Penile Allotransplantation for Complex Genitourinary Reconstruction

Research output: Research - peer-reviewArticle

Abstract

Purpose: Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. Penile transplantation is a novel vascularized composite allotransplantation treatment option for severe penile tissue loss and disfigurement. Three allogeneic human penile transplantations have been reported. We review these cases as well as penile transplant indications, preclinical models and immunosuppression therapy. Materials and Methods: We performed a comprehensive literature review for the years 1970 to 2016 via MEDLINE®, PubMed® and Google with the key words "penis transplantation," "penile rejection," "penile replantation," "penile tissue loss" and "penis vascularized composite allotransplantation." Relevant articles, including original research, reviews and nonscientific press reports, were selected based on contents, and a review of this literature was generated. Results: Three human allogeneic penile transplantations have been performed to date, of which 1 was removed 14 days after transplantation. The second recipient reports natural spontaneous erections and impregnating his partner. All 3 patients were able to void spontaneously through the graft's urethra. The complexity of the transplant is determined by how proximally the penile shaft anastomosis is performed and additional pelvic tissue may be transplanted en bloc if needed. Conclusions: Penile transplantation is a technically demanding procedure with significant ethical and psychosocial implications that can provide tissue and functional replacement, including urinary diversion and natural erections. It is unclear how rejection and immunosuppression may affect graft function. Better models and more preclinical research are needed to better understand and optimize penile transplantation.

LanguageEnglish (US)
JournalJournal of Urology
DOIs
StateAccepted/In press - 2017

Fingerprint

Transplantation
Transplants
Vascularized Composite Allotransplantation
Penis
Immunosuppression
Research
Therapeutics
Urinary Diversion
Replantation
Homologous Transplantation
Graft Rejection
Urethra
PubMed
MEDLINE

Keywords

  • Graft rejection
  • Penis
  • Penis agenesis
  • Tissue transplantation

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Penile Allotransplantation for Complex Genitourinary Reconstruction",
abstract = "Purpose: Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. Penile transplantation is a novel vascularized composite allotransplantation treatment option for severe penile tissue loss and disfigurement. Three allogeneic human penile transplantations have been reported. We review these cases as well as penile transplant indications, preclinical models and immunosuppression therapy. Materials and Methods: We performed a comprehensive literature review for the years 1970 to 2016 via MEDLINE®, PubMed® and Google with the key words {"}penis transplantation,{"} {"}penile rejection,{"} {"}penile replantation,{"} {"}penile tissue loss{"} and {"}penis vascularized composite allotransplantation.{"} Relevant articles, including original research, reviews and nonscientific press reports, were selected based on contents, and a review of this literature was generated. Results: Three human allogeneic penile transplantations have been performed to date, of which 1 was removed 14 days after transplantation. The second recipient reports natural spontaneous erections and impregnating his partner. All 3 patients were able to void spontaneously through the graft's urethra. The complexity of the transplant is determined by how proximally the penile shaft anastomosis is performed and additional pelvic tissue may be transplanted en bloc if needed. Conclusions: Penile transplantation is a technically demanding procedure with significant ethical and psychosocial implications that can provide tissue and functional replacement, including urinary diversion and natural erections. It is unclear how rejection and immunosuppression may affect graft function. Better models and more preclinical research are needed to better understand and optimize penile transplantation.",
keywords = "Graft rejection, Penis, Penis agenesis, Tissue transplantation",
author = "Sopko, {Nikolai A.} and Tuffaha, {Sami H.} and Denver Lough and Gerald Brandacher and Lee, {W. P.Andrew} and Bivalacqua, {Trinity J.} and Redett, {Richard J.} and Burnett, {Arthur L.}",
year = "2017",
doi = "10.1016/j.juro.2016.10.134",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Penile Allotransplantation for Complex Genitourinary Reconstruction

AU - Sopko,Nikolai A.

AU - Tuffaha,Sami H.

AU - Lough,Denver

AU - Brandacher,Gerald

AU - Lee,W. P.Andrew

AU - Bivalacqua,Trinity J.

AU - Redett,Richard J.

AU - Burnett,Arthur L.

PY - 2017

Y1 - 2017

N2 - Purpose: Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. Penile transplantation is a novel vascularized composite allotransplantation treatment option for severe penile tissue loss and disfigurement. Three allogeneic human penile transplantations have been reported. We review these cases as well as penile transplant indications, preclinical models and immunosuppression therapy. Materials and Methods: We performed a comprehensive literature review for the years 1970 to 2016 via MEDLINE®, PubMed® and Google with the key words "penis transplantation," "penile rejection," "penile replantation," "penile tissue loss" and "penis vascularized composite allotransplantation." Relevant articles, including original research, reviews and nonscientific press reports, were selected based on contents, and a review of this literature was generated. Results: Three human allogeneic penile transplantations have been performed to date, of which 1 was removed 14 days after transplantation. The second recipient reports natural spontaneous erections and impregnating his partner. All 3 patients were able to void spontaneously through the graft's urethra. The complexity of the transplant is determined by how proximally the penile shaft anastomosis is performed and additional pelvic tissue may be transplanted en bloc if needed. Conclusions: Penile transplantation is a technically demanding procedure with significant ethical and psychosocial implications that can provide tissue and functional replacement, including urinary diversion and natural erections. It is unclear how rejection and immunosuppression may affect graft function. Better models and more preclinical research are needed to better understand and optimize penile transplantation.

AB - Purpose: Reconstruction of complex functional structures is increasingly being performed with vascularized composite allotransplantation. Penile transplantation is a novel vascularized composite allotransplantation treatment option for severe penile tissue loss and disfigurement. Three allogeneic human penile transplantations have been reported. We review these cases as well as penile transplant indications, preclinical models and immunosuppression therapy. Materials and Methods: We performed a comprehensive literature review for the years 1970 to 2016 via MEDLINE®, PubMed® and Google with the key words "penis transplantation," "penile rejection," "penile replantation," "penile tissue loss" and "penis vascularized composite allotransplantation." Relevant articles, including original research, reviews and nonscientific press reports, were selected based on contents, and a review of this literature was generated. Results: Three human allogeneic penile transplantations have been performed to date, of which 1 was removed 14 days after transplantation. The second recipient reports natural spontaneous erections and impregnating his partner. All 3 patients were able to void spontaneously through the graft's urethra. The complexity of the transplant is determined by how proximally the penile shaft anastomosis is performed and additional pelvic tissue may be transplanted en bloc if needed. Conclusions: Penile transplantation is a technically demanding procedure with significant ethical and psychosocial implications that can provide tissue and functional replacement, including urinary diversion and natural erections. It is unclear how rejection and immunosuppression may affect graft function. Better models and more preclinical research are needed to better understand and optimize penile transplantation.

KW - Graft rejection

KW - Penis

KW - Penis agenesis

KW - Tissue transplantation

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