Successful allotransplantation of cryopreserved tracheal grafts with preservation of the pars membranacea in nonhuman primates Tomohiro Murakawa, MD,

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Successful allotransplantation of cryopreserved tracheal grafts with preservation of the pars membranacea in nonhuman primates Tomohiro Murakawa, MD, Jun Nakajima, MD, Noboru Motomura, MD, Arata Murakami, MD, Shinichi Takamoto, MD The Journal of Thoracic and Cardiovascular Surgery Volume 123, Issue 1, Pages 153-160 (January 2002) DOI: 10.1067/mtc.2002.119056 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Preparations of cryopreserved tracheal allografts and operative procedure. A cryopreserved tracheal allograft was prepared (A). Five rings of the recipient trachea were resected with the membranous portion of the graft left intact (B), and a cryopreserved tracheal allograft was transplanted after the resection of the membranous portion (C). The donor trachea was orthotopically transplanted (D). The Journal of Thoracic and Cardiovascular Surgery 2002 123, 153-160DOI: (10.1067/mtc.2002.119056) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Histologic and electron microscopic findings after graft thawing. After the cryopreservation and thawing procedure, the major histologic change was the detachment of the airway epithelium (A and B). The intracellular organelles in the residual epithelium were mostly destroyed (C). The cartilage was well preserved, even after 12 months of cryopreservation (A). A, Hematoxylin-and-eosin staining, original magnificant ×10; B, scanning electron microscopy, original magnification ×2400; C, transmission electron microscopy, original magnification ×6000. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 153-160DOI: (10.1067/mtc.2002.119056) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Bronchoscopic, macroscopic, and histologic findings of the cryopreserved tracheal allotransplantation group. Bronchoscopic findings in the cryopreserved tracheal allotransplantation group revealed that grafts were well incorporated, with good airway patency and a good airway epithelium lining (A). Macroscopic and histologic examination of the transplanted grafts in the cryopreserved allotransplantation group revealed a good patency of the implanted grafts with dense epithelial lining and well-maintained cartilaginous viability (B-E). A small degree of intercartilaginous tissue shrinkage was observed (C), and a mild degree of mononuclear cell infiltration was observed in the submucosal layer (E). This Figure represents findings 12 months after transplantation. Hematoxylin-and-eosin staining: C and D, originally ×4; E, originally ×10. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 153-160DOI: (10.1067/mtc.2002.119056) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Electron microscopic findings of the cryopreserved tracheal allotransplantation group. Electron microscopic examination revealed a dense covering of airway epithelial cells on the implanted grafts (A) and well-developed intracellular organelles, indicating good cellular function (B). This Figure represents findings 12 months after transplantation. A, Scanning electron microscopy; original magnification ×2400; B, transmission electron microscopy, original magnification ×6000. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 153-160DOI: (10.1067/mtc.2002.119056) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Bronchoscopic, macroscopic, and histologic findings of the control group. In the control group severe stenosis occurred in all animals (A and B). Histologically, remarkable cellular infiltration in the transplanted grafts of the fresh allo-transplantation animals (C) and severe fibrosis and the destruction of the cartilaginous rings in the transplanted graft of the simply frozen allograft animal (D) were observed. This Figure represents findings 3 months after transplantation. Hematoxylin-and-eosin staining: original magnifications ×4 (C and D). The Journal of Thoracic and Cardiovascular Surgery 2002 123, 153-160DOI: (10.1067/mtc.2002.119056) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions