Human Penile Allotransplantation
Design: This is a non-randomized subject self-controlled clinical trial to implement a cell-based immunomodulatory protocol for penile allotransplantation. An intermediate deliverable is achieving allograft survival and functional return with reduced dosing/frequency of maintenance immunosuppression on steroid-free monotherapy (tacrolimus) immunosuppression. The long-term deliverable and goal is to demonstrate superior outcomes when compared to satisfaction and QOL in conventional phalloplasty patients 12-60 months post-transplant.
• Males aged 16 - 65 years.
• Brain dead meeting the criteria for Determination of Death.
• Family consent for penile graft donation.
• Stable donor (i.e., does not require excessive vasopressors to maintain blood pressure).
• Same blood type as recipient.
• Negative lymphocytotoxic crossmatch.
• Accurately matched for skin tone
• Males of any race, color or ethnicity; aged 18-69 years.
• Recent (≥6 months) or remote (i.e., several decades) penile injury resulting in the loss of ≥75% of the phallus.
• Penectomy secondary to penile cancer
• Penile Cancer Survivors \> 5 years
• Micropenis associated with congenital/birth defect and severely ambiguous male genitalia
• Must have completed a clinic appointment with one of the study surgeons to discuss all penile reconstructive options.
• Completes the protocol informed consent form(s).
• No co-existing medical condition which, in the opinion of the study team, could affect the immunomodulatory protocol, surgical procedure, or functional results (If the condition is amenable to treatment, the study team must agree that said condition should not significantly enhance the surgical risks of penile transplantation.).
• No co-existing psycho-social problems (i.e., alcoholism, drug abuse).
• Negative for malignancy for past 5 years.
• Negative for HIV at transplant.
• Negative crossmatch with donor.
• Consents to sample (i.e., skin biopsy) collection and storage and bone marrow infusion as part of the treatment regimen.
• USA citizen or equivalent.
• Patient agrees to comply with the protocol and states a dedication to the immunomodulatory treatment regimen.