A variety of benign and malignant disorders affecting the trachea can theoretically be treated by simple resection and subsequent end-to-end anastomosis of remained trachea. Unfortunately, it is feasible only when the affected tracheal length does not exceed 50% of the entire length in adults and about 30% in children. Tracheal transplantation may be a treatment option for those patients, but still has many problems to be solved, such as immunological rejection, revascularization, infection and granulation tissue hyperplasia. This review focuses on how to use different methods to inhibit immunological rejection of tracheal transplantation, and current research progress of immunological rejection in tracheal allograft.
In vivo transplantation of tracheal grafts utilizes natural environment in vivo to improve cell adhesion, growth and scaffold properties, which can not only promote graft revascularization, but also induce immune tolerance and increase postoperative survival rate. Decellularized trachea with stem cells covering the outside layer and airway epithelial cells covering the inside layer can achieve complete mucosa re-epithelialization, cartilage cell growth and revascularization, using own body as a natural bioreactor to boost the maturity of tissue engineered trachea. Then transplantation at a normotopic in situ positioning is performed. This transplantation strategy provides a promising approach for the treatment of long-segment tracheal defects. This review focuses on the significance and research progress of constructing tissue engineered trachea in vivo.