After a penis transplant – “almost anything is possible”

Tyrolean transplant surgeon and researcher Gerald Brandacher still lives in the US. There he starred in the world’s first full male genital transplant (penis plus scrotum) for a soldier wounded in war. Before returning to Innsbruck Medical University in September, Brandacher spoke to the “Krone” about the future of transplant medicine.

„Crown“: Mr. Brandacher, the extraordinary penis transplant was five years ago. How is the patient today?
Gerald Brandacher: The patient recently came to us for a check-up. He’s doing very well. He feels – as he puts it himself – whole and normal again. That is the highest compliment we can get in reconstructive transplant medicine. The purpose of the operation was to replace form and function. We have achieved both. An operation like this will always be the great exception, but it has proven that almost anything is possible nowadays.

So can any part of the body, any organ be transplanted?
Surgically and technically there are practically no restrictions anymore. The limits are immunological in nature. Where organs are rejected by the recipient’s body. To prevent this, patients now have to take medicines for life. This is stressful for the organism and has side effects. Recent research now shows that there are alternatives.

One of your main areas of research is on this topic. Is it conceivable that in the future patients will no longer have to take immunosuppressants to counteract the rejection reaction?
There is legitimate hope that this long-term therapy can be minimized or even made obsolete. We also want to set accents in Innsbruck. A paradigm shift is underway from classical drug therapy to cell-based immunotherapy.

How does this work?
There are different approaches. In the most common method, immune cells from the donor are infused into the recipient. So you have two immune systems in one person, so to speak. These systems can communicate with each other, essentially balancing each other and preventing repulsion. This has already been achieved in clinical studies. Research is now about stabilizing this collaboration.

What does this mean for the development of transplant medicine?
The new methods make it possible to transplant patients who are now excluded because the immune suppression would be too burdensome for them, for example patients after a tumor diagnosis. If we manage to control the rejection effects without drugs, we can also consider considerably more transplants, including in children. I am thinking, for example, of functional facial units that are difficult to reconstruct, such as eyelids, parts of the lip or ears. In these cases, a transplant is still not an option if you have to take immunosuppressants for the rest of your life.

The Innsbruck Transplant Center enjoys an excellent international reputation. But for researchers of their caliber, the US is considered an ideal base. Why the return to Tyrol?
Innsbruck was and is an innovative center. Formerly initiated by Professor Raimund Margreiter, today by Clinic Director Stefan Schneeberger. Academically, I accomplished everything there was to achieve in the US. I have built an internationally renowned research program and have been involved in America’s first double hand transplant, the first arm transplant and the world’s first complete male genital transplant, as mentioned. The call from Innsbruck is now a new challenge for me and the opportunity to integrate research even more closely into daily clinical work. Last but not least, it is also a unique opportunity to go back to my roots, to my homeland. You don’t get an opportunity like that very often in life.