Mayo Clinic announced a breakthrough in organ transplantation, offering hope to thousands of people who have lost the ability to speak, swallow or breathe on their own due to the weakened or lost function of their larynx. A multidisciplinary team of doctors in Arizona has performed the third total larynx transplant in the United States. The case also marks a medical milestone as it is the first total larynx transplant performed as part of a clinical trial and the first total larynx transplant in the United States on a patient with active cancer.
“The surgery and the patient’s recovery exceeded our expectations. This is an exciting achievement that paves the way for the future of laryngeal transplantation.”
David Lott, MD, chief of the Department of Otolaryngology (ENT)-Head and Neck Surgery/Audiology at Mayo Clinic, Arizona
Dr. Lott’s paper on the case was published in the peer-reviewed medical journal Proceedings of the Mayo Clinic on July 9. The larynx is located at the back of the throat and is commonly known as the laryngeal apparatus. Laryngeal transplantation is a rare and complex surgery that has only been performed a few times worldwide. More notably, the Mayo Clinic surgical team was the first in the world to successfully perform a laryngeal transplant on a patient with active cancer.
Six surgeons from Mayo Clinic performed the 21-hour transplant operation, which involved the larynx, pharynx, upper trachea, upper esophagus, thyroid and parathyroid glands, blood vessels and nerves.
The transplant was performed by Marty Kedian, a Massachusetts resident. Kedian was diagnosed with a rare form of laryngeal cancer called chondrosarcoma. Over the course of 10 years, Kedian underwent dozens of surgeries, eventually losing his voice and the ability to swallow and breathe. A few years ago, Kedian had to undergo a tracheotomy, which allowed him to breathe through a hole in his neck. Kedian says the tracheotomy and loss of his voice significantly reduced his quality of life. “I was alive, but I wasn’t living,” he said. “I loved talking to people everywhere I went, and now I can’t do that anymore. I felt weird, and I couldn’t go anywhere.”
After years of surgery, doctors told Kedian his only option was to undergo a laryngectomy and completely remove his larynx. He refused. “I didn’t want to have a laryngectomy. I wanted to find a way to get my quality of life back,” he said.
Kedian found what he was looking for in the Mayo Clinic’s Larynx and Trachea Transplant Program, where Dr. Lott was leading the first laryngeal transplant clinical trial in the United States. After being accepted as a patient for the clinical trial, Kedian and his wife, Gina, moved into a temporary home in Phoenix. On February 29, Kedian became the first patient to receive a total laryngeal transplant at Mayo Clinic. “I wanted this transplant so I could talk and breathe normally with my newborn granddaughter and read her bedtime stories in my own voice,” Kedian said.
Because the Mayo case was part of a clinical trial, it’s seen as an important step toward making this rare procedure available to a wider range of people. “Until now, laryngeal transplants have been performed on a one-off basis,” says Dr. Lott. “This clinical trial allows us to conduct a true scientific investigation aimed at thoroughly investigating whether laryngeal transplants are a reliable option for patients.” The program is approved to perform additional laryngeal transplants over the next few years.
The American Cancer Society estimates that 12,650 new cases of laryngeal cancer will occur in the United States this year. Until now, many of these patients had little hope for future laryngeal transplant options due to the risks associated with the use of immunosuppressive therapy. Transplant patients undergo immunosuppressive therapy to lower the body’s immune response and reduce the risk of organ rejection. However, immunosuppressants also increase the risk of cancer metastasis.
Kedian’s case was unique; he had already had a kidney transplant and was on immunosuppressive therapy. “By working with a patient with active cancer who was already immunosuppressed, we were able to perform the transplant safely and without any additional risk, in a way that has never been done before,” says Girish Moule, MBBS, medical director of the program. Dr. Lott adds, “Being able to perform this transplant with the rigor and oversight of a clinical trial in the setting of active cancer in a patient already on immunosuppressive therapy allows us to better understand safety and take an important step towards making laryngeal transplantation a standard option for cancer patients.”
Removing the cancer was the surgical team’s main priority. “Firstly, we removed Kedian’s larynx, which was affected by cancer,” explains Dr. Lott. “After that, the team was confident that the cancer was gone and could then focus on the transplant.”
Four months after the surgery, Kedian is speaking, swallowing and breathing with a new voice, which Dr. Lott calls a great thing. “Kedian has already regained about 60% of his voice, which we didn’t think would be restored for at least a year. He speaks with the same voice and Boston accent he had before the cancer,” Dr. Lott says. “He can eat burgers, mac and cheese, pretty much anything, and he has no trouble swallowing. His breathing is steadily improving.” Doctors plan to remove Kedian’s tracheotomy tube once he is able to breathe completely on his own.
“The team at Mayo gave me my life back,” Khedian said. “I’m so grateful. I’m so grateful to Dr. Lott’s team, and especially to the generosity of my organ donors and their families. I hope one day I’ll be able to say ‘thank you.'”
“This case represents a breakthrough. It represents the future of laryngeal transplantation, where all patients who require a total laryngectomy will have a reconstructive surgery option that preserves their quality of life,” said Marshall Strom, MD, who made medical history in 1998 by performing the world’s first successful total laryngeal transplant. “With clinical trials underway, Dr. Lott and his team are positioned to advance the field in ways that other programs cannot currently achieve. The Mayo team has discovered the Holy Grail in the management of laryngeal cancer, and we believe it will be a reality by the end of this decade.”
Dr. Lott calls Kedian’s case the culmination of 20 years of research. In addition to clinical trials, Dr. Lott’s research team is studying ways to restore laryngeal function through improved transplant techniques and pioneering regenerative medicine techniques. “I decided to become a laryngeal surgeon and researcher, and built a program that would push the boundaries of science,” Dr. Lott says. “Our mission is to find reliable options to serve the thousands of patients suffering from laryngeal dysfunction and preserve their health and quality of life. That’s the purpose of this clinical trial.”
Kedian will return to Massachusetts next week, where she looks forward to reuniting with family and friends and reading her granddaughter bedtime stories. Kedian also plans to share her story and be a voice of hope for others. “Thanks to Mayo and Dr. Lott, I was able to get my quality of life back,” Kedian says. “My job now is to recover. My next job is to show others that it can be done too.”
