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Cui P, Zhao D, Liang L, Liu P, Li S. De-Epithelialized Viable Tracheal Allotransplantation Without Immunosuppressants: 5-Year Follow-Up. Ann Otol Rhinol Laryngol 2024; 133:384-389. [PMID: 38197389 DOI: 10.1177/00034894231221900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Tracheal transplantation could be a better option for patients with long segmental laryngotracheal stenosis or defects, but the need for immunosuppressants limits its widespread use due to the antigenicity of the tracheal epithelium. Chemically treated or cryopreserved nonviable tracheal allografts have no immunogenicity but lead to necrosis and stenosis in long-term outcomes. The present report describes the 5-year outcomes of de-epithelialized viable tracheal allotransplantation without immunosuppressants in a patient with severe laryngotracheal stenosis. METHODS The recipient was a 47-year-old female with relapsing polychondritis affecting the larynx and cervical trachea and producing a 5 cm long stenosis that could not be repaired using resection and anastomosis. A tracheal allograft was obtained from a 45-year-old male donor and treated with a combination of 3% sodium dodecyl sulfate (SDS) and organ preservation solution for 138 hours. The allograft was revascularized by heterotopical implantation in the infrahyoid muscles of the recipient for 3 months and then transplantation to the laryngotracheal defect with a split-thickness skin graft sutured to the lumen and a silicon T-tube. No immunosuppressants were used postoperatively. RESULTS The allograft was de-epithelialized, and most of the cartilage rings remained viable after the treatment. The allograft was revascularized, viable, and mechanically stable after 3 months of heterotopic implantation. No apparent signs of rejection or destruction were observed. The T-tube was removed, and the internal lining of the allograft was repopulated 4 months after orthotopic transplantation, despite the skin graft necrotizing at 2 weeks. Endoscopy and computed tomography showed a patent airway 5 years after orthotopic transplantation. The patient was able to resume her usual quality of life. CONCLUSION The present study demonstrates that transplantation of the de-epithelialized viable tracheal allograft without immunosuppressants is safe and promising for patients with long laryngotracheal stenosis or defects, especially for those with malignant tumor resections.
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Affiliation(s)
- Pengcheng Cui
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Daqing Zhao
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Leping Liang
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Pengfei Liu
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shuqin Li
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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Taniguchi D, Kamata S, Rostami S, Tuin S, Marin-Araujo A, Guthrie K, Petersen T, Waddell TK, Karoubi G, Keshavjee S, Haykal S. Evaluation of a decellularized bronchial patch transplant in a porcine model. Sci Rep 2023; 13:21773. [PMID: 38066170 PMCID: PMC10709302 DOI: 10.1038/s41598-023-48643-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
Biological scaffolds for airway reconstruction are an important clinical need and have been extensively investigated experimentally and clinically, but without uniform success. In this study, we evaluated the use of a decellularized bronchus graft for airway reconstruction. Decellularized left bronchi were procured from decellularized porcine lungs and utilized as grafts for airway patch transplantation. A tracheal window was created and the decellularized bronchus was transplanted into the defect in a porcine model. Animals were euthanized at 7 days, 1 month, and 2 months post-operatively. Histological analysis, immunohistochemistry, scanning electron microscopy, and strength tests were conducted in order to evaluate epithelialization, inflammation, and physical strength of the graft. All pigs recovered from general anesthesia and survived without airway obstruction until the planned euthanasia timepoint. Histological and electron microscopy analyses revealed that the decellularized bronchus graft was well integrated with native tissue and covered by an epithelial layer at 1 month. Immunostaining of the decellularized bronchus graft was positive for CD31 and no difference was observed with immune markers (CD3, CD11b, myeloperoxidase) at two months. Although not significant, tensile strength was decreased after one month, but recovered by two months. Decellularized bronchial grafts show promising results for airway patch reconstruction in a porcine model. Revascularization and re-epithelialization were observed and the immunological reaction was comparable with the autografts. This approach is clinically relevant and could potentially be utilized for future applications for tracheal replacement.
