STUDY PURPOSE: Penis transplantation represents a new paradigm in restoring function and anatomic appearance following genitourinary tissue loss. To date, only two penis transplants have been performed worldwide. We describe the first successful penis transplant in the United States in a patient with history of subtotal penectomy for penile cancer.

METHODS: Following IRB approval, extensive medical, surgical, and radiological evaluations of the patient were performed. Candidacy was reviewed by a multidisciplinary team of surgeons, physicians, psychiatrists, social workers, and nurse coordinators. After appropriate donor identification and recipient induction with Thymoglobulin, allograft procurement and recipient preparation took place concurrently. Anastomoses of the urethra, corpora, cavernosal and dorsal arteries, dorsal vein, and dorsal nerves were performed as well as inclusion of a donor skin pedicle as the composite allograft. Maintenance immunosuppression consisted of mycophenolate, tacrolimus and methylprednisolone.

RESULTS: After revascularization the allograft had excellent capillary refill and strong Doppler signals. Operative re-interventions on POD2 and 13 were required for hematoma evacuation and skin eschar debridement. Steroid resistant-rejection developed on POD28 (Banff III), requiring a repeat course of Thymoblobulin. At 7-months, the patient has recovered partial sensation of the penile shaft and spontaneous penile tumescence. Our patient reports increased overall health satisfaction, dramatic self-image improvement, and significant optimism for the future. CONCLUSIONS: We have shown that it is feasible to perform penile transplantation with excellent results. Furthermore, this experience demonstrates that penile transplantation can be successfully performed with conventional immunosuppression. We propose that our successful penile transplantation pilot experience represents proof of concept for an evolution in reconstructive transplantation.

CITATION INFORMATION: Ko D, Li K, Salinas H, Schol I, Treiser M, McGovern F, Feldman A, Bojovic B, Winograd J, Grant M, Ehrlichmann R, Tanrikut C, Lee J, Choy G, Liu R, Rosales I, Colvin R, Eberlin K, Cetrulo, Jr C. Penis Transplantation: First U.S. Experience. Am J Transplant. 2017;17 (suppl 3).

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