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Doctors Grow New Trachea in 14-Year-Old’s Abdomen and Resect Trachea
Brianna Ranzino. Inset: Brianna and her mom Lisa arrive at BWH prior to surgery
Even after doctors at four hospitals couldn’t save her life and gave her a year to live, Brianna Ranzino’s will to live brought her to BWH, where a team came up with a first-of-its-kind procedure to grow a trachea from her own cells in her abdomen.
“The doctors here have given us a lot of hope,” said her mother, Lisa Ranzino, of Washington Township in Sewell, New Jersey. “I believe this is her opportunity to live.”
Brianna already had endured multiple procedures and surgeries that resulted in 32 incisions—she keeps count—on her young body in the three years since she was diagnosed with a benign granular cell tumor that began crushing her airway. She also developed a tracheal-esophageal fistula, which created a hole between her esophagus and trachea.
“I really don’t remember normal life,” said Brianna, who, since age 11, has had tremendous difficulty eating and drinking, sometimes even swallowing her own spit, because anything she swallows goes into her lungs and causes intense coughing and frequent vomiting. “There are things I miss, like going to school and stuff. But I still have fun.”
The Ranzinos’ had high hopes for the last hospital they visited, where they believed surgeons would be able to close the fistula and surgically reconstruct her trachea. But during the operation, surgeons discovered the tumor had spread. “We were devastated to hear there was nothing they could do,” said her mother. “They gave her a year to live if we did nothing.”
Doing nothing wasn’t an option for the Ranzinos. Even after hearing this news, they kept hoping for a miracle that would allow Brianna to return to the happy, healthy life she had led before the tumor changed everything.
“My daughter and my will for her to live keep me going,” said Lisa Ranzino. “It’s a roller coaster; every time we think we are on the right path, another rug has been pulled out from under us. We weren’t sure where to turn at that point.”
Turning to BWH
The Ranzinos’ hospital in Pennsylvania found BWH’s Chief of Thoracic Surgery David Sugarbaker, MD, and Charles Vacanti, MD, chair of Anesthesiology, Perioperative and Pain Medicine, who proposed a procedure that has never been done before.
Vacanti would take cartilage cells from one of Brianna’s ribs and grow them in an incubator for several months, seeding them with polymer fibers and wrapping the fibers around a tube shaped like her trachea. This would be wrapped in fat and placed in her abdomen for two months, where it was nourished and ultimately would grow. After several months, Sugarbaker would remove the damaged section of the trachea and the tumor and transplant the tissue-engineered trachea.
“I think it’s odd, but it’s cool in a way,” Brianna said. “I call myself the sci-fi child.”
As the trachea grew inside her abdomen in the months leading up to her surgery, Brianna’s strength never wavered. “My family helps me, my best friend Cassidy is always there for me, and I have a dog, Benji, who makes me smile,” she said. “And texting helps, too.”
“I’m not scared for surgery,” she added. “I know it’s going to be painful, but I’ll be better in the end.”
Over three years, she had developed ways to cope with her illness and stay positive. “I think you kind of build up a wall, not so that you forget about it, but just so you don’t let it bother you,” Brianna said.
When she couldn’t eat, she took up cooking and prepared entrees frequently for her parents. “I was depressed at first when I couldn’t eat, so I cooked for everyone else,” she said. “Sometimes I could chew it. It made me feel better.”
And in the past, when other hospitals were unable to help her, she continued looking forward to her future. “She is usually consoling us,” her mother said. “She tells us it’s going to be ok, that someday she is going to get married, have a baby—live her life. She’s an inspiration to all of us.”
On March 18, Brianna was taken to the Operating Room for what would become a 14-hour surgery. Sugarbaker, Raphael Bueno, MD, associate chief of Thoracic Surgery, and their team first removed the tissue-engineered trachea from her abdomen. Vacanti and Koji Kojima, MD, PhD, of Anesthesiology, Perioperative and Pain Medicine, realized that it had not formed enough to transplant.
“This was the first attempt in the world to replace a tissue that would save someone’s life,” said Vacanti, noting that her cells had multiplied very well in the incubator, and the great progress will someday be able to help many other patients. “She has been very courageous throughout the last few months.”
Sugarbaker and Bueno had created back-up plans for various scenarios that could happen during the surgery, including if they weren’t able to use the new trachea. They found the tumor was smaller than they had believed, and they were able to remove it, along with sections of her esophagus and trachea, and pull up the remaining trachea sections and suture them together.
“As far as we know, this operation of removing the esophagus, the windpipe and the carina (the point where the trachea splits into the left and right primary bronchus) has not been reported,” Sugarbaker said. “This little girl had more courage than I’ve witnessed in all my years of practice.”
“Something We Dreamed About”
After several weeks of receiving care in the Thoracic ICU on Tower 11, Brianna and her parents left BWH last week.
“To be in the recovery part is something that we have just dreamed about,” said Lisa Ranzino. “We just had a feeling from the start that the team here was going to be able to make her better.”
The Ranzinos are overcome with gratitude for everyone who played a role in Brianna’s care at BWH. “It’s perfect here,” Brianna said. “You get attached.”
She is looking forward to a full future with school, horseback riding and eating her favorite spicy foods again.
“We are eternally grateful,” Lisa Ranzino said. “Our gratitude runs deep. I don’t know how we found this place, but we did. She is living proof that life will go on.”