- On September 2nd and 3rd, surgeons from the Hospices Civils de Lyon performed the first laryngeal transplant in France.
- Two months later, the very long rehabilitation work has just begun for the patient, who has to relearn how to breathe in and out to begin with.
- The same team now plans to perform the first uterus and penile transplants within two years.
Her husband, she said, "had forgotten the sound" of her voice. And her two "daughters had never heard her speak." The first patient to have received a larynx transplant in France – the eleventh in the world – Karine, 49, prefers to give her impressions on paper, while maintaining her anonymity. It is still difficult to speak. Two months after the transplant, carried out at the beginning of September by the surgeons of the Hospices Civils de Lyon, only a grave, almost metallic patch escaped from his throat.
"The mucous membrane is well laid but the larynx is not yet moving. The vocal cords are not strained," explains Philippe Céruse, the instigator of this first transplant. For the time being, Karine finds "her voice abominable," the specialist reveals. "In the first few weeks after surgery, patients always feel like they're going backwards. It's normal, we can't talk again in a few days," adds Lionel Badet, head of the urology and transplant surgery department at Edouard Herriot Hospital.
A very long rehabilitation process
The very long work of rehabilitation has only just begun. It will be necessary to wait for the "nervous regrowth" to regain a zest of sensitivity in the throat within six months. And between twelve and eighteen months for the onset of motor skills of the larynx. This could allow Karine, who is fed by a tube, to be able to eat again. For now, the patient is relearning the essentials: inhale, exhale.
"One day she told me she smelled something weird. It was simply air passing through her upper respiratory tract," said Nathalie Crouzet Victoire, a speech therapist who cared for the mother for two months. She had forgotten what it was. It's hard, but she has faith. »
"Laryngeal innervation is the most complicated thing," says Philippe Céruse. Today, the medical team is not hiding its face. If the surgery is a feat, the total success of the transplant is not guaranteed. Far from it, despite hopes. "The price to pay is patience and uncertainty," confirms Lionel Badet, stressing that it takes "a long time for the transplant to be functional". "When you graft, you set up a timer and that timer defines the survival of the graft. No one is able to predict it. It cannot be ruled out that one day the patient will lose her graft. It's a sword of Damocles hanging over our heads. You have to learn to live with it. »
First uterus and penis transplants?
Karine, who had been breathing through a tracheostomy for twenty years following complications of intubation after a cardiac arrest in 1996, wanted to "get back to a normal life". She volunteered ten years ago knowingly, she writes in a written statement: "I knew it would take courage and patience."
If the HCL has a budget to perform two more laryngeal transplants, it will be necessary to wait until this first patient "is perfectly well" before taking the plunge. In the meantime, the transplant teams in Lyon hope to be the first to carry out "next year or within two years", a uterus transplant for "women affected by permanent and non-reversible sterility" as well as a penis transplant for men "amputated of the penis" who have had a "terrible experience". Two non-vital organs that are "synonymous with social death" in the event of dysfunction, concludes Lionel Badet.