Laryngotracheal transplantation: Evolution and experience

Historically, the field of transplantation has been focused on the restoration of organ functions necessary for survival, such as those of heart, kidney, or liver. However, in recent years, there has been a shift in the approach of vascular composite allografts (VCA) where transplants are performed not just to save a life, but to improve a recipient's quality of life. Laryngotracheal, hand, face, and uterine transplantations are examples of VCA transplantation. While the first larynx transplant was performed in 1998, advances in transplantation of the larynx and trachea have progressed at a slower pace than solid organ transplantation as there are viable alternatives to bypass organ function for patients with irreparable disease at these sites. For example, a nonfunctional larynx can generally be treated with total laryngectomy. Tracheal stenosis can be treated with multiple forms of tracheal reconstruction or bypassed with a tracheostomy. However, the quality of life of individuals with total laryngectomy or persistent tracheostomy can be devastating, and functional replacement of these organ systems can revolutionize airway reconstruction and patient outcomes. The future of laryngotracheal transplantation relies on advancing functional outcomes and reducing requirements for extensive immunosuppressive regimens. As regenerative approaches advance this will further improve outcomes and possibilities for functional replacement.