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Growth and Development of Homograft Tracheal Transplants in the Piglet Model
LTC Jeffrey A. Faulkner, MC, USA;
Lt Col Eric A. Mair, USAF, MC
Arch Otolaryngol Head Neck Surg. 2001;127:426-431.
Objective To determine the growth characteristics of homograft tracheal transplants
in piglets.
Design Prospective controlled animal study.
Setting Clinical animal laboratory.
Subjects Seventeen Yorkshire swine piglets.
Interventions The tracheae of adult Yorkshire swine were harvested and treated with
formaldehyde, thimerosal, and acetone to remove immunogenic major histocompatibility
complexes. Eleven piglets had these chemically treated homografts transplanted
into 6-cm surgically created tracheal defects. The transplants were stented.
Three control piglets had a 6-cm anterior tracheofissure, no transplant, and
surgical placement of the stent. Three other control piglets had no transplant,
and the stent was placed endoscopically.
Main Outcome Measures Growth outcome measurements were tracheal length and diameter. Functional
outcome measurements were lumen patency and graft viability indicated by cartilage
retention.
Results The mean diameter of the tracheae in the stented tracheal transplant
group was 11.7 mm before transplantation and 6.6 mm 2 months after transplantation.
The transplanted segments were significantly malacic 2 months after transplantation.
The mean diameter of the tracheae in the tracheofissure group was 9.0 mm before
surgery and 11.0 mm 2 months after surgery. The mean diameter of the tracheae
in the endoscopically stented group was 11.0 mm before surgery and 14.0 mm
2 months after stent placement. All homografts showed evidence of extensive
resorption of the graft cartilage. The graft cartilage was replaced by collagen,
with minimal evidence of neochondrification. There was no evidence of host-vs-graft
rejection. All grafted trachea had severe tracheomalacia with granulation
tissue.
Conclusions Homograft tracheal transplantation results in a tracheal segment that
is replaced with collagen. The transplanted cartilage is resorbed, leaving
a significantly malacic segment. Homograft tracheal transplantation might
result in a small malacic airway with little potential for growth when performed
in children.
From the Department of Otolaryngology–Head and Neck Surgery,
Walter Reed Army Medical Center, Washington, DC. LTC Faulkner is now Chief
of the Department of Otolaryngology, Irwin Army Community Hospital, Ft Riley,
Kan.
Corresponding author: LTC Jeffrey A. Faulkner, MC, USA, Department
of Otolaryngology–Head and Neck Surgery, Walter Reed Army Medical Center,
Washington, DC 20307-5001 (e-mail: Jeffery.Faulkner{at}cen.amedd.army.mil).
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