title: Penile Allotransplantation for Complex Genitourinary Reconstruction.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nikolai A
authors.initials: NA
authors.lastname: Sopko
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sami H
authors.initials: SH
authors.lastname: Tuffaha
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Denver
authors.initials: D
authors.lastname: Lough
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: W P Andrew
authors.initials: WPA
authors.lastname: Lee
authors.affiliation: The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
authors.affiliation: The James Buchannan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: Aburnet1@jhmi.edu.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
mesh_terms: D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008297:Male; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000098:blood supply / Q000293:injuries; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000941:ethics / Q000379:methods*; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000941:ethics / Q000379:methods*; D063986:Vascularized Composite Allotransplantation / Q000009:adverse effects / Q000941:ethics / Q000379:methods*; D000093667:Penile Transplantation
keywords: graft rejection; penis; penis agenesis; tissue transplantation