Identified only by her first name, Karine, the 49-year-old patient had been breathing through a tracheostomy for around 20 years, unable to speak, due to complications arising from intubation following a cardiac arrest in 1996.
A few days after the transplant, which took place on September 2nd and 3rd in Lyon, she managed to say a few words. Since then, Karine has been undergoing re-education sessions for her vocal cords, swallowing and breathing with a speech therapist, in the hope of permanently recovering her ability to speak.
Her immunosuppressive treatment was intensified after rejection began, but she was able to return home to the south of France on October 26.
She did not participate in the presentation of the operation this Monday, but explained in writing that she had volunteered ten years ago “to return to a normal life”.
“My daughters have never heard me speak”
“My daughters have never heard me speak,” she wrote, ensuring that she was armed with “courage” and “patience” to deal with the pain and the work of relearning how to articulate words.
Professor Philippe Céruse, head of the department of otorhinolaryngology and neck-facial surgery at the Red Cross hospital, also demonstrated determination before coordinating the transplant, the first of its kind in France.
The idea for the operation came about 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.
The French surgeon asked questions and investigated the case, but did not go any further until 2010 when, “somewhat by chance”, he met a Colombian colleague at a conference who had reproduced this very delicate transplant, but without ever having published anything.
Then the Colombian doctor, Luis Fernando Tintinago Londono, invited him to Cali for a week to show how to harvest a larynx, “one of the most complex aspects” of the process, because this organ “is structured by very small nerves and vascularized by arteries and very small intersecting veins”, as explained by French professor and surgeon, Philippe Céruse.
Over the next decade, he trained with a team of specialists, obtained clearances and began looking for eligible patients for the surgery. In 2019, “Karine” was identified, but Covid halted the entire process.
In the meantime, two laryngeal transplants have been recorded in the medical literature, one in California in 2010 and the other in Poland in 2015. Not much, because these operations are not a priority: a dysfunctional larynx is very disabling, but poses no risk of life.
Uterus and penis
In 2022, the French team returned to work. All that was left was to find a compatible donor, which for a larynx requires “anatomical characteristics perfectly compatible with the recipient, in terms of sex, weight, height, blood group, etc.”.
This happened on September 1st. After the family gave their consent, the operation could begin. It lasted a total of 27 hours, about ten hours for the removal and 17 for the transplant.
Twelve surgeons and around 50 employees from the University Hospital of Lyon participated in this first operation, coordinated by Professor Céruse and his colleague Lionel Badet, head of the department of urology and transplant surgery at the Edouard Herriot Hospital.
We will have to wait a whole year to be sure of the final success of the transplant, but Professor Céruse “thinks we can say that there will be more” larynx transplants in Lyon.
Lyon’s hospitals were once the site of the world’s first hand transplant, in 1998, and the first transplant of both hands, in 2000, carried out by Professor Jean-Michel Dubernard, one of the world’s transplant pioneers, who died in 2021.
Badet recalls his involvement in this “transplant adventure”, which is paving the way for new specialties. And he predicts that, after arms, forearms and larynxes, tomorrow will be the turn of “uterus and penis transplants”.