Fig 4 - available via license: Creative Commons Attribution-NonCommercial 3.0 Unported
Content may be subject to copyright.
Source publication
Background
Laryngeal allotransplantation (LA) is a technique involving transplantation of a deceased donor's larynx into a recipient, and it may be substituted for conventional laryngeal reconstruction. There are widely different views on LA, as the recipient is administered continuous, potentially life-threatening, immunosuppressive therapy for a...
Context in source publication
Context 1
... occurs (displayed as a percentage from 0% to 100% and the higher probability means maximal improvement). Moreover, the subjects marked about how significant they consider the function of the transplanted larynx (restoration of voice) and appearance (image of being complete) into a number from 0 to 10 and the higher number means greater importance (Figs. 4, ...
Similar publications
This study investigates the antibacterial mechanism of action of electrospun chitosan-based nanofibers (CNFs), against Escherichia coli, Salmonella enterica serovar Typhimurium, Staphylococcus aureus and Listeria innocua, bacteria frequently involved in food contamination and spoilage. CNFs were prepared by electrospinning of chitosan and poly(ethy...
In order to examine the condition of intermediate sodiumtosodium heat exchangers (IHX) and to substantiate their operation life extension to 45 years at the BN600 reactor plant at Beloyarsk NPP Unit 3, one of the six heat exchangers was removed from the reactor in April 2006. Inspection revealed cracks with 7 maximum depth of mm on the outer surfac...
Life Extension and resistance increase of metal materials and constructions to the corrosion destruction processes is the most important scientific and technical problem. To solve this problem it is necessary to develop complex scientific research to study the corrosion phenomena, along with practical actions against corrosion directed to selecting...
Copyright 2012, ABENDI, PROMAI. Trabalho apresentado durante oXXX – Congresso Nacional de Ensaios Não Destrutivos e Inspeção. 16ª IEV – Conferencia Internacional sobre Evaluación de Integridad y Extensión de Vida de EquiposIndustriales. As informações e opiniões contidas neste trabalho são de exclusiva responsabilidade do(s) autor(es). SINOPSE Os a...
During the service life of flexible asphalt pavements, asphalt concrete degrades due to traffic loading and environmental conditions like temperature, rain, oxidation, ultraviolet-radiation from the sun. All these environmental factors have adverse effects on the performance of bitumen, which is the binder of asphalt concrete. They are known to cau...
Citations
... This has been borne out by previously published studies. [6][7][8] The first patient went from being unemployed to working as a motivational speaker. His principal improvement in quality of life came from being able to communicate emotion through voice. ...
... These considerations are exemplified in the literature to date, as evidenced by the 12 articles identified in our search that centered on public opinion and expert commentary on laryngeal transplantation ethics. [6][7][8][17][18][19][20][21][22][23][24][25] A survey of laryngectomy patients found a relatively strong feeling that laryngeal transplantation was an acceptable procedure. 20 Another study questioned the desirability of laryngeal transplantation when compared with double hand, heart, and lung transplantation in a group of laryngectomy patients, other solid organ transplant recipients, and healthy subjects, demonstrating that laryngectomees were willing to give up an average of 1.2 years of life for successful laryngeal transplantion. ...
Objectives:
Human laryngeal allotransplantation has long been contemplated as a surgical option following laryngectomy, but there is a paucity of information regarding the indications, surgical procedure, and patient outcomes. Our objectives were to identify all human laryngeal allotransplants that have been undertaken and reported in the English literature and to evaluate the success of the procedure.
Data sources:
MEDLINE, Embase, Current Index to Nursing and Allied Health Literature, Web of Science and Scopus, and the Gray literature.
Review methods:
A comprehensive search strategy was undertaken across multiple databases. Inclusion criteria were case reports of patients who had undergone human laryngeal allotransplantation. Information regarding indications, operative techniques, complications, graft viability, and functional outcomes were extracted.
Results:
A total of 5,961 articles, following removal of duplicates, matched the search criteria and were screened, with five case reports relating to two patients, ultimately fulfilling the entry criteria.
Conclusions:
Two laryngeal transplants have been reported in the medical literature. Although both patients report improved quality of life relating to their ability to communicate with voice, further research is necessary to shape our understanding of this complicated operation, its indications, and its functional outcomes. Laryngoscope, 127:1861-1868, 2017.
... In South Korea, similar studies have been conducted to evaluate risk acceptance and expectations for allotransplantation of the face, hands, feet, and larynx [5][6][7]. However, no such survey study has been performed on scalp allotransplantation within South Korea. ...
... A sample from the population outside of the hospital might better represent the general population. In particular, the general public group should be selected in consideration of more varied demographic and socioeconomic status.e present study found results, which echo ndings from other international studies and that from the allotransplantation conducted within South Korea[5][6][7]12]. Despite differences in transplantation type and study populations, the fact that study results were similar indicates that the most in uential factor could be "expectations" of the general public group with the lack of knowledge regarding subject matter. ...
Background
In scalp allotransplantation, the scalp from a brain-dead donor, including hair, is transferred to a recipient with scalp defects. Opinions differ on the appropriateness of scalp allotransplantation. In order to maintain graft function and cosmetic outcomes, scalp transplantation recipients would need to receive lifelong immunosuppression treatments. The risks of this immunosuppression have to be balanced against the fact that receiving a scalp allotransplant does not extend lifespan or restore a physical function. Therefore, the present study aimed to investigate risk acceptance and expectations regarding scalp allotransplantation in different populations.
Methods
A questionnaire survey study was conducted. A total of 300 subjects participated; survey was conducted amongst the general public (n=100), kidney transplantation recipients (n=50), a group of patient who required scalp reconstruction due to tumor or trauma (n=50), and physicians (n=100). The survey was modified by using the Korean version of the Louisville instrument for transplantation questionnaire.
