New Era of Organ Transplant dawns

                In a first-of-its-kind procedure, doctors in the United States have successfully transplanted a “composite” skull and scalp flap, along with kidney and pancreas – all from the same donor – in a 55 year old patient. The patient was suffering from a non-healing scalp defect and declining organ kidney and pancreas function. Hopefully, this case and others like it will help to widen the narrow indications for this fascinating new field of reconstructive surgery.

                The experience may open the way to further procedures combining “vascularised composite allotransplantation” (VCA) with organ transplants, in patients who have already accepted the need for lifelong immunosuppressive therapy. VCA refers to transplant procedures combining different type of tissues, such as skin, muscle, blood vessels, nerves and bone.

                However, they have a major drawback – the need for immunosuppressive drugs to prevent the recipient’s immune system from rejecting the transplant. Two decade earlier, the 55 year old patient had undergone kidney transplantation for diabetic kidney disease, but that kidney was now failing.

                He also had a large, unstable wound of the scalp and skull – a complication of surgery and radiation therapy for a scalp tumour. Since the patient was already receiving immunosuppressive therapy and would need another organ transplant in any case, doctors suggested a procedure in which a VCA of scalp and skull would be performed at the same time as a kidney/pancreas transplant, all coming from the same door.