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The First U.S. Penis Transplant: 8-Year Follow-Up
Katya Remy, MD1, Brooke L. Moore, MD
1, Lisa Gfrerer, MD PhD
1, Gabriella J. Avellino, MD
2, Kassem Safa, MD
1, Jonathan Winograd, MD
1, William G. Austen, Jr., MD
1, Kyle R. Eberlin, MD
1, Dicken SC Ko, MD
2, Curtis L. Cetrulo, Jr., MD
3.
1Massachusetts General Hospital, Boston, MA, USA, 2Brown University Warren Alpert Medical School, Providence, RI, USA, 3Cedars-Sinai Medical Center, Los Angeles, CA, USA.
PURPOSE: The first U.S. penis transplant marked a significant milestone in vascularized composite allotransplantation, offering patients the potential to restore urinary/sexual function. However, only five transplants have been performed globally, with only three recipients retaining their grafts. To help establish best practices, we discuss the long-term outcomes of the first U.S. case performed in a 62-year-old male following oncologic subtotal penectomy.
METHODS: Eight-year follow-up evaluation included immunologic (regimen/course/biopsies), erection (rigidity/Sexual Health Inventory for Men (SHIM) score/doppler), urinary (cystoscopy/uroflowmetry/ultrasound), and sensory (objective/patient-reported) function.
RESULTS: Following induction immunosuppression with rabbit anti-thymocytes globulin, maintenance included tacrolimus/mycophenolate/prednisone. Two brief acute rejections were managed with anti-thymocytes globulin/prednisone and cellular rejection with sirolimus (discontinued). Immunologic status remained stable thereafter, with biopsies at year 6 demonstrating subepithelial/perifollicular fibrosis with mild inflammation but no rejection. Combination of intraurethral Trimix, Tadalafil and audio/visual stimulation resulted in the most significant improvement of erection, sufficient for penetration: 60% rigidity increase, 20 SHIM score (mild dysfunction), mild arterial insufficiency, inhibition of venous leak. There were no urinary anastomotic strictures/irregularities between native and allograft mucosa, and only mild decrease in peak flow, corresponding to the patient’s asymptomatic voiding and post-void ultrasound. The shaft/glans were sensitive to monofilament/vibration/pinprick, albeit with reduced temperature (cold/warm/heat pain) and absent two-point discrimination. The patient reported “some” (3/5) light touch/pressure/temperature/erogenous sensation, denied hypersensitivity/pain, and was overall “very satisfied” with sensation. Excellent aesthetics were achieved.
CONCLUSION: These promising long-term immunologic/erectile/urinary/sensory/aesthetic outcomes encourage the broader adoption of penis transplantation, offering new hope for patients with traumatic/oncologic genitourinay loss, including wounded warriors.
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