Tracheal allotransplantation after withdrawal of immunosuppressive therapy

N Engl J Med. 2010 Jan 14;362(2):138-45. doi: 10.1056/NEJMoa0810653.


Reconstruction of long-segment tracheal defects requires a vascularized allograft. We report successful tracheal allotransplantation after indirect revascularization of the graft in a heterotopic position. Immunosuppressive therapy was administered before the operation, and the tracheal allograft was wrapped in the recipient's forearm fascia. Once revascularization was achieved, the mucosal lining was replaced progressively with buccal mucosa from the recipient. At 4 months, the tracheal chimera was fully lined with mucosa, which consisted of respiratory epithelium from the donor and buccal mucosa from the recipient. After withdrawal of immunosuppressive therapy, the tracheal allograft was moved to its correct anatomical position with an intact blood supply. No treatment-limiting adverse effects occurred.

Publication types

  • Case Reports

MeSH terms

  • Female
  • Forearm
  • Humans
  • Immune Tolerance
  • Immunosuppression
  • Immunosuppressive Agents
  • Middle Aged
  • Mouth Mucosa / transplantation
  • Neovascularization, Physiologic
  • Tissue and Organ Harvesting / methods*
  • Trachea / blood supply
  • Trachea / transplantation*
  • Tracheal Diseases / surgery
  • Transplantation Chimera
  • Transplantation Immunology*
  • Transplantation, Heterotopic
  • Transplantation, Homologous
  • Transplants*


  • Immunosuppressive Agents