Rejection, Desensitization, and Tissue Preservation in Male Urogenital Allotransplantation

To flourish as a human being one does not only require organs, but also a face that enables communication, hands that can cook food, and genitalia that are functional. In the field of reconstructive transplantation these needs are met through the replacement of such functional body parts that were previously lost with donor tissue from a different (deceased) person. Now 25 years after the first hand transplant, face- arm- and penis transplants have been performed across the world.

Many challenges remain for the field of reconstructive transplantation. Currently, relatively little is known about the unique rejection patterns of penis- and hand transplants. Additionally, transplants can only be preserved for short time periods and patients who went through pregnancy or received blood transfusions often cannot receive a transplant due to the immunological memory they developed. This thesis consists of studies that address these issues through experiments in rats and pigs. Additionally, the ethical considerations related to penis transplants are discussed and the extensive transplant of a penis, scrotum, and abdominal wall in a soldier who was wounded through an IED blast is described.