Penile transplantation: the US experience and institutional program set-up

Abstract

Penile transplantation using vascularized composite allografts is an emerging technique to treat genital loss. In the United States, this procedure has been performed successfully at Massachusetts General Hospital in a patient who had previously undergone treatment for penile cancer. The Johns Hopkins Medical Institutions has developed a research protocol to perform penile transplantation in patients with genital loss secondary to trauma. The process of selecting the appropriate candidate for genitourinary (GU) vascularized composite allograft surgery is rigorous including extensive physical examination, laboratory testing, imaging and psychological evaluations. After transplantation, limiting the potential complications associated with immunosuppression is critical given that the procedure is intended to improve quality of life and is not life-saving. Ultimately, penile transplant is a surgical intervention which may have numerous applications. Optimization of the pre-operative screening process, surgical technique, and immunosuppressive protocol is required to establish this method as the standard treatment for patients with genital loss and limited reconstructive options.

A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction

“…However, the process of selecting the appropriate candidate for genitourinary vascularized composite allograft surgery is rigorous with extensive clinical visits, laboratory testing, imaging and psychological evaluations [71]. Side effects of high dose immunosuppression, including infection and renal toxicity, should be discussed and recipients are screened for possible rejection of the graft with multiple tissue biopsies and regular blood test monitoring for the rest of their life.…”

Penile Allotransplantation: Pushing the Limits

“…The immunomodulatory regimen comprised alemtuzumab and steroid induction, tacrolimus maintenance monotherapy, and a donor bone-marrow infusion on postoperative day 14 [6]. With this novel approach to manipulating the recipient's immune responses and accepting donor tissue as self, the patient now requires a very low dose of oral immunosuppressive medication [7,8].…”

Current status of vascularized composite allografts transplant

“…Un al treilea transplant de penis, primul din SUA, a fost realizat în anul 2016, primitorul fiind un pacient în vârstă de 64 ani, al cărui penis a fost amputat în urma unei neoplazii [56].…”