Trachea transplantation: from laboratory to patient

Abstract

Today, tracheal lesions occupying < 30% of the trachea in children and < 50% in adults can be treated with primary resection, followed by end‐to‐end anastomosis. However, lesions larger than this require a tracheal replacement, of which there are currently few options available. The recent advancement of tissue‐engineering principles in tracheal research is quickly opening up new vistas for airway reconstruction and creating a very promising future for medical science. This review discusses the main criteria required for the development of a tissue‐engineered tracheal replacement. The criteria include: (a) appropriate cell types and sources; (b) biomolecules to direct the differentiation of the cells to the desired lineage; (c) a suitable scaffold for a cellular matrix; and (d) a bioreactor to facilitate cell attachment and proliferation and construct transport to theatre. Our group has designed and developed the world's first synthetic tracheal replacement, using a novel nanocomposite material, also developed in our laboratory. It was implanted clinically in June 2011 with a successful outcome. The application of tissue‐engineering approaches to tracheal replacement development is the first step towards the much‐anticipated ‘off‐the‐shelf’ tissue‐engineered technology, contributing extensively to the advancement in treatment and rehabilitation of patients afflicted with tracheal pathology. Copyright © 2014 John Wiley & Sons, Ltd.