A team of surgeons at Massachusetts General Hospital (MGH), led by Curtis L. Cetrulo, Jr., MD, and Dicken S.C. Ko, MD, announced today that they have performed the nation's first genitourinary reconstructive (penile) transplant. The 15-hour operation, which took place earlier this month, involved surgically grafting the complex microscopic vascular and neural structures of a donor organ onto the comparable structures of the recipient.
The patient, Thomas Manning, 64, of Halifax, Mass, continues to recover well, with blood flow established to the donor organ and no signs of bleeding, rejection or infection. While the patient is still early in the post-surgical healing process, his physicians say they are cautiously optimistic he will regain function that he lost in 2012 when a diagnosis of penile cancer led him to undergo a curative partial penectomy - or amputation of the penis.
Called a genitourinary vascularized composite allograft (GUVCA) transplant, this month's landmark procedure represents the culmination of more than 3½ years of research and collaboration across multiple departments and divisions within the MGH - including Plastic and Reconstructive Surgery, Urology, Psychiatry, Infectious Disease, Nursing, and Social Work - all of which are part of the MGH Transplant Center. Cetrulo and Ko together began researching the possibility of performing a GUVCA transplant in 2012, shortly after an MGH team led by Cetrulo completed its first hand transplant. Working closely with the New England Organ Bank, both surgeons developed key strategic surgical approaches aimed at helping patients with devastating genitourinary injuries.
According to the surgeons, the three major goals of GUVCA transplants are to reconstruct external genitalia to a more natural appearance, re-establish urinary function, and potentially achieve sexual function.
The loss of genitalia can be truly devastating to an individual's identity and sense of manhood. While individuals who have lost their penises to disease or who have suffered genitourinary injuries in combat or through a traumatic event can live without an intact organ, the psychological aspects of such an injury can be overwhelming, the surgeons said. The ability to offer a more acceptable long-term solution has been the motivation driving this research.
"We are hopeful that these reconstructive techniques will allow us to alleviate the suffering and despair of those who have experienced devastating genitourinary injuries and are often so despondent they consider taking their own lives," said Cetrulo, of the MGH Division of Plastic and Reconstructive Surgery and the Transplant Center. "The entire transplant team has worked tirelessly to ensure that our patient is on the path to recovery, thanks in part to the gift of organ donation."
Ko, a urologist and transplant surgeon, attributes the ability to achieve this most recent transplant milestone to an "extraordinary multidisciplinary team coupled with the distinctive surgical expertise" at the MGH. "These proof-of-principle cases will help establish the techniques used in this procedure and will forge the path to future treatment of patients with significant pelvic and genitourinary tissue loss related to cancer, trauma or infection," said Ko, who directs the MGH Urology Regional Program and is the past-president of the Urologic Society for Transplantation and Renal Surgery. "We are delighted to have taken the first steps to help those patients who have suffered silently for far too long."
In a statement, the patient expressed his desire to tell his story to help others who may benefit from this type of procedure. "Today I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries, particularly for our service members who put their lives on the line and suffer serious damage as a result," Manning wrote. "In sharing this success with all of you, it's my hope we can usher in a bright future for this type of transplantation." Manning thanked his family and his medical team, and he extended his sympathies and gratitude to the generous family of the donor who gave him the chance for an improved quality of life.
Alexandra Glazier, president and CEO of the New England Organ Bank, noted that the transplant was made possible because the donor family had the strength to look past its own grief and see the ability to help someone in need. "To this donor family, we offer our thoughts as they struggle with their loss and our humble thank you, deep appreciation and admiration for the humanity they showed," Glazier said. "They wish the recipient to know that they feel blessed and are delighted to hear his recovery is going well and are praying that his recovery continues."
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. Transplantation research is aimed at enabling patients to live drug-free after transplant through the induction of immunologic tolerance to the donor organ. The MGH topped the Nature Index list of health care organizations publishing in leading scientific journals in 2015; ranked number one on the 2015-'16 U.S. News & World Report list of "America's Best Hospitals"; and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service.