{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:17:17Z","timestamp":1787822237184,"version":"build-2784847793"},"reference-count":103,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Laryngeal transplantation represents one of the most complex forms of vascularized composite allotransplantation (VCA), aiming to restore respiration, phonation, and swallowing in patients with irreversible laryngeal dysfunction. Over the past decades, systematic preclinical research\u2014including refinement of large-animal and rodent models, organ preservation optimization, and elucidation of immunological mechanisms\u2014has laid the scientific foundation for clinical translation. Advances in static cold storage, emerging machine perfusion technologies, and biomarker-based precision monitoring have further improved graft viability and rejection surveillance. Clinically, since the first successful human laryngeal transplantation in 1998, approximately 16 cases worldwide have demonstrated the feasibility of long-term graft survival and meaningful functional recovery. More recently, indications have expanded from trauma-related defects to carefully selected oncologic patients under rigorous immunological and ethical oversight. Surgical progress has focused on microvascular reconstruction, selective neural reinnervation, and airway stabilization, while postoperative management emphasizes individualized immunosuppression, structured rehabilitation, infection prophylaxis, and lifelong surveillance for rejection and malignancy. Nonetheless, major challenges persist, including chronic rejection, variability in functional outcomes, oncologic safety under immunosuppression, donor scarcity, and unresolved ethical issues in a non\u2013life-saving transplant context. Future directions center on integrating multi-omics biomarkers, machine-learning\u2013based monitoring, bioengineered scaffolds, and personalized immunomodulation to enhance long-term graft function and safety. Overall, laryngeal transplantation has evolved from experimental feasibility to a clinically realistic reconstructive strategy, yet its broader application will depend on multidisciplinary innovation and rigorous ethical governance.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1833564","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:18:38Z","timestamp":1787818718000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Laryngeal transplantation: from experimental feasibility to multidisciplinary clinical reality"],"prefix":"10.3389","volume":"13","author":[{"given":"Lu","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Surgery and Intervention Center\u200c, West China Hospital, Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longhao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University , Chengdu","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1097\/MOT.0000000000001028","article-title":"Vascularized composite allotransplantation: emerging psychosocial issues in hand, face, and uterine transplant","volume":"27","author":"Kumnig","year":"2022","journal-title":"Curr Opin Organ Transplant"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1097\/TP.0b013e3181ff1472","article-title":"The international registry on hand and composite tissue transplantation","volume":"90","author":"Petruzzo","year":"2010","journal-title":"Transplantation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e70126","DOI":"10.1111\/ctr.70126","article-title":"Strategic development of a larynx and Trachea transplantation program: the mayo clinic Arizona experience","volume":"39","author":"Zacharias","year":"2025","journal-title":"Clin Transplant"},{"key":"B4","doi-asserted-by":"publisher","first-page":"505","DOI":"10.5999\/aps.2014.41.5.505","article-title":"Risk acceptance and expectations of laryngeal allotransplantation","volume":"41","author":"Jo","year":"2014","journal-title":"Arch Plast Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"106301","DOI":"10.1016\/j.oraloncology.2022.106301","article-title":"Survival and functional outcomes after total glossectomy with total laryngectomy: case series from a high-volume tertiary institution","volume":"137","author":"Burnham","year":"2023","journal-title":"Oral Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ijom.2024.07.005","article-title":"Functional outcomes and survival after total glossectomy with laryngectomy: a systematic review","volume":"54","author":"Weyh","year":"2025","journal-title":"Int J Oral Maxillofac Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1002\/hed.70001","article-title":"A new orthotopic mouse model of laryngeal squamous cell carcinoma","volume":"48","author":"Wang","year":"2026","journal-title":"Head Neck"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1002\/lary.26503","article-title":"The current status of human laryngeal transplantation in 2017: a state of the field review","volume":"127","author":"Krishnan","year":"2017","journal-title":"Laryngoscope"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1631525","DOI":"10.3389\/fimmu.2025.1631525","article-title":"What are the functional outcomes of total laryngeal transplantation? 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