Just 13 days after receiving a pioneering larynx transplant, a Californian woman was able to speak her first words in a decade. Her own larynx was permanently damaged by an operation 11 years ago.
The first combined larynx and thyroid transplant was performed in 1998, but in the latest operation Brenda Charett Jensen of Modesto, California, received a section of trachea too. The feat, which took 18 hours, was performed last October at the Medical Center of the University of California, Davis, but announced only yesterday.
The transplant also works far better than the first because more of the donated organs鈥� nerves have been plugged into the 52-year-old woman鈥檚 own nervous system. This enables her to move muscles that control speaking by moving the vocal cords, and others that will eventually allow her to swallow again, once she relearns how to do it.
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鈥淚t is a miracle,鈥� says Jensen. 鈥淚鈥檓 talking, talking, talking, which just amazes my family and friends.鈥� The sound of her voice is her own, rather than that of the donor.
Her own voice again
Jensen lost her speech 11 years ago through complications during surgery that blocked her airway. The blockage stopped her larynx working, so for years she has communicated with a handheld voice synthesiser. That operation also left her breathing dependent on a tracheotomy 鈥� a tube inserted into her windpipe. With the new trachea, the hope is that she should also be able to breathe normally and dispense with the tracheotomy.
One of the reasons that Jensen was chosen was that she was already on immunosuppressive drugs because of a previous kidney-pancreas transplant, reducing the risk of organ rejection.
Led by surgeon , the team transplanted the larynx, thyroid and trachea of a woman who died in an accident . The thyroid has to be transplanted too, because it supplies blood to the larynx.
Farwell and his colleagues plumbed numerous blood vessels from the donated organs into Jensen鈥檚 own, and also reconnected five major nerves to maximise her control over the muscle tissue that came with the transplant.
鈥淭he first larynx transplant only reconnected three nerves,鈥� says of University College London, who served as chief scientific adviser to the team, specialising in reconnection of the nerves. 鈥淗ere, we鈥檝e done five nerves with the intention of restoring much more laryngeal function than the original, and eventually getting rid of the tracheotomy.鈥�
Rapid progress
Birchall said that although the man who received the original larynx transplant at the Cleveland Research Clinic in Ohio in 1998 is doing well and has recovered some speech, he still has a tracheotomy. His vocal cords have never moved, whereas Jensen鈥檚 were moving in just a fortnight. 鈥淲e鈥檝e already seen much quicker progress in speech,鈥� says Birchall.
The breakthrough is the latest to exploit rapid improvements in microsurgical techniques since the first face transplant in 2005. The increasingly ambitious use of more complex transplants including muscles, nerves and bones has also highlighted the greater functionality that this allows the recipient.
Birchall believes that recipients will benefit even more if their own stem cells are extracted and used to coat donated organs chemically stripped of all donor cells. Because all that鈥檚 then left of the donated organ is a 鈥渟caffold鈥� of the protein collagen, it can be covered with the recipient鈥檚 own cells and transplanted into their body with no fear of rejection.
In 2008, Birchall was part of a team that demonstrated this can be done by performing the world鈥檚 first trachea transplant.
Complex challenge
Birchall told New 杏吧原创 that such an approach would be possible with the larynx, but unlike the trachea 鈥� which is simply a tube 鈥� a recoated larynx would also have to include artificially constructed muscles and blood vessels because of its much more complex function.
鈥淚t鈥檚 much more complex than the trachea, but we do have ways to address these things,鈥� says Birchall. 鈥淩egenerative medicine using stem cells is now moving at a furious pace, and the airways and plumbing systems are at the forefront,鈥� he says.
