Cancer patient receives first-ever complete larynx transplant to restore his voice

A 59-year-old man from Massachusetts is the first known patient to receive a larynx transplant despite active cancer. Patient Marty Kedian joins a very short list of people who have undergone this operation in the past. Surgeons at the Mayo Clinic in Arizona hope that the procedure can soon be offered to more people who have lost their voice to cancer.

The larynx, also called the “vocal apparatus,” is a small, tube-shaped structure that sits above the windpipe and in front of the esophagus. It has a number of important functions: it contains both the vocal cords, which give the human voice sound, and the epiglottis, which prevents food and liquid from entering the esophagus.

Injury can lead to laryngeal dysfunction, and in cases of laryngeal cancer, surgery to remove the larynx may be necessary. This can have life-changing consequences, as the medical team that performed the recent surgery explained in their case report: “These patients may become dependent on tracheostomy tubes or gastrostomy tubes and may lose their ability to communicate verbally.”

A larynx transplant may be the solution, but the operation is difficult to perform and the results are difficult to predict. For this reason, only a handful of people worldwide have undergone the operation, including just two in the United States – one in 1998 and one in 2012.

A team at the Mayo Clinic is currently conducting a clinical trial to better explore the potential of this surgery. Kedian was the first patient to receive his transplant on February 29, 2024. His case differs from the two previous cases in the U.S. in one key way – he had cancer, while both previous transplant recipients had suffered a laryngeal injury.

Kedian had undergone several surgeries to remove the cancer and preserve the function of his larynx, but he subsequently had difficulty speaking and swallowing and required a tracheal tube.

One problem with performing this transplant on cancer patients is the need to take anti-rejection drugs afterwards. Since these drugs weaken the immune system, there is a risk that the cancer will return. In Kedian’s case, however, one point was in his favor: he was already taking immunosuppressants after a kidney transplant and it was thought that these would have no effect on the type of throat cancer he was suffering from, chondrosarcoma.

It took 10 months to find a donor larynx of the right size, then a team of surgeons performed the transplant in a 21-hour operation. Using groundbreaking microsurgery, the nerves that control swallowing and vocal cord movement were reconnected.

Three weeks after the procedure, Kedian was able to say his first word: “Hello.” Since then, he has learned to swallow again and his speech ability continues to improve.

“Every day I’m getting better,” he told AP. “I’m trying to do it faster because I want to get these tubes out and get back to a normal life.”

Since being diagnosed with throat cancer, Kedian has been afraid of losing his voice. “I would love to talk to people everywhere I go, but I just couldn’t. I felt strange and didn’t want to go anywhere,” he said in a statement.

“I wanted this so I could speak and breathe normally with my new granddaughter. I want to read her bedtime stories in my own voice.”

Although throat cancer is a relatively rare cancer overall (184,615 cases were reported worldwide in 2020), it is the most common cause of damage leading to laryngectomy. For the surgical team, transplants offer hope for a significantly improved quality of life for their patients.

“People need to keep their voice,” Kedian told AP. “I want people to know that this is possible.”

The study was published in the journal Mayo Clinic Proceedings.