Human Penile Allotransplantation
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - 69 |
| Updated: | 3/3/2019 |
| Start Date: | June 2014 |
| End Date: | June 2024 |
| Contact: | Jane Littleton, CRNP, MSN |
| Email: | jlittl38@jhmi.edu |
| Phone: | 410-955-6875 |
Injuries to the external genitalia are of great concern to the military with emphasis being
placed on the surgical reconstruction and psychological health of these Wounded Warriors.
However, despite significant surgical advances in microvascular surgery and autologous free
tissue transfer, conventional reconstructions cannot truly replace the complicated structures
and functions of the penis including the urethra, erogenous sensation, and erectile corporal
bodies. Conventional reconstruction poses several challenges: patients may not have
sufficient donor tissue (i.e., the forearm or thigh) due to other injuries or previous
surgery; multiple operations are often needed to restore the neophallus; the final
reconstruction only approximates the penis' native form; recreating the urethra is
challenging and the new urethra is prone to stricture and fistula formation; the erectile
function necessary for sexual intercourse is often lacking; and insufficient protective
sensation can lead to penile implant extrusion, infection, and subsequent explantation or
loss of the reconstruction.
For these reasons, the investigators propose the current clinical trial to determine
functional outcomes and quality of life (QOL) for Wounded Warriors and civilians who choose
to undergo penile allotransplantation. The investigators will combine extensive experience
performing total penile reconstruction in a large population affected by congenital,
traumatic, and therapeutically extirpated Genitourinary (GU) deformities and expertise in
reconstructive transplantation using an immunomodulatory protocol to implement this study.
The investigators anticipate that penile transplantation can potentially replace "like with
like," restoring the appearance, anatomy, and function of the recipient in a manner far
superior to autologous reconstruction. This project will establish the ability to perform
penile allotransplantation using an immunomodulatory protocol and will compare outcomes with
conventional phalloplasty patient results.
Study 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 equivalent or
superior outcomes when compared to satisfaction and QOL in conventional phalloplasty patients
12-60 months post-transplant.
placed on the surgical reconstruction and psychological health of these Wounded Warriors.
However, despite significant surgical advances in microvascular surgery and autologous free
tissue transfer, conventional reconstructions cannot truly replace the complicated structures
and functions of the penis including the urethra, erogenous sensation, and erectile corporal
bodies. Conventional reconstruction poses several challenges: patients may not have
sufficient donor tissue (i.e., the forearm or thigh) due to other injuries or previous
surgery; multiple operations are often needed to restore the neophallus; the final
reconstruction only approximates the penis' native form; recreating the urethra is
challenging and the new urethra is prone to stricture and fistula formation; the erectile
function necessary for sexual intercourse is often lacking; and insufficient protective
sensation can lead to penile implant extrusion, infection, and subsequent explantation or
loss of the reconstruction.
For these reasons, the investigators propose the current clinical trial to determine
functional outcomes and quality of life (QOL) for Wounded Warriors and civilians who choose
to undergo penile allotransplantation. The investigators will combine extensive experience
performing total penile reconstruction in a large population affected by congenital,
traumatic, and therapeutically extirpated Genitourinary (GU) deformities and expertise in
reconstructive transplantation using an immunomodulatory protocol to implement this study.
The investigators anticipate that penile transplantation can potentially replace "like with
like," restoring the appearance, anatomy, and function of the recipient in a manner far
superior to autologous reconstruction. This project will establish the ability to perform
penile allotransplantation using an immunomodulatory protocol and will compare outcomes with
conventional phalloplasty patient results.
Study 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 equivalent or
superior outcomes when compared to satisfaction and QOL in conventional phalloplasty patients
12-60 months post-transplant.
Specific Aims: 1) To assess the feasibility and function of penile allotransplantation in
Wounded Warriors and civilians who have lost their penis due to battle or traumatic injury,
using an immunomodulatory protocol to reduce immunosuppression; 2) To assess pre-to-post
changes in QOL in patients who undergo penile allotransplantation.
Wounded Warriors and civilians who have lost their penis due to battle or traumatic injury,
using an immunomodulatory protocol to reduce immunosuppression; 2) To assess pre-to-post
changes in QOL in patients who undergo penile allotransplantation.
Donor Inclusion Criteria:
- 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
Recipient Inclusion Criteria:
- 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.
- 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.
Recipient and Donor Exclusion Criteria:
- Untreated sepsis.
- HIV (active or seropositive).
- Active tuberculosis.
- Active Hepatitis B infection.
- Hepatitis C.
- Viral encephalitis.
- Toxoplasmosis.
- Malignancy (within past 5 years).
- Current/recent (within 3 months of donation/screening consent) IV drug abuse.
- Paralysis of ischemic or traumatic origin.
- Inherited peripheral neuropathy.
- Infectious, post infectious, or inflammatory (axonal or demyelinating) neuropathy.
- Toxic neuropathy (i.e. heavy metal poisoning, drug toxicity, industrial agent
exposure).
- Mixed connective tissue disease.
- Severe deforming rheumatoid or osteoarthritis in the limb.
Donor Only Exclusion Criteria:
- Evidence of active herpes simplex virus-2 (HSV-2) infection.
- Tattoos: non-professional tattoo within the last 6 months, or personally identifiable
tattoo (i.e., donor name) on potential transplant.
Recipient Only Exclusion Criteria:
- Conditions that, in the opinion of the study team, may impact the immunomodulatory
protocol potentially exposing the recipient to an unacceptable risk under
immunosuppressive treatment.
- Sensitized recipients with high levels (50%) of panel-reactive human leukocyte antigen
(HLA) antibodies.
- Conditions that may impact the success of the surgical procedure or increase the risk
of postoperative complications including inherited coagulopathies like Hemophilia,
Von-Willebrand's disease, Protein C and S deficiency, Thrombocythemias, Thalassemias,
Sickle Cell disease, etc.
- Conditions that may impact functional outcomes including Lipopolysaccharidosis and
amyloidosis (may impact nerve regeneration).
- Patients considered psychologically/psychiatrically unsuitable.
We found this trial at
1
site
733 North Broadway
Baltimore, Maryland 21205
Baltimore, Maryland 21205
(410) 955-3182
Phone: 443-287-4629
Johns Hopkins University School of Medicine Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is...
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