Man gets his voice back after US surgeons perform first known larynx transplant on cancer patient

A Massachusetts man has regained his voice after surgeons Laryngeal cancer and, in a pioneering move, replaced it with a donated copy.

Transplants of what is known as the larynx are extremely rare and not usually an option for people with active cancer. Marty Kedian is only the third person in the U.S. to ever undergo a full larynx transplant—the others years ago were due to injury—and one of a handful of cases reported worldwide.

Surgeons at the Mayo Clinic in Arizona offered Kedian the transplant as part of a new clinical trial that aims to make the potentially life-changing surgery available to more patients, including some with cancer, the most common cause of laryngeal loss.

“People need to keep their voice,” Kedian, 59, told the Associated Press four months after his transplant – he’s still hoarse but able to hold an hour-long conversation. “I want people to know that’s possible.”

He became emotional as he recalled the first time after surgery he called his 82-year-old mother “and she could hear me. … That was important to me, to talk to my mother.”

The study is small – only nine more people will be enrolled – but it can teach scientists best practices for these complex transplants so they can one day be offered to more people who cannot breathe, swallow or speak on their own because of a damaged or surgically removed larynx.

“The patients become very withdrawn and isolated from the rest of the world,” says Dr. David Lott, chief of the division of head and neck surgery at the Mayo Institute in Phoenix. He began the study because “my patients tell me, ‘Yes, I may be alive, but I’m not really living.'”

Lott’s team reported initial results of the operation on Tuesday in the journal Mayo Clinic Proceedings.

The larynx may be best known as the vocal apparatus, but it’s also vital to breathing and swallowing. Muscle tissue flaps called vocal cords open to let air into the lungs, close to prevent food or drink from going the wrong way—and vibrate as air passes them to produce speech.

The first two laryngeal transplant recipients in the United States – in 1998 at the Cleveland Clinic and in 2010 at the University of California, Davis – had lost their voices due to injuries; one sustained in a motorcycle accident, the other while on a ventilator in the hospital.

The most common cause, however, is cancer. The American Cancer Society estimates that more than 12,600 people will develop some form of throat cancer this year. While many today undergo voice-preserving treatment, thousands of people have had their larynx removed entirely. They now breathe through a tracheostomy tube in their throat and have difficulty communicating.

Although the first U.S. recipients achieved near-normal speech, doctors have not embraced these transplants, in part because people can survive without a larynx — while drugs that suppress the immune system and prevent rejection can trigger new or recurring tumors.

“We want to push those boundaries, but do so as safely and ethically as possible,” Lott said.

Head and neck specialists believe the Mayo study may be instrumental in making laryngeal transplants a viable option.

“This is not a one-time event,” but an opportunity to finally learn from one patient before operating on the next, says Dr. Marshall Strome, who led the 1998 transplant in Cleveland.

This first trial on a cancer patient “is the next important step,” he said.

Other options are being explored, noted Dr. Peter Belafsky of UC Davis, who helped with the 2010 transplant. His patients, who are at high risk of laryngeal loss, record their voices in anticipation of next-generation speech devices that sound like them.

However, Belafsky said there is “still a chance” that laryngeal transplants will become more common, but cautioned that research will likely take years. One hurdle is achieving sufficient nerve growth to allow breathing without a tracheal tube.

At Kedian, a rare laryngeal cartilage cancer about a decade ago. The Haverhill, Massachusetts, man underwent more than a dozen surgeries and eventually needed a tracheal tube to help him breathe and swallow – and struggled to produce even a croaking whisper through it. He was forced to retire on disability.

Still, the once gregarious Kedian, known for his long conversations with strangers, refused to let doctors remove his entire larynx to cure the cancer. He was determined to read bedtime stories to his granddaughter, using his own voice rather than what he called robotic-sounding speech machines.

Then Kedian’s wife, Gina, tracked down the Mayo trial. Lott concluded he was a good candidate because his cancer was slow to spread and, importantly, Kedian was already taking anti-rejection medications from a previous kidney transplant.

It took ten months to find a deceased donor with a sufficiently healthy larynx of the right size.

On February 29, six surgeons operated for 21 hours. After removing Kedian’s cancerous larynx, they transplanted the donated larynx, as well as necessary adjacent tissues – the thyroid and parathyroid glands, the throat and the upper part of the trachea – and tiny blood vessels to supply them. Finally, using new microsurgical techniques, they connected nerves that are crucial for Kedian to sense when to swallow and to move the vocal cords.

About three weeks later, Kedian said hello. Soon he had learned to swallow again and was working his way up from applesauce to macaroni and cheese to hamburgers. He was allowed to say hello to his granddaughter Charlotte via video; part of his homework to just keep talking.

“Every day is getting better,” said Kedian, who is moving back to Massachusetts soon. His tracheostomy will remain in place for at least a few more months, but “I’m trying to make it faster because I want to get these tubes out and start living a normal life again.”

And just as Lott had assured him, Kedian retained his beloved Boston accent.