“It feels strange to speak again,” comments Karine, who in September benefited from the first larynx transplant carried out in France. An intervention announced last week, and presented Monday in Lyon by the medical team, who hopes to be able to repeat this “feat” soon. The patient, aged 49, had been breathing through a tracheotomy without being able to speak for around twenty years due to complications linked to intubation after a cardiac arrest in 1996.
The transplant was carried out on September 2 and 3 in Lyon, and a few days later Karine was able to pronounce a few words in a still very weak voice. Since then, she has undergone vocal cord, swallowing and breathing rehabilitation sessions with a speech therapist to recover all her abilities. Her immunosuppressive treatment was reinforced following the onset of rejection, but she was able to return home to the south of France on October 26. She therefore did not participate in the presentation of the intervention on Monday, but explained in writing that she had volunteered ten years ago “to return to a normal life”. “My daughters had never heard me speak,” she confides, ensuring that she is armed with “courage” and “patience” to face the pain and the work of relearning. Professor Philippe Céruse, head of the ENT and head and neck surgery department at the Croix-Rousse hospital, also showed determination before coordinating this unprecedented transplant in France.
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The idea for this type of surgery arose during the world's first larynx transplant, carried out in 1998 in Cleveland, United States, on a man who had lost his vocal cords in a motorcycle accident. Surgeon Philippe Céruse inquires, but leaves it there. Then in 2010, he met a Colombian colleague who reproduced this very delicate intervention without ever publishing anything. Dr. Luis Fernando Tintinago Londono invites him to spend a week in Cali to show him how to remove a larynx. This is “one of the most complex aspects”, because this organ “is innervated by very small nerves and vascularized by very small arteries and veins which intersect”, explains Philippe Céruse.
For the next decade, he trained with a team of experts on pigs or cadavers, obtained authorization to perform the transplant in humans and began looking for eligible patients. In 2019, its first patient was identified. But Covid interrupts everything. In the meantime, two larynx transplants are recorded in the medical literature, one in California in 2010 and one in Poland in 2015. This is not much, because these operations are not a priority: a dysfunctional larynx is very disabling, but does not not endanger the lives of patients.
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In 2022, the French team gets back to work. It remains to find a compatible donor, which requires "anatomical characteristics perfectly compatible with the recipient, in terms of sex, weight, height, blood group...". The donor was found on September 1st. After the family's agreement, the intervention can begin. It will last 27 hours in total. Twelve surgeons and around fifty staff from the Lyon University Hospital are participating in this first under the coordination of Philippe Céruse and his colleague Lionel Badet, head of the urology and transplant surgery department at the Edouard Herriot hospital. The team, “proud” of this “prowess”, nevertheless remains cautious. “It is the patient who will say if it is a success,” notes Professor Philippe Céruse, noting that it will take 12 to 18 months for her to regain motor function in her larynx “the time for nerve regrowth” . He will therefore wait until she is “doing perfectly well” before embarking on the two other larynx transplants for which he has a budget.
In the meantime, the Lyon transplant teams, who have already carried out the world's first hand transplant in 1998, continue to work on other non-vital organs whose dysfunctions are synonymous with "social death", reveals Professor Badet. And to project that after the arms, the forearms and the larynx, it will be the turn “within the next two years of uterus and penis transplants”.