Vascularized Composite Allograft: Lead a More Normal Life!!!

Organ transplantation is a medical procedure which involves surgical transfer of a donated organ to a patient diagnosed with organ failure. An organ and/or tissues that are transplanted within the same person’s body, is called autografts. Transplants that are performed between two different people are called allografts. Organ transplantation is a novel phenomenon in medical sciences and has been an important achievement and a sign of the advancement for the medical centers around the world.

The milestone in organ transplant is the latest series of medical advancements that have pushed transplantation science beyond simply lifesaving. The first successful organ transplant was performed in 1954 (renal transplant), and since then, surgeons have achieved transplantation of such vital organs as livers, lungs, and hearts. They have been also trying to replace hands, arms, uteruses, penises and even faces in the last two decades.

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Recently, by the significant results and success achieved over the past 50 years in solid organ transplantation, surgeons have introduced a new technique of transplantation, which involves transplantation of multiple tissues such as bones, tendons, ligaments, muscles, and skin, as a multiple functional unit (e.g., face or a hand) from a donor to the recipient with severe injuries. This novel technology is known as Vascularized Composite Allograft (VCA). Mostly clinical teams are applying this technology to patients with Non-salvageable injuries such as limb amputation or severe burns.

Autologous (patient’s own) tissue are mostly used for performing  reconstruction procedures for major injuries or defects caused due to congenital anomalies, tumor removal, trauma, skin burns. However, there are various complex injuries that cannot be reconstructed in this conventional reconstruction way. VCA could possibly achieve near normal tissue reconstruction, restoration and replacement with proper or improved functional and esthetic outcomes.

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VCA has been performed over 10 years where, over 90 patients have received this technology based surgery worldwide, in which hand transplants were the most common. Along with hand transplants, 17 facial transplants were also performed with promising results and functional outcomes and intermediate to long-term allograft (transplantation between two different people) survival. These early successes have proved that the surgery involving VCA can be successful and also indicates that this area need support and further research to change the complete dimension of organ transplantation in modern era.

It was thought that VCA based surgery can serve as potential replacements for traumatic tissue losses such as limb loss from explosive devices, accidents with farm machinery, injuries or major burns. VCAs though very effective can tolerate only limited ischemia time (it can’t be stored or processed), also it requires rapid processing of blood flow, and donor-recipient matching. Thus they have unique characteristics for regulatory purposes.

Recently in March 26, 2018, VCA (Vascularized Composite Allotransplantation or Allograft) was performed successfully in a surgery involving transplantation of entire penis along with scrotum (without testicles to avoid the ethical issues that might ensue if he later had children). This was the first of its kind surgery where an entire penis along with scrotum was transplanted.

Previously, the first in South Africa in 2014 and the second at Massachusetts General Hospital in 2016 involved only the penis transplantation.

This surgery was a 14-hour procedure performed at Johns Hopkins School of Medicine carried out by two urological surgeons and nine plastic surgeons, where they removed the patient’s damaged tissues and connected three arteries, four veins, two nerves and the urethra to the donated tissues. The recipient (who wishes to remain anonymous) is a U.S. veteran who was severely injured by an IED (explosive device) blast in Afghanistan. He lost both legs below his knees, but was particularly distraught by the loss of his genitals. A single piece of tissue was restored that weighed around five pounds and was about 10 inches in length. A deceased donor provided the entire penis, scrotum (without testicles), and partial abdominal wall. And the surgeons transplanted the skin, muscles, tendons, nerves, bone, and blood vessels.

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From the latest updates — the patient is doing well and the first test to know whether the surgery restored urinary function is expected any day now. It is expected that in another six months the patient may regain sexual functions and sensations as well. Gerald Brandacher (who handled the immune aspects of the transplant) said, the recipient’s body may reject the donated tissue at any time, so he has to be on continuous therapy to control his immune system. Also to reduce the risk of rejection, the sergeant was also infused with bone marrow from the donor.

The surgical team headed by plastic surgeon Richard Redett, at a news conference on April 23, said that now the patients will have a chance to “Lead A More Normal Life.”

©BforBiotech by Bedadyuti Mohanty, Assistant Managing Editor by Profession and Bio-technologist by heart. 

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