For the first time, Vietnam has successfully performed a tracheal transplant from a brain-dead donor.

After surgery, the patient is monitored and receives intensive care (including tracheostomy: creating a hole in the neck for breathing when breathing through the nose is no longer possible). Once stable, the patient is transferred to a local hospital for further treatment.

One month after the tracheostomy, the patient underwent a consultation for conservative treatment, including tracheal dilation and stenting, which failed. Subsequently, a tracheostomy and anastomosis surgery was performed at a medical facility in Hanoi, but it was unsuccessful due to complex lesions and strictures over a long segment of the trachea (after about 2 months, shortness of breath appeared and a permanent tracheostomy had to be performed again).

During the recent treatment for cervical tracheal stenosis, before the need for a permanent tracheostomy, the patient ate and drank completely normally orally and received injections of anti-scarring medication at the stenotic site (the patient received 6 injections, each spaced 1-2 months apart).

In May 2023, after the sixth injection, the patient experienced milky fluid leakage through the tracheostomy site. Gastroenterologists diagnosed a tracheoesophageal fistula at the anti-scarring injection site of the trachea and proceeded with gastrostomy for feeding.

The patient continues to receive regular check-ups at Viet Duc Friendship Hospital. For the past two years, the patient has been unable to eat orally (requiring feeding via gastrostomy tube), and has not been breathing through the nose but through a tracheostomy tube in the neck (frequently experiencing ulceration, bleeding, and infection at the tracheostomy site).

The patient's father and family were very pessimistic about the future of a young man who was once able to work but is now disabled. Life seemed hopeless, and the patient and his father (who always accompanied him to every doctor's visit and treatment) fell into a state of despair and depression...

Given the patient's complex injuries, doctors at Viet Duc Friendship Hospital held a multidisciplinary consultation (ENT, gastroenterology, thoracic surgery, rehabilitation, anesthesia and resuscitation, tissue bank, nutrition, etc.) and unanimously agreed to perform a two-stage surgery.

Then, one surgery involves resection and anastomosis of the narrowed cervical esophagus or esophageal reconstruction using a segment of the colon; the other involves glottic reconstruction combined with cervical tracheal transplantation using a tracheal segment from a brain-dead donor.

With meticulous preparation by a team of leading experts at Viet Duc Friendship Hospital, on April 11, 2024, the patient underwent reconstructive surgery involving resection and anastomosis of the cervical esophagus, resection of the tracheal scar tissue, and preparation of both tracheal ends for the second surgery.

On May 13, 2024, the patient underwent surgery to perform a double cervical tracheal transplant using trachea from a brain-dead donor, combined with tracheal stent placement and bilateral sternoclavicular muscle transposition to cover the grafted tracheal segment.

After a period of intensive treatment, the patient was discharged and returned home on June 25, 2024. A follow-up examination one month later showed the patient in good health (having gained 5 kg), with the surgical scar healing well, able to eat and drink orally, and breathing independently through the nose again.

Results of esophagoscopy and tracheoscopy: surgical scar healed well, grafted tracheal segment was pink, not congested or necrotic, and not stenotic.

Three months after the follow-up examination, the patient had gained 10 kg, was in good overall health, breathing independently through the nose, and eating orally. The patient is scheduled to have the tracheal stent removed in the 5th or 6th month.

The patient's and his father's current condition has completely changed: The patient has regained weight, his health is improving, he can eat orally and breathe through his nose normally; both the patient and his family are optimistic and cheerful again, and the family atmosphere is no longer tense or tiring.

To date, tracheal transplantation in general, and airway transplantation in particular, remains a challenge in surgery and in the medical community worldwide.

There are many short-term reports on tracheal segment grafting surgery, but the results are modest, and many challenges remain, with no single most effective method yet for managing this type of injury (tracheal segment injury longer than 6 cm).

Specifically, how to choose the graft material, how to nourish the grafted trachea segment, how to provide post-transplant care; whether or not to use anti-rejection medication... All these issues were raised during the consultation process chaired by the Director of Viet Duc Friendship Hospital.

Furthermore, the clinical case at Viet Duc Friendship Hospital was extremely complex due to the simultaneous presence of two lesions (both trachea and esophagus) in a young patient with an uncertain future ahead;

The issues of choosing the appropriate treatment method for these two types of injuries, the timing of the procedure, and the post-operative care plan were carefully considered and yielded positive results, as presented.

This patient's results open up a bright prospect for patients with tracheal injuries longer than 6cm (due to trauma, congenital stenosis, or tumors, etc.) to potentially restore optimal airway function.

Currently, Viet Duc Friendship Hospital, with its high-quality workforce and leading experts in the field of organ transplantation, combined with the support of international experts and the foresight of the hospital's leadership, considers organ transplantation a key focus of development. In addition to more routine multi-organ transplants (liver, heart, kidney, and lung), the hospital will implement many other types of transplants in the future, including tracheal, pancreatic, and intestinal transplants, bringing many benefits to patients that were previously unavailable.