title: Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor.
abstract: BACKGROUND
  Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation.
  
  
  METHODS
  A previous recipient of a kidney-pancreas transplant presented with osteoradionecrosis of the calvaria and a large area of unstable scalp following successful, curative treatment of a scalp tumor. His kidney and pancreas functions were also critically poor. A multidisciplinary, multi-institutional plan was developed to perform a simultaneous scalp, skull, and repeated kidney and pancreas transplantation, all from a single donor.
  
  
  RESULTS
  Eighteen months after the patient was listed with the United Network for Organ Sharing, a donor was identified and the multiorgan vascularized composite allotransplantation was performed. Twenty physicians and 15 hours were required to perform donor and recipient procedures. The patient recovered well and was discharged on postoperative day 15. He has had one episode of scalp rejection confirmed by biopsy and treated successfully. His creatinine value is currently 0.8 mg/dl, from 5.0 mg/dl, and his blood glucose levels are normal without supplemental insulin. Aesthetic outcome is very satisfactory. The patient is now 1 year post-transplantation and doing well.
  
  
  CONCLUSIONS
  Vascularized composite allotransplantation in solid organ recipients is an expansion of current indications to already immunosuppressed patients. Rejection of the vascularized composite allotransplant without solid organ rejection can occur and is treatable. Methodical planning, an interdisciplinary approach, and careful management of all organs are critical to success.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Lilian
authors.initials: L
authors.lastname: Gaber
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Michael
authors.initials: M
authors.lastname: Klebuc
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Todd
authors.initials: T
authors.lastname: Trask
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.affiliation: Houston, Texas.|From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center; and the Departments of Surgery, Plastic Surgery, and Neurosurgery and the J.C. Walter Jr. Transplant Center, Houston Methodist Hospital.
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D003131:Combined Modality Therapy; D064595:Composite Tissue Allografts; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D016030:Kidney Transplantation; D007890:Leiomyosarcoma / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000601:surgery; D016035:Pancreas Transplantation; D010294:Parietal Bone / Q000528:radiation effects / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation / Q000379:methods; D012535:Scalp / Q000637:transplantation*; D012878:Skin Neoplasms / Q000601:surgery; D012886:Skull / Q000637:transplantation*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D009927:Tissue and Organ Procurement / Q000379:methods