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TRANSPLANTATION OF A VASCULARIZED, MUCOSALIZED TRACHEAL HOMOGRAFT IN NEW ZEALAND WHITE RABBITS
Armando Uribe-Rivera, DDS1, Evan J. Propst, MD, MSc, FRCSC2, Alessandro DeAlarcon, MD, MPH1, Michael J. Rutter, M.D., FRACS1, Christopher B. Gordon, M.D.1.
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 2The Hospital for Sick Children, Toronto, ON, Canada.

Tracheal Replacement with Tissue Engineered Trachea
Purpose: To develop a vascularized, mucosalized and epithelialized trachea for transplantation into long tracheal defects.
Methods: Tracheas of 12 New Zealand white rabbits were removed and processed using a proprietary gentle decellularization process that maintains extracellular matrix proteins. Processed tracheas were implanted into the rectus muscles of live rabbits. Five processed tracheas were injected with a mixture of mucosal cells (biopsied during bronchoscopy), abdominal fat (stem cell source) and phosphate buffered saline (PBS). Five processed tracheas were injected with an additional growth factor (IGF1). Two tracheas served as controls and were not injected. Animals were survived for 8 weeks while tracheal constructs were incubated. The constructs were scoped to confirm remucosalization. Tracheal constructs embedded in rectus muscle were rotated into a created tracheal defect (mean 5.75 +/- 1.5 tracheal rings) and animals were extubated immediately postoperatively. They had no signs of respiratory compromise and survived for 8 weeks, at which point they were euthanized and the explanted tracheas were analyzed.
Results: Rabbits transplanted with tracheal lumen injected with mucosal cells, fat and PBS had less respiratory compromise, survived longer, and histopathologically maintained greater airway patency with less scar formation compared to those receiving additional growth factor. These rabbits also demonstrated remucosalization of their newly transplanted trachea with evidence of extensive ciliation without significant stenosis
Conclusions: It is possible to create a durable, biocompatible, vascularized, mucosalized and epithelialized trachea which permits staged tracheal reconstruction of long defects. This work provides proof of concept and serves as a basis for reconstruction of long tracheal defects in humans.


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