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Affiliation(s)
- Daisuke Taniguchi
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Satoshi Kamata
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
| | - Sara Rostami
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
| | - Stephen Tuin
- United Therapeutics Corp, Research Triangle Park, NC, 27709, USA
| | - Alba Marin-Araujo
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
| | - Kelly Guthrie
- United Therapeutics Corp, Research Triangle Park, NC, 27709, USA
| | - Thomas Petersen
- United Therapeutics Corp, Research Triangle Park, NC, 27709, USA
| | - Thomas K Waddell
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Golnaz Karoubi
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Shaf Keshavjee
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Siba Haykal
- Latner Thoracic Research Laboratories, Division of Thoracic Surgery, Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street suite 8N-869, Toronto, ON, M5G2C4, Canada.
- Division of Plastic & Reconstructive Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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Zeng N, Chen Y, Wu Y, Zang M, Largo RD, Chang EI, Schaverien MV, Yu P, Zhang Q. Pre-epithelialized cryopreserved tracheal allograft for neo-trachea flap engineering. Front Bioeng Biotechnol 2023; 11:1196521. [PMID: 37214293 PMCID: PMC10198577 DOI: 10.3389/fbioe.2023.1196521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Background: Tracheal reconstruction presents a challenge because of the difficulty in maintaining the rigidity of the trachea to ensure an open lumen and in achieving an intact luminal lining that secretes mucus to protect against infection. Methods: On the basis of the finding that tracheal cartilage has immune privilege, researchers recently started subjecting tracheal allografts to "partial decellularization" (in which only the epithelium and its antigenicity are removed), rather than complete decellularization, to maintain the tracheal cartilage as an ideal scaffold for tracheal tissue engineering and reconstruction. In the present study, we combined a bioengineering approach and a cryopreservation technique to fabricate a neo-trachea using pre-epithelialized cryopreserved tracheal allograft (ReCTA). Results: Our findings in rat heterotopic and orthotopic implantation models confirmed that tracheal cartilage has sufficient mechanical properties to bear neck movement and compression; indicated that pre-epithelialization with respiratory epithelial cells can prevent fibrosis obliteration and maintain lumen/airway patency; and showed that a pedicled adipose tissue flap can be easily integrated with a tracheal construct to achieve neovascularization. Conclusion: ReCTA can be pre-epithelialized and pre-vascularized using a 2-stage bioengineering approach and thus provides a promising strategy for tracheal tissue engineering.
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Affiliation(s)
| | | | | | | | | | | | | | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Qixu Zhang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Kato A, Go T, Otsuki Y, Yokota N, Soo CS, Misaki N, Yajima T, Yokomise H. Perpendicular implantation of porcine trachea extracellular matrix for enhanced xenogeneic scaffold surface epithelialization in a canine model. Front Surg 2023; 9:1089403. [PMID: 36713663 PMCID: PMC9877415 DOI: 10.3389/fsurg.2022.1089403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
Objective The availability of clinically applied medical materials in thoracic surgery remains insufficient, especially materials for treating tracheal defects. Herein, the potential of porcine extracellular matrix (P-ECM) as a new airway reconstruction material was explored by xenotransplanting it into a canine trachea. Methods P-ECM was first transplanted into the buttocks of Narc Beagle dogs (n = 3) and its overall immuno-induced effects were evaluated. Subsequently, nine dogs underwent surgery to create a tracheal defect that was 1 × 2 cm. In group A, the P-ECM was implanted parallel to the tracheal axis (n = 3), whereas in group B the P-ECM was implanted perpendicular to the tracheal axis (n = 6). The grafts were periodically observed by bronchoscopy and evaluated postoperatively at 1 and 3 months through macroscopic and microscopic examinations. Immunosuppressants were not administered. Statistical evaluation was performed for Bronchoscopic stenosis rate, graft epithelialization rate, shrinkage rate and ECM live-implantation rate. Results No sign of P-ECM rejection was observed after its implantation in the buttocks. Bronchoscopic findings showed no improvement concerning stenosis in group A until 3 months after surgery; epithelialization of the graft site was not evident, and the ECM site appeared scarred and faded. In contrast, stenosis gradually improved in group B, with continuous epithelium within the host tissues and P-ECM. Histologically, the graft site contracted longitudinally and no epithelialization was observed in group A, whereas full epithelialization was observed on the P-ECM in group B. No sign of cartilage regeneration was confirmed in both groups. No statistically significant differences were found in bronchoscopic stenosis rate, shrinkage rate and ECM live-implantation rate, but graft epithelialization rate showed a statistically significant difference (G-A; sporadic (25%) 3, vs. G-B; full covered (100%) 3; p = 0.047). Conclusions P-ECM can support full re-epithelialization without chondrocyte regeneration, with perpendicular implantation facilitating epithelialization of the ECM. Our results showed that our decellularized tracheal matrix holds clinical potential as a biological xenogeneic material for airway defect repair.
