Professor Martin Birchall on the landmark larynx transplant
28 January 2011
Professor Martin Birchall (UCL Ear Institute) was scientific advisor and UK member of the surgical team that performed a rare larynx (voicebox) transplant on a US patient, attracting worldwide attention. Here, he explains the significance of the operation and the issues surrounding this kind of transplant.
To view images of the transplant team and patient, click on the gallery below. Select 'show info' to view captions
"The world’s first larynx transplant was performed in 1998 by Marshall Strome and his team at the Cleveland Clinic, Ohio.
This operation is different because it is much bigger – the larynx, trachea and thyroid gland have all been transplanted. It is also unique because we have repaired the nerves so the muscles in the larynx will move again.
We won’t know for six months if that nerve repair has been fully successful, but today the vocal cords are already moving impressively and her voice is more or less normal.
The nerve repair in particular will be a major breakthrough if all goes well and allow us to take out the tracheostomy – a hole in the windpipe allowing the patient to breathe in case of blockage – something that’s not been possible for the 1998 patient.
We’ve been amazed by how well Brenda has recovered, speaking 13 days after the surgery for the first time in 11 years, and now speaking fluidly with a practically normal voice. This is incredibly moving to hear and her voice and swallowing continue to improve.
This will never be a very common operation. It is an enormous undertaking and will be exceptional in that respect.
However, there is a pool of patients who need it. The Royal College of Surgeons of England will soon release a report about laryngeal transplantation, examining under what circumstances it would be appropriate to operate on the first UK patients.
We hope to set-up a European centre here at UCL and The Royal Free Hospital for laryngeal transplantation with colleagues who are doing great work on face transplantation also.
Organ transplants have been a key part of healthcare for decades, saving hundreds of thousands of lives in the UK.
But they have major drawbacks: depending on
a pool of potential donors and requiring a lifetime of immunosuppressant drugs.
We want to avoid this in the long run, which is why we’ve started to explore
stem cell technologies to make custom-made alternatives.
We’re not at the point yet where we can construct organs from stem cells which actually move – which would be necessary in the case of the larynx.
However, we were able in 2008 and 2010 to provide patients with the world’s first organ transplants grown from stem cells, providing new windpipes for these patients.
So, we know that stem cell based technology can provide an alternative to transplantation, albeit to start with just in the realms of a non-moving organs.
We’re inching towards a position where in 10-20 years time hopefully we won’t need to use laryngeal transplants, as we’ll be able to build bespoke organs in the lab.
However, that’s some time away and for now laryngeal transplantation offers a major viable alternative for these rare patients with irreversible damage to the larynx and trachea."
This piece was first published on the Daily Telegraph website. Link.