ONE-STAGE ALLOTRANSPLANTATION OF THORACIC SEGMENT OF THE TRACHEA IN APATIENT WITH IDIOPATHIC FIBROSING MEDIASTINITIS AND MARKED TRACHEAL STENOSIS

The authors observed a 24-year-old female with idiopathic fibrosing me diastinitis affecting the thoracic segment of the trachea and producin g marked stenosis. Taking into consideration the common occurrence of cicatrical stenosis and the inefficacy of its conservative treatment, an attempt at one-stage allotransplantation of the trachea with omento pexy of the graft and the lines of anastomosis was made. In spite of i mmunosuppressive therapy (cyclosporine and azathioprine), signs of rej ection appeared on the 10th postoperative day, which were arrested by antithymocyte globulin and loading doses of corticosteroids. Subsequen tly, the condition of the patient became stable. By the end of the 2nd month the graft appeared vital, its lumen being about 10 mm, the line s of anastomoses were epithelialized. Four months after operation sign s of the graft stenosis appeared, possibly caused by pogressive fibros ing mediastinitis. Because of this complication a silicon stent was us ed for the prophylaxis of further graft stenosis. This satisfactory re sult of tracheal allotransplantation is thought to be related to adequ ate selection of the donor-recipient pair, modern immunosuppressive th erapy and utilization of omentopexy for early graft revascularization.