“People need to keep their voice,” said Marty Kedian, 59, in an interview with The Associated Press, four months after undergoing a rare voice box transplant. Although his voice remains hoarse, Kedian can now engage in hour-long conversations. “I want people to know this can be done,” he emphasized.
Kedian, who posed for a photo in Mayo Clinic’s Head and Neck Regenerative Medicine Laboratory in Scottsdale, Arizona, became emotional when recalling the first time he called his 82-year-old mother post-surgery. “She could hear me. That was important to me, to talk to my mother,” he said.
The study, which is still in its early stages, aims to enroll nine more participants. The goal is to develop best practices for these complex transplants, potentially offering a solution for more people who can’t breathe, swallow, or speak due to a damaged or surgically removed larynx. “Patients become very reclusive and walled off from the rest of the world,” said Dr. David Lott, Mayo’s chair of head and neck surgery in Phoenix. He initiated the study because his patients often tell him, “Yeah, I may be alive, but I’m not really living.”
Lott’s team reported the early results of the surgery in the journal Mayo Clinic Proceedings. The larynx, commonly known as the voice box, is crucial for breathing and swallowing. Vocal cords within the larynx open to allow air into the lungs, close to prevent food or drink from entering the wrong way, and vibrate to produce speech.
The first two U.S. larynx transplant recipients, who underwent surgery at the Cleveland Clinic in 1998 and the University of California, Davis, in 2010, had lost their voices due to injuries. However, cancer remains the most common reason for larynx removal. The American Cancer Society estimates that over 12,600 people will be diagnosed with some form of laryngeal cancer this year. While many now undergo voice-preserving treatments, thousands have had their larynx completely removed, leading to breathing through a tracheostomy tube and struggling to communicate.
Despite the success of earlier transplants, the medical community has been hesitant to embrace these procedures. This reluctance is partly due to the fact that people can survive without a larynx, while the antirejection drugs required for the transplant could potentially trigger new or recurring tumors. “We want to push those boundaries but do it as safely and ethically as we can,” Lott said.
Head-and-neck specialists believe the Mayo trial is crucial for making larynx transplants a viable option. “It isn’t a ‘one-off,’” said Dr. Marshall Strome, who led the 1998 transplant in Cleveland. “This first attempt in a cancer patient is the next important step.”
Other alternatives are also being explored. Dr. Peter Belafsky of UC Davis, who helped perform the 2010 transplant, noted that his patients at high risk of larynx loss record their voices in anticipation of next-generation speech devices that sound like them. However, he believes there is “still a shot” for larynx transplants to become more common, although it will likely require years of additional research. One significant challenge has been achieving sufficient nerve regrowth to breathe without a trach tube.
Kedian was diagnosed with a rare laryngeal cartilage cancer about a decade ago. The Haverhill, Massachusetts, resident underwent more than a dozen surgeries and eventually needed a trach tube to help him breathe and swallow. He struggled to even muster a raspy whisper and had to retire on disability. Despite his condition, Kedian, known for his long conversations with strangers, refused to let doctors remove his entire larynx. He wanted to read bedtime stories to his granddaughter with his own voice rather than using robotic-sounding speech devices.
Kedian’s wife, Gina, discovered the Mayo study, and Lott determined that Kedian was a good candidate because his cancer wasn’t fast-growing and he was already taking antirejection drugs for a previous kidney transplant. It took 10 months to find a deceased donor with a healthy larynx of the right size.
On February 29, six surgeons operated for 21 hours. They removed Kedian’s cancerous larynx and transplanted the donated one, along with necessary adjoining tissues such as the thyroid and parathyroid glands, the pharynx, and the upper part of the trachea. They also connected tiny blood vessels and nerves critical for Kedian to feel when he needs to swallow and to move the vocal cords.
About three weeks later, Kedian said “hello.” He soon relearned to swallow, progressing from applesauce to macaroni and cheese and hamburgers. He even got to say hi to his granddaughter Charlotte via video, part of his homework to keep talking. “Every day it’s getting better,” said Kedian, who plans to move back to Massachusetts soon. His tracheostomy remains in place for at least a few more months, but he is eager to remove the tubes and return to a normal life. “I’m pushing myself to make it go faster because I want these tubes out of me,” he said.
Just as Lott had assured him, Kedian retained his beloved Boston accent.
Source: Associated Press