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A Standardised Approach to the Biomechanical Evaluation of Tracheal Grafts. Biomolecules 2021; 11:biom11101461. [PMID: 34680094 PMCID: PMC8533576 DOI: 10.3390/biom11101461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
The ideal tracheal substitute must have biomechanical properties comparable to the native trachea, but currently there is no standardised approach to evaluating these properties. Here we propose a novel method for evaluating and comparing the properties of tracheal substitutes, thus systematising both measurement and data curation. This system was tested by comparing native rabbit tracheas to frozen and decellularised specimens and determining the histological characteristics of those specimens. We performed radial compression tests on the anteroposterior tracheal axis and longitudinal axial tensile tests with the specimens anastomosed to the jaw connected to a measuring system. All calculations and results were adjusted according to tracheal size, always using variables relative to the tracheal dimensions, thus permitting comparison of different sized organs. The biomechanical properties of the decellularised specimens were only slightly reduced compared to controls and significant in regard to the maximum stress withstood in the longitudinal axis (-0.246 MPa CI [-0.248, -0.145] MPa) and the energy stored per volume unit (-0.124 mJ·mm-3 CI [-0.195, -0.055] mJ·mm-3). The proposed method is suitable for the systematic characterisation of the biomechanical properties of different tracheal substitutes, regardless of the size or nature of the substitute, thus allowing for direct comparisons.
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Martínez-Hernández NJ, Díaz-Cuevas A, Milián-Medina L, Sancho-Tello M, Roselló-Ferrando J, Morcillo-Aixelá A, Campo-Cañaveral JL, Roig-Bataller A, Mata-Roig M. Decellularized tracheal prelamination implant: A proposed bilateral double organ technique. Artif Organs 2021; 45:1491-1500. [PMID: 34310703 DOI: 10.1111/aor.14043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 01/08/2023]
Abstract
In tracheal replacement transplantation, prelamination is a critical stage. Nowadays, the most widely used prelamination technique is the prethoracic fascia flap with lateral thoracic artery. We propose a flap based on the internal thoracic artery, which allows a relatively non-aggressive double organ implant, and we have tested its efficacy in decellularized tracheas. Tracheas of albino New Zealand rabbits were decellularized following a protocol that uses detergents and cryogenization, sterilized with 1kGy gamma radiation, and tutorized with a stent. Bilateral pedicled flaps made of pectoral fascia and a muscular component were harvested through a longitudinal 3-cm central thoracic incision, wrapping the tracheas with them in 16 rabbits, remaining them implanted for 2, 4, 8, and 12 weeks. The tracheas were then studied histologically using standard stainings plus immunohistochemistry (CD31). The models were adjusted with Bayesian statistics using ordinal regression; results as odds ratios and credibility intervals. All analysis were performed using R software. Acute inflammatory cell invasion was observed at 2 weeks, which almost disappeared at week 8 after implant. Only macrophages and giant cells increased between Weeks 8 and 12 (OR 10.487, CI [1.603-97.327]). The cartilage maintained its structure, with slight signs of ischemia in a few cases. New CD31-positive vessels were observed from Week 2 and increasing thereafter, reaching a maximum peak at Week 8. We propose a bilateral implant technique that is viable and effective as a prelamination option for two concurrent tracheas, achieving perfect vascularization and integration of the organ with hardly any inflammatory response in the medium or long term.
