World’s first successful voice box transplant helps patient talk again

Mayo Clinic recently made a significant advancement in organ transplantation, providing new hope for those who have lost their ability to speak, swallow, and breathe independently due to larynx dysfunction or loss. A team of doctors in Arizona performed the third known total larynx transplant in the U.S., marking the first such transplant within a clinical trial and on a patient with active cancer in the country.

Dr. David Lott, chair of the Department of Otolaryngology - Head and Neck Surgery/Audiology at Mayo Clinic in Arizona, expressed his excitement about the success of the procedure. "The surgery and patient's progress have exceeded our expectations," he said. "This is a tremendous accomplishment in launching what we believe is the future for laryngeal transplantation."

The case was detailed in a paper by Dr. Lott, published in the Mayo Clinic Proceedings journal. The larynx, or voice box, is essential for speaking, breathing, and swallowing. Total larynx transplantation is extremely rare and complex, performed only a few times worldwide. Mayo Clinic’s achievement is especially notable as it involved a patient with active cancer, a global first.

The 21-hour surgery involved six surgeons who transplanted the larynx, pharynx, upper trachea, upper esophagus, thyroid and parathyroid glands, blood vessels, and nerves. The patient, Marty Kedian from Massachusetts, had been battling a rare form of laryngeal cancer called chondrosarcoma for a decade, undergoing numerous surgeries that ultimately left him unable to speak, swallow, or breathe normally.

He had been using a tracheostomy tube for years, which significantly impacted his quality of life. "I was alive, but I wasn't living," Kedian reflected. "I love to talk to people everywhere I go, and I just couldn't. I felt strange, and I wouldn't go out anywhere."

Kedian's hope was restored when he found Mayo Clinic's Larynx and Trachea Transplant Program, led by Dr. Lott. After being accepted into the clinical trial, Kedian moved to Phoenix with his wife. On February 29, he became the clinic’s first total larynx transplant patient. "I wanted this so I could talk and breathe normally with my new granddaughter. I want to read her bedtime stories with my own voice," he said.

This clinical trial is crucial in making the rare procedure more accessible. "Until now, laryngeal transplants have been done as one-offs," Dr. Lott explained. "This clinical trial allows us to conduct a true scientific investigation aimed at thoroughly researching the safety and efficacy of laryngeal transplantation as a trusted option for patients." The program is set to perform additional transplants in the coming years.

The American Cancer Society estimates that 12,650 new cases of laryngeal cancer will be diagnosed in the U.S. this year. For many of these patients, the prospect of a laryngeal transplant was dim due to the risks associated with immunosuppressive therapy, which lowers the body's immune response to reduce organ rejection but increases the risk of cancer spreading.

Kedian's unique case, being already on immunosuppressive therapy from a previous kidney transplant, allowed the procedure to be safely performed. "Having a patient with an active cancer who already had his own immune suppression allowed us to do the transplant safely without introducing additional risk in a way that has rarely, if ever, been done before," said Dr. Girish Mour, medical director of the program.

Dr. Lott added, "Being able to perform this transplant in the setting of active cancer in a patient already on immunosuppressive therapy, under the rigor and oversight of a clinical trial, enabled us to take that vital step toward better understanding the safety for cancer patients and potentially making larynx transplant a standard option."

The surgical team's first priority was removing the cancer. "First, we removed Mr. Kedian's cancerous larynx," Dr. Lott explained. "Then, with the confidence of our team that the cancer was gone, we focused on the transplant."

Four months post-surgery, Kedian can speak, swallow, and breathe on his own, which Dr. Lott describes as remarkable. "Mr. Kedian has already regained about 60% of his voice, which I wouldn't have thought would happen for at least a year. He still speaks with the same voice and Boston accent he had prior to the cancer," said Dr. Lott. "He can also eat hamburgers, macaroni and cheese, almost anything, and swallow with no problem. His breathing also continues to steadily improve." The plan is to remove the tracheostomy tube once Kedian fully regains his breathing capability.

Kedian is deeply grateful for the team at Mayo Clinic. "The team at Mayo has given me my life back," he said. "I'm so grateful. I have the deepest gratitude for Dr. Lott's team and especially the generosity of my organ donor and donor family. I hope one day I get the chance to tell them, 'Thank you.'"

Dr. Marshall Strome, who performed the world's first total laryngeal transplant in 1998, emphasized the significance of this case. "This case signifies a monumental breakthrough. It represents the future of laryngeal transplantation, where every patient needing a total laryngectomy will have the option of a reconstruction that allows them to maintain their quality of life," he said. "With the clinical trial underway, Dr. Lott and his team are positioned to advance the field in ways no other program can currently achieve. The Mayo team has discovered the holy grail for managing laryngeal cancer, which I believe will come to fruition by the end of this decade."

For Dr. Lott, Kedian's case represents the culmination of two decades of research. Alongside the clinical trial, his team is investigating ways to restore laryngeal function through improved transplantation techniques and pioneering regenerative medicine technologies.

"I set my path on becoming a laryngeal surgeon and researcher to build a program that is pushing the boundaries of science forward," he said. "Our dedication is to the thousands of individuals who suffer from laryngeal dysfunction and to find trusted options that preserve their health and their quality of life. That's what this clinical trial is all about."

Next week, Kedian will return to Massachusetts, excited to be with his family and friends and to read bedtime stories to his granddaughter. He also plans to use his experience to inspire others. "Mayo and Dr. Lott have helped me regain my quality of life," he said. "My job now is to get better. My next job will be to show others they can do it too."

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