One-stage allotransplantation of thoracic segment of the trachea in a patient with idiopathic fibrosing mediastinitis and marked tracheal stenosis

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Abstract
The authors observed a 24-year-old female with idiopathic fibrosing mediastinitis affecting the thoracic segment of the trachea and producing marked stenosis. Taking into consideration the common occurrence of cicatricial stenosis and the inefficacy of its conservative treatment, anattempt at one-stage allotransplantation of the trachea with omentopexy ofthe graft and the lines of anastomosis was made. In spite ofimmunosuppressive therapy (cyclosporine and azathioprine), signs ofrejection appeared on the 10th postoperative day, which were arrested byantithymocyte globulin and loading doses of corticosteroids. Subsequently,the condition of the patient became stable. By the end of the 2nd month thegraft appeared vital, its lumen being about 10 mm, the lines of anastomoseswere epithelialized. Four months after operation signs of the graftstenosis appeared, possibly caused by progressive fibrosing mediastinitis.Because of this complication a silicon stent was used for the prophylaxisof further graft stenosis. This satisfactory result of trachealallotransplantation is thought to be related to adequate selection of thedonor-recipient pair, modern immunosuppressive therapy and utilization ofomentopexy for early graft revascularization.

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