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Affiliation(s)
| | | | - Lara Milián-Medina
- Pathology Department, Medicine and Odontology Faculty, Universitat de València, València, Spain
| | | | | | | | | | | | - Manuel Mata-Roig
- Pathology Department, Medicine and Odontology Faculty, Universitat de València, València, Spain.,Networking Research Center on Respiratory Diseases (CIBERER), ISCIII, Madrid, Spain
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7
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Cui P, Liu P, Li S, Ma R. De-Epithelialized Heterotopic Tracheal Allografts without Immunosuppressants in Dogs: Long-Term Results for Cartilage Viability and Structural Integrity. Ann Otol Rhinol Laryngol 2020; 130:441-449. [PMID: 32911959 DOI: 10.1177/0003489420957357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstruction of long segmental tracheal defects is difficult because no ideal tracheal substitutes are currently available. Tracheal allotransplantation maintains cartilage and epithelium viability but requires immunosuppression because of epithelial immunogenicity. We aimed to obtain an epithelium-decellularized allograft that maintains cartilage viability and to evaluate long-term outcomes of such allografts implanted on dog backs without immunosuppressants. METHODS Twenty-five tracheas harvested from mongrel dogs were used to explore the period of epithelium decellularization by combined use of 1% sodium dodecyl sulfate and an organ preservation solution and to assess the chondrocyte viability and immunogenicity of the tracheas after decellularization. Sixteen epithelium-decellularized tracheal allografts and 10 fresh tracheal segments (6 cm long) were implanted in 26 beagles for durations of 10 days and 1, 3, 6, and 12 months. Macroscopic and microscopic examinations were used to evaluate the morphology, viability, and immune rejection of the allografts. Safranin-O staining was used to detect glycosaminoglycans. RESULTS The epithelium disappeared after 24 hours of decellularization. At 72 hours, almost no nuclei remained in the mucosa, while the mean survival rate of chondrocytes was 88.1%. Histological analysis demonstrated that the allograft retained intact tracheal rings and viable cartilage after heterotopic implantation for 1 year, with no immunological rejection. There were no significant differences in the glycosaminoglycan contents among the implanted epithelium-decellularized allografts. CONCLUSIONS Epithelium-decellularized tracheal allografts with chondrocyte viability can be achieved by combined use of a detergent and organ preservation solution, which showed satisfactory cartilage viability and structural integrity after long-term heterotopic transplantation. Further studies on orthotopic transplantation are needed to assess the feasibility of allografts in reconstructing long segmental tracheal defects.
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Affiliation(s)
- Pengcheng Cui
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Pengfei Liu
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shuqin Li
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Ruina Ma
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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Murata D, Arai K, Nakayama K. Scaffold-Free Bio-3D Printing Using Spheroids as "Bio-Inks" for Tissue (Re-)Construction and Drug Response Tests. Adv Healthc Mater 2020; 9:e1901831. [PMID: 32378363 DOI: 10.1002/adhm.201901831] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
In recent years, scaffold-free bio-3D printing using cell aggregates (spheroids) as "bio-inks" has attracted increasing attention as a method for 3D cell construction. Bio-3D printing uses a technique called the Kenzan method, wherein spheroids are placed one-by-one in a microneedle array (the "Kenzan") using a bio-3D printer. The bio-3D printer is a machine that was developed to perform bio-3D printing automatically. Recently, it has been reported that cell constructs can be produced by a bio-3D printer using spheroids composed of many types of cells and that this can contribute to tissue (re-)construction. This progress report summarizes the production and effectiveness of various cell constructs prepared using bio-3D printers. It also considers the future issues and prospects of various cell constructs obtained by using this method for further development of scaffold-free 3D cell constructions.
