France's first larynx transplant: a patient regains speech

Steph Deschamps / November 23, 2023

After transplants in the United States, Colombia and Poland, France has just performed its first larynx transplant, enabling a woman to speak again.

"It feels strange to be talking again," comments Karine, who in September benefited from the first larynx transplant performed in France. The operation was announced last week, and presented on Monday in Lyon by the medical team, who hope to be able to repeat this "feat" in the near future. The 49-year-old patient had been breathing through a tracheostomy without being able to speak for some twenty years, due to complications following intubation after cardiac arrest in 1996.

The transplant was carried out on September 2 and 3 in Lyon, and a few days later Karine was able to utter a few words in a voice that was still very weak. Since then, she has been undergoing vocal cord, swallowing and breathing re-education sessions with a speech therapist in order to regain her full capabilities. Her immunosuppressive treatment was reinforced following the onset of rejection, but she was able to return home to the south of France on October 26. She therefore did not take part in Monday's presentation of the operation, but explained in writing that she had volunteered ten years ago "to get back to a normal life". "My daughters had never heard me speak", she confided, assuring us that she was armed with "courage" and "patience" to cope with the pain and the work of relearning. Pr Philippe Céruse, head of the ENT and cervico-facial surgery department at the Croix-Rousse hospital, also showed determination before coordinating this transplant, the first of its kind in France.

The idea for this type of surgery arose from the world's first larynx transplant, performed in 1998 in Cleveland, USA, on a man who had lost his vocal cords in a motorcycle accident. Surgeon Philippe Céruse made enquiries, but left it at that. Then, in 2010, he met a Colombian colleague who had reproduced this very delicate operation without ever publishing anything. Dr. Luis Fernando Tintinago Londono invited him to spend a week in Cali to show him how to harvest a larynx. This is "one of the most complex aspects", as this organ "is innervated by tiny nerves and vascularized by tiny arteries and veins that intersect", explains Philippe Céruse.

Over the next decade, he trained with a team of experts on pigs and cadavers, obtained the necessary authorizations to carry out the transplant in humans, and began looking for eligible patients. In 2019, his first patient is identified. But Covid brings everything to a halt. In the meantime, two larynx transplants are recorded in the medical literature, one in California in 2010 and one in Poland in 2015. It's not much, because these operations are not a priority: a dysfunctional larynx is very disabling, but not life-threatening.

In 2022, the French team is back at work. All that remained was to find a compatible donor, which implied "anatomical characteristics perfectly compatible with the recipient, in terms of sex, weight, height, blood type...". The donor was found on September 1. Once the family had given their consent, the procedure could begin. It lasted a total of 27 hours. Twelve surgeons and some fifty staff from Lyon's University Hospital took part in this first operation, coordinated by Philippe Céruse and his colleague Lionel Badet, head of the Urology and Transplant Surgery Department at the Edouard Herriot Hospital. The team is "proud" of this "feat", but remains cautious. "It's the patient who will say if it's a success", notes Pr Philippe Céruse, noting that it will take 12 to 18 months for her to regain the motricity of her larynx "the time it takes for nerve regrowth". He will therefore wait until she is "doing perfectly well" before embarking on the other two larynx transplants for which he has a budget.

In the meantime, Lyon's transplant teams, who already performed the world's first hand transplant in 1998, are continuing to work on other non-vital organs whose dysfunction is synonymous with "social death", reveals Prof. Badet. And he predicts that, after arms, forearms and larynx, uterus and penis transplants will follow "in the next two years ».