Tracheal Transplantation: State of the Art and Key Role of Blood Supply in Its Success.

The trachea is one of the most difficult organs to transplant because its segmental blood supply involves blood vessels that are too small to allow for microvascular anastomosis. Through an ingenious sequence of revascularization and wound-healing mechanisms under temporary immunosuppression, the authors have developed a tracheal allotransplantation technique that allows the creation of a true chimeric trachea. The donor component of this chimeric trachea is tolerated permanently based on immune ignorance. This technique holds great promise for the development of a standardized approach for the repair of large tracheal defects.