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Affiliation(s)
- Daiki Murata
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Kenichi Arai
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Koichi Nakayama
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
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Boada M, Guzmán R, Sandoval E. Long tracheal replacement or the philosopher's stone. Ann Cardiothorac Surg 2020; 9:58-59. [PMID: 32175243 DOI: 10.21037/acs.2019.11.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marc Boada
- Department of Thoracic Surgery, ICR, Hospital Clínic, Barcelona, Spain
| | - Rudith Guzmán
- Department of Thoracic Surgery, ICR, Hospital Clínic, Barcelona, Spain
| | - Elena Sandoval
- Department of Cardiovascular Surgery, ICCV, Hospital Clínic, Barcelona, Spain
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Lu T, Huang Y, Qiao Y, Zhang Y, Liu Y. Evaluation of changes in cartilage viability in detergent-treated tracheal grafts for immunosuppressant-free allotransplantation in dogs. Eur J Cardiothorac Surg 2019; 53:672-679. [PMID: 28958037 DOI: 10.1093/ejcts/ezx317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/09/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The first tissue-engineered clinical tracheal transplant prepared using the detergent-enzymatic method resulted in graft stenosis, possibly from detergent-enzymatic method-induced graft non-viability. We reported on the transplantation of de-epithelialized tracheal allografts while maintaining cartilage viability in dogs. No lethal stenosis occurred in allografts. Herein, on the basis of previous experimentation, we assessed cartilage viability in detergent-treated cartilages. METHODS Six canine tracheal grafts were treated with detergent [1% t-octylphenoxypolyethoxyethanol (Triton X-100)] before transplantation. The histoarchitecture was evaluated, and the viable chondrocytes ratio was calculated. Glycosaminoglycan was detected using safranin-O staining. Collagen II was tested using immunohistochemistry. RESULTS The epithelium was completely removed in 5 grafts. Compared with fresh tracheas, the viable chondrocyte ratio was significantly reduced in the de-epithelialized grafts (100 vs 54.70 ± 8.56%; P < 0.001). Image analysis revealed that the mean optical density of glycosaminoglycan (0.363 ± 0.027 vs 0.307 ± 0.012; P = 0.007) and collagen II (0.115 ± 0.013 vs 0.092 ± 0.011; P = 0.028) was decreased. The observation period ranged from 91 to 792 days. No stenosis occurred in 5 allografts; moderate stenosis developed in 1 allograft during the 4th week after surgery. The chondrocyte nuclei almost completely disappeared. Both glycosaminoglycan (0.307 ± 0.012 vs 0.164 ± 0.104; P = 0.044) and collagen II (0.092 ± 0.011 vs 0.068 ± 0.022; P = 0.022) were significantly degraded. CONCLUSIONS This study demonstrated successful tracheal transplantation; about 50% of the viable chondrocytes were retained in the cartilage that could prevent development of a lethal stenosis in tracheal grafts.
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Affiliation(s)
- Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yulei Qiao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongxing Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Liu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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11
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Parshin VD, Rusakov MA, Parshin VV, Titov VA, Parshin AV, Starostin AV. [Tracheolaryngeal resection for cicatricle stenosis]. Khirurgiia (Mosk) 2018:41-48. [PMID: 29953099 DOI: 10.17116/hirurgia2018641-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches. MATERIAL AND METHODS For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy. RESULTS In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V A Titov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Starostin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
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De Wolf J, Brieu M, Zawadzki C, Ung A, Kipnis E, Jashari R, Hubert T, Fayoux P, Mariette C, Copin MC, Wurtz A. Successful immunosuppressant-free heterotopic transplantation of tracheal allografts in the pig. Eur J Cardiothorac Surg 2018; 52:248-255. [PMID: 28472471 DOI: 10.1093/ejcts/ezx116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/04/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES It has been demonstrated that both heterotopic and orthotopic transplants of epithelium-denuded cryopreserved tracheal allografts are feasible in immunosuppressant-free rabbits. Validation of these results in large animals is required before considering clinical applications. We evaluated the viability, immune tolerance and strain properties of such tracheal allografts heterotopically transplanted in a pig model. METHODS Ten tracheal segments, 5 short (5 rings) and 5 long (10 rings), were obtained from male Landrace pigs. The tracheal segments were surgically denuded of their epithelium, then cryopreserved and stored in a tissue bank for 33 to 232 days. After thawing, tracheal segments stented with a silicone tube were wrapped in the omentum in 2 groups of 5 female recipients. The animals did not receive any immunosuppressive drugs. The animals were euthanized from Day 6 to Day 90 in both groups. RESULTS An effective revascularization of allografts regardless of length was observed. Lymphocyte infiltrate was shown in the early postoperative period and became non-significant after 30 days. Allografts displayed high levels of neoangiogenesis and viable cartilage rings with islets of calcification. Biomechanical measurements demonstrated strain properties similar to those of a fresh tracheal segment from Day 58. CONCLUSIONS Our results demonstrate the acceptability and satisfactory stiffness of epithelium-denuded cryopreserved tracheal allografts implanted in the omentum, despite the absence of immunosuppressive drugs. Since the omentum has the capability to reach the tracheal region, this approach should be investigated in the setting of orthotopic transplants in a pig model before considering clinical applications.