Results
Risk acceptance and expectations for scalp transplantation varied widely across the groups. Kidney transplantation recipients revealed the highest risk acceptance and expectations, whereas the physicians were most resistant to the risks of scalp transplantation.
Conclusion
Our study demonstrates that, in specific groups, scalp allotransplantation and the need for immunosuppression carries an acceptable risk despite the lack of lifeextending benefits. Our results suggest that scalp allotransplantation can be an acceptable alternative to existing scalp reconstruction surgeries in patients with pre-existing need for immunosuppression.
... They concluded that laryngeal transplant could be considered a viable rehabilitative procedure in the future. [28] Thus, there is a growing demand for a rehabilitative procedure that significantly improves the quality of life to make it similar to what it was before the laryngectomy. As the larynx is a multifunctional organ, no prostheses or implant or tissue transfer is likely to replace it satisfactorily. ...
There is very less literature about laryngeal transplant, particularly in India. In the past, laryngeal transplant along with other “nonvital” organ transplant had been considered unethical as the risks associated with chronic immunosuppression outweighed the gains of the transplanted organ. However, with the advent of newer immunomodulatory drugs and drug delivery systems, the risks of immunosuppression are considerably low. This has prompted the growth and expansion of nonvital organ transplant which was evident by the first hand transplant performed in India. In the following discussion, the success of the two laryngeal transplants performed till date and the need for optimism in this field is outlaid. This article is directed toward all the ear-nose-throat and head-neck surgeons who treat laryngeal cancer on a regular basis.
The purpose of this chapter is to introduce the reader to the importance of complex tissue grafts in the head and neck region. It presents the principles of qualifying donors and recipients for this type of transplant. Additionally, the techniques and operating procedures used during face and neck tissue transplants have been described in detail. Postoperative care and rehabilitation of patients play a special role in this type of surgery, which is why part of the text in this chapter is devoted to this issue.
Laryngeal transplant is an emerging reconstructive option for end-stage laryngotracheal dysfunction after traditional methods have failed. While laryngeal allotransplantation carries ethical dilemmas and imparts immunosuppression risks including de novo or recurrent malignancies, it is an attractive option because other existing methods fail to comparably replicate laryngeal functions. Traditionally, immunosuppression and malignancy risk were major hurdles to widespread adoption of laryngeal transplantation outside of idealized patients, such as those with preexisting immunosuppression indications and/or benign laryngotracheal disease. However, advances in immunosuppression, ethical shifts surrounding nonvital organ transplantation, and limitation of post-malignancy laryngeal transplantation to oncologically cured patients have made laryngeal transplantation more accessible, including the first successful postmalignancy laryngeal transplantation in 2015. Currently, postlaryngeal transplant glottic airway restoration and tracheostomy decannulation are limited principally by outcomes of currently available recurrent laryngeal nerve reinnervation techniques. Selective posterior cricoarytenoid reinnervation and laryngeal pacemakers may help restore spontaneous arytenoid abduction and thereby aid in decannulating future laryngeal transplants.
Background:
On February 2, 2017, the surgical team of ten board-certified hand specialists of W Hospital in Korea successfully performed the nation's first hand transplantation at Yeungnam University Medical Center (YUMC). This paper reports on the legal, financial, and cultural hurdles that were overcome to open the way for hand transplantation and its functional outcomes at 36 months after the operation.
Methods:
W Hospital formed a memorandum of understanding with Daegu city and YUMC to comply with government regulations regarding hand transplantation. Campaigns were initiated in the media to increase public awareness and understanding. With the city's financial and legal support and the university's medical cooperation, a surgical team performed a left distal forearm hand transplantation from a brain-dead 48-year-old man to a 35-year-old left-handed man.
Results:
With this successful allotransplantation, the Korean Act on Organ Transplantation has now been amended to include hand transplantation. Korean national health insurance has also begun covering hand transplantation. Functional outcome at 36 months after the operation showed satisfactory progress in both motor and sensory functions. The disabilities of the arm, shoulder, and hand score were 23. The final Hand Transplantation Score was 90 points. Functional brain magnetic resonance imaging shows significant cortical reorganization of the corticospinal tract, and reinnervation of intrinsic muscle is observed.
Conclusions:
Hand transplantation at the distal forearm shows very satisfactory outcomes in functional, aesthetical, and psychological aspects. Legal and financial barriers against hand transplantation have long been the most burdensome issues. Despite this momentous success, there have been no other clinical applications of vascularized composite allotransplantation due to the limited acceptance by Korean doctors and people. Further public education campaigns for vascularized composite allotransplantation are needed to increase awareness and acceptance.
Transplantation in reconstructive surgery has been performed for more than 20 years, although the official beginning of these procedures is considered the first successful transplantation of the hand in 1998. The original name "Composite Tissue Transplantation" has been used less frequently; more common is the term "Vascularized Composite Allotransplant", which better describes the basis of the procedure. There have been so far approximately 180 transplantations performed, the exact number is difficult to find. The most known transplantation from this group include transplantation of the hand and face, the other, such as transplantation of the abdominal wall, joints, bones, trachea, larynx, tongue, penis, uterus, etc. are less common and less well known. The common characteristics is that they are not used for salvage or prolongation of life, but to improve its quality. The quality of life is a value, which cannot be objectively measured and the opinions regarding its importance significantly differ. Therefore there is still an unsolved ethical issue regarding these procedures, which is based on the justification to use immunosuppressive therapy with its serious risks in cases when the procedure is not needed for salvage or preservation of life.
