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Two-piece cryopreserved tracheal allotransplantation: an experimental study

Gaziantep University, Medical School, Thoracic Surgery Department, Gaziantep, Turkey

Received 19 December 2008; received in revised form 20 April 2009; accepted 27 April 2009.

^_* Corresponding author. Address: Gaziantep Üniversitesi, Tp Fakültesi, Göüs Cerrahisi AD, 27310 ehitkamil, Gaziantep, Turkey. Tel.: +90 5325438897; fax: +90 3423606729. (Email: sanli{at}gantep.edu.tr).

Objectives: For successful reconstruction with tracheal allotransplants following long tracheal resections, problems related to the preservation and vascularisation of the tracheal graft have to be solved. In this study, instead of using a long-segment single-piece graft, we used a graft that has been split into two. The aim was to use this graft after cryopreservation in order to ease neo-vascularisation and to maintain tracheal integrity by transplanting it to two separate regions of the dog cervical trachea. Methods: This experimental study was conducted in animal laboratories of the medical school on 11 half-blood dogs. The trachea obtained from the first dog was 8 cm in length; it was split into two pieces of 4 cm each and stored in the preservation solution at –80 °C for 4 weeks. Following this, the dog was sacrificed. Two 2 cm portions of cervical trachea were excised from the second dog. These parts were then reconstructed with two tracheal grafts of the same length as the cryopreserved ones. Ten dogs that were grouped into five groups of two dogs each underwent the same procedure. The subjects had a bronchoscopic evaluation on the third postoperative week. Anastomosis regions of the test tracheas were resected to be examined histopathologically. Results: Seven subjects were found to have third-degree obstructions during bronchoscopy; two had close to fourth-degree obstructions. In the histopathological examination, contrary to the findings of the bronchoscopies, 75% of the anastomoses had intact epithelium. The cartilage was seen to have well-preserved structural characteristics in all the anastomoses. Twelve anastomoses had moderate, seven mild and one had severe inflammation. All anastomoses had either good or very good level of vascularisation. Conclusions: The integrity of the tracheal epithelium can be maintained with cryopreservation and split anastomosis technique. The cartilage preserves its structural characteristics despite losing its viability, thereby offering an advantage to maintain airway patency.

Key Words: Trachea • Allotransplantation • Cryopreservation • Anastomosis