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Affiliation(s)
- Julien De Wolf
- Department of Thoracic Surgery, CHU Lille, Lille, France.,Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
| | - Mathias Brieu
- Laboratoire de Mécanique de Lille, UMR CNRS 8107, Centrale Lille, Villeneuve d'Ascq, France
| | | | - Alexandre Ung
- Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
| | - Eric Kipnis
- Department of Surgical Critical Care, CHU Lille, Lille, France
| | | | - Thomas Hubert
- Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
| | - Pierre Fayoux
- Department of Otolaryngology-Head and Neck Surgery, CHU Lille, Lille, France
| | | | | | - Alain Wurtz
- Department of Thoracic Surgery, CHU Lille, Lille, France.,Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
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Taniguchi D, Matsumoto K, Tsuchiya T, Machino R, Takeoka Y, Elgalad A, Gunge K, Takagi K, Taura Y, Hatachi G, Matsuo N, Yamasaki N, Nakayama K, Nagayasu T. Scaffold-free trachea regeneration by tissue engineering with bio-3D printing†. Interact Cardiovasc Thorac Surg 2018; 26:745-752. [DOI: 10.1093/icvts/ivx444] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Daisuke Taniguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yosuke Takeoka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Abdelmotagaly Elgalad
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyofumi Gunge
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsunori Takagi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuaki Taura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Go Hatachi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoto Matsuo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Yamasaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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14
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Lu T, Huang Y, Liu Y, Shen Y, Qiao Y, Zhang Y. Effects of cryopreservation on tracheal allograft antigenicity in dogs. J Thorac Dis 2017; 9:2038-2047. [PMID: 28840004 DOI: 10.21037/jtd.2017.06.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prolonged cryopreservation (~8-10 months) has been shown to reduce the antigenicity of tracheal allografts due to subsequent denuding of epithelium. In the present study, tracheal epithelium was assessed after variable periods of cryopreservation. Immunosuppressant-free allotransplantation was then undertaken to evaluate the impact of cryopreservation on tracheal antigenicity in dogs. METHODS Tracheal rings [7-8] were removed from mongrel adult dogs for cryopreservation (1-10 months, -85 °C) and grafting. Before transplantation, one ring was sectioned from each end for histologic examination. The residual five-ring segments of mediastinal trachea were then transplanted into recipient dogs after 1-7 months (group 1, n=9) or 8-10 months (group 2, n=6) of cryopreservation. Anastomotic sites and allografts were covered by omental pedicles. No immunosuppressants whatsoever were administered. RESULTS In microscopic views, the ciliated tracheal epithelium of most grafts showed variable loss but was generally intact after cryopreservation, still demonstrating major histocompatibility complex (MHC)-II positivity. By postoperative bronchoscopy, allografts in both groups had largely developed lethal strictures. In group 1, eight dogs were sacrificed or died within 50 days post-transplantation, whereas survival times in group 2 were somewhat longer, with three dogs surviving for >60 days. Upon sacrifice, histologic preparations of grafted tissue in both groups were typically denuded of epithelium, with marked lymphocytic/monocytic submucosal infiltrates. Tracheal cartilage had been absorbed or destroyed. CONCLUSIONS After cryopreservation, some degree of tracheal epithelium loss maybe expected, but complete denudation is not obligatory. Retained epithelial antigenicity is thus capable of triggering rejection, resulting in transplant failures. Although prolonging transplant survival to an extent, fatal rejection of tracheal allografts was not preventable by prior cryopreservation.
