant’Andrea hospital-university company, the largest Italian reference center for tracheal surgery and one of the major European centers. In 2020, 1323 interventions were carried out, despite the greater organizational complexity due to the Covid emergency. The rector of Sapienza attended the presentation, among others Antonella Polimeni, the Councilor for Health of the Lazio Region Alessio D’Amato, the general manager of the Sant’Andrea University Hospital Adriano Marcolongo, the dean of the Faculty of Medicine and Psychology Fabio Lucidi, who shared the brilliant result, explaining the complexity of the organizational machine set in motion to complete the transplant.

“This success is a source of satisfaction for our entire community and represents further confirmation of the excellent clinical results of the medical and scientific research produced by the University, at the service of the health of the community”, says the rector Antonella Polimeni. “The fact that this operation sees a young surgeon at the forefront is a strong sign of how female skills can be established in professional fields such as surgery, traditionally almost the exclusive prerogative of men.”

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