AB215. Penis transplant: a long way to success

OBJECTIVE: Transplant seems to be an ideal and mature treatment for some late-stage diseases. The first penis transplant operation was performed in China about 9 years ago and recently, a piece of news reporting another successful penis transplant in South Africa had spread throughout the world. Overall, penis transplant was seldom reported. METHODS: PubMed, ISI Web of Science and Google Scholar databases (until January 2016) were searched for relevant publications on penis transplant. RESULTS: Penile defects caused by various reasons and transsexual persons might be an ideal graft recipient for penis transplant. Graft donor might be confined to some volunteer organ donors or male-to-female transsexual persons. Although for patients with penis defects, penis replantation, penis reconstruction and penis lengthening were widely used, those treatments were often accompanied with shortcomings such as multiple operations, nerve/vascular damage and limited ischemic time. In penis transplant, except for anatomical technical skills, functional issues should also be addressed. Penis transplant required not only a successful urination but also a well erectile function. Experience of several penis replantation operations of amputated penis in our hospital showed that the anastomoses of blood vessels (deep/dorsal artery, superficial/deep dorsal vein) with microsurgical technique could ensure its survival. Meanwhile, well dorsal nerves repair could make the erectile function rehabilitation possible. Similarly, penis transplant also required above repair of blood vessels and nerves. Besides, penis transplant needed further care to avoid allograft rejection just like other transplants. However, at present, no guidelines could be referred for the application of immunosuppression drugs in penis transplants. Unlike kidney transplants, which require only anastomoses of vessels, penis transplants need skin and nerve repair. Thus, immunosuppressants should refer to some composite tissue transplants such as face/hand transplants. Penis transplant prompted much ethical discussion and also brought some psychological concerns for recipients and his partners. Ethical/Psychological issues were also a key point for successful transplant operations. CONCLUSIONS: Penis transplant should be performed in collaboration with surgeons, anesthetists, nurses, psychologists and ethicists. Since some concerns about functional issues, immunosuppression-related problems and ethical/psychological concerns, the application of penis transplant was often limited. However, when all the problems are solved, penis transplant will be a new ideal option and I believe it will come in the near future.