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Affiliation(s)
- Tao Lu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Liu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yulei Qiao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yongxing Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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15
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Hoetzenecker K, Schweiger T, Roesner I, Leonhard M, Marta G, Denk-Linnert DM, Schneider-Stickler B, Bigenzahn W, Klepetko W. A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting. J Thorac Cardiovasc Surg 2016; 152:1008-17. [DOI: 10.1016/j.jtcvs.2016.01.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/01/2016] [Accepted: 01/17/2016] [Indexed: 11/16/2022]
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16
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Hamilton NJ, Kanani M, Roebuck DJ, Hewitt RJ, Cetto R, McLaren CA, Butler CR, Crowley C, Janes SM, O'Callaghan C, Culme-Seymour EJ, Mason C, De Coppi P, Lowdell MW, Elliott MJ, Birchall MA. Reply to: "Recent Advances in Circumferential Tracheal Replacement and Transplantation". Am J Transplant 2016; 16:1336-7. [PMID: 26813777 DOI: 10.1111/ajt.13736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N J Hamilton
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - M Kanani
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - D J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R J Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, London, UK
| | - R Cetto
- Department of Aeronautics, Imperial College London, London, UK
| | - C A McLaren
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - C R Butler
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C Crowley
- University College London Centre for Nanotechnology and Regenerative Medicine, Royal Free Hospital, London, UK
| | - S M Janes
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C O'Callaghan
- Department of Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | | | - C Mason
- London Regenerative Medicine Network, London, UK
| | - P De Coppi
- Department of Surgery, Great Ormond Street Hospital, London, UK
| | - M W Lowdell
- Department of Haematology, Royal Free Hospital, University College London Paul O'Gorman Laboratory of Cellular Therapeutics, London, UK
| | - M J Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - M A Birchall
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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17
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Wurtz A, Hysi I, Kipnis E, Copin MC. Recent Advances in Circumferential Tracheal Replacement and Transplantation. Am J Transplant 2016; 16:1334-5. [PMID: 26695386 DOI: 10.1111/ajt.13633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A Wurtz
- IMPRT-IFR 114, EA 4489, Lille University Medical School, UDSL-Université Lille Nord de France, Lille, France.,Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHULille, Lille, France
| | - I Hysi
- IMPRT-IFR 114, EA 4489, Lille University Medical School, UDSL-Université Lille Nord de France, Lille, France
| | - E Kipnis
- Surgical Critical Care Unit-Department of Anesthesiology and Critical Care, Lille University Teaching Hospital, CHULille, Lille, France
| | - M C Copin
- Institute of Pathology, Lille University Teaching Hospital, CHULille, Lille, France
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18
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Candas F, Gorur R, Haholu A, Yildizhan A, Yucel O, Ay H, Memis A, Isitmangil T. Is Tracheal Transplantation Possible With Cryopreserved Tracheal Allograft and Hyperbaric Oxygen Therapy? An Experimental Study. Ann Thorac Surg 2015; 101:1139-44. [PMID: 26518377 DOI: 10.1016/j.athoracsur.2015.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/31/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allografts have achieved prominence for tracheal reconstruction because of their natural physiologic and anatomic structure, which preserves respiratory tract flexibility and lumen patency. The immunomodulatory effects of cryopreservation prevent tracheal allograft rejection. In addition, hyperbaric oxygen therapy (HBOT) accelerates wound healing by promoting epithelization and neovascularization. This experimental study investigated the early and late effects of HBOT on cryopreserved tracheal allografts (CTAs). METHODS The study used 33 outbred Wistar rats weighing 300 to 350 g as allograft transplantation donors and recipients. Among these, 22 recipient rats were randomly assigned to the HBOT (n = 11) and control (n = 11) groups. Rats in the HBOT group were treated with 100% oxygen for 60 minutes at 2.5 atmospheres of absolute pressure for 7 days. Recipient rats in both groups were euthanized at 1 week (n = 5) and 4 weeks (n = 6) after transplantation, defined as the early and late periods, respectively. RESULTS In the early period, no significant histopathologic differences were observed between groups (p > 0.05). However, microscopic evaluation of the control group during the late period showed low epithelization of the CTA. In contrast, microscopic evaluation of the HBOT group during this same period revealed epithelium covering the transplanted CTA lumen. Significant epithelization and vascularization and significantly reduced inflammation and fibrosis were found in the HBOT group compared with the control group (p < 0.05). CONCLUSIONS HBOT may be effective in tracheal reconstruction by increasing epithelization and neovascularization after extended tracheal resection. HBOT, therefore, should be considered in CTA transplantation.
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Affiliation(s)
- Fatih Candas
- Department of Thoracic Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
| | - Rauf Gorur
- Department of Thoracic Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Aptullah Haholu
- Department of Pathology, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Akin Yildizhan
- Department of Thoracic Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Orhan Yucel
- Department of Thoracic Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Hakan Ay
- Department of Underwater and Hyperbaric Medicine, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Ali Memis
- Department of Underwater and Hyperbaric Medicine, GATA Haydarpasa Training Hospital, Istanbul, Turkey
| | - Turgut Isitmangil
- Department of Thoracic Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey
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