PHOENIX, Ariz. — On Feb. 29, Mayo Clinic marked a milestone: its first larynx transplant.
It is only the third transplant of its kind in the United States and the first done on a patient with cancer. A team of six surgeons performed the 21-hour surgery in Phoenix. After removing the patient's larynx — also known as the voice box — and the remaining cancer, the team transplanted a donor larynx, pharynx, the upper parts of the trachea and esophagus, thyroid, parathyroid glands, blood vessels and nerves into his throat.
"This is an exciting time because it helps us to bridge that gap between dysfunction of that larynx and restoring its ability to work once again," said Dr. David Lott, a member of the Mayo Clinic Larynx and Trachea Transplant Program team. The patient, Marty Kedian, had been diagnosed with a rare type of laryngeal cancer in 2013.
Over a decade, Kedian underwent several surgeries to treat his cancer and eventually had a tracheostomy tube placed in his neck so that he could breathe. Ultimately, Kedian could not swallow normally or talk. Faced with laryngectomy, the removal of the larynx, as the next course of action, Kedian said he wanted an alternative.
The Massachusetts man and his wife, Gina Kedian, found Lott, who is also the chair of Mayo Clinic Arizona's Department of Otolaryngology-Head and Neck Surgery/Audiology. "The larynx is responsible for our ability to breathe, to let air get into our lungs," Lott said. "It's also responsible for our ability to swallow, to get food and drink into our stomach and helps prevent that same food and liquid from going into our lungs.
And, in addition, it helps create a voice, helps us express ourselves, so it's an incredibly important organ that, really, nobody ever thinks about." A concern for performing a larynx transplant on a patient with active cancer, Lott said, was that the medication needed to prevent the body from rejecting the transplant could, by suppressing the body's immune system, cause the cancer the spread. Kedian, however, was already on immunosuppressive drugs because he had a kidney transplant earlier in life.
"We were not adding risk to his case by adding more immunosuppression," Lott said. "He was already on immunosuppression, and we didn't need to really add anything for the long term." Speaking at a press conference on Tuesday, with his voice still on the path to recovery, Kedian thanked the surgical team and said that he will keep talking to spread awareness about larynx transplant.
"It couldn't get rid of my Boston accent, so I'm stuck with it, I guess, forever," Kedian joked. Kedian is also now able to eat regular food. The transplant was part of a clinical trial, which Lott said could provide more knowledge so that more larynx transplants can be performed in the future.
"Done under the rigor and oversight of a clinical trial, it's really allowed us to take that next step toward understanding the safety for these cancer patients," Lott said, "and hopefully, in the future, having this become a treatment option for those many patients." Lott said the intent is for future larynx transplants to occur at Mayo Clinic in Rochester and at its Florida campus. "This is something that we would like to see enterprise-wide, throughout Mayo Clinic," Lott said.
"The goal for this transplant is to make it become available worldwide. So, we started off to make sure things were safe and focused in one area, with then plans to expand enterprise-wide.".
