Introduction
Vascularized Composite Allotransplantation (VCA) has been a clinical reality in hand transplantation since the late 1990s and in facial transplantation since 2005. VCA has ushered in a very exciting and explosive era of research and new modalities to offer patients in need of options the potential for restorative operative interventions. In addition to upper extremity and facial VCA, much interest has been given to genitourinary VCA, specifically penile transplantation. Recent conflicts that have rendered many wounded warriors with devastating genitourinary injuries, a subset of penile cancer patient survivors previously left with disfiguring or minimal residual penile function, and a newer group of transgender patients interested in more realistic reconstruction than current autologous state-of-the-art techniques can offer, have furthered research and interest in penile VCA. Two prior successful penile VCA cases have been performed to date in the world literature experience.
Methods
A protocol for penile VCA was approved by the Internal Review Board at Massachusetts General Hospital (MGH) Appropriate candidate screening and selection was approved by the patient selection committee. Preoperative preparation via recipient patient defect-specific cadaveric dissection sessions was performed. The New England Organ Bank (NEOB) facilitated donor patient screening for protocol screened and approved recipient candidates.
Results
In early May, 2016, a potential donor was identified by the NEOB for a recipient patient accepted by the IRB-approved protocol at MGH. Team mobilization ensued and the recipient patient was informed. Subsequently, the first successful penile VCA in the United States was performed over the course of a 15 hour operation. One week out from the successful procedure, the recipient patient is doing well and meeting expected milestones in recovery.
Conclusions
We herein present the first successful penile VCA performed in the United States and have demonstrated proof of concept. This now becomes the third case in the world literature experience and opens the discussion of genitourinary VCA to a new geographic focus in the world, possibly leading to further such transplants to now be considered and performed in this important and deserving patient population.