A collaboration between The University of Texas MD Anderson Cancer Center and the Houston Methodist Hospital resulted in the first successful transplant of a scalp and skull while performing a pancreas and kidney transplant. The surgery was performed in James Boysen, a 55-year-old software developer from Austin, Texas.
Boysen was diagnosed with diabetes at the age of five and had a pancreas and kidney transplant in 1992. In 2006 he was diagnosed with leiomyosarcoma, a rare, aggressive cancer of the soft tissue, in his case on the scalp. The cancer was treated successfully with chemotherapy and radiation, but Boysen was left with a considerable deep wound on his head comprising the scalp and the full thickness of his skull down to his brain. Apart from the major reconstructive procedure that the craniofacial wound required, Boysen’s pancreas and kidneys were also failing and required a new transplant.
The declining health condition of the patient over the years prompted the double-organ transplant. However, the scalp and skull wound compromised the organ transplant. On the other hand, Boysen’s critical pancreas and kidney functions along with his immunosuppression medication compromised a safe scalp reconstruction. In this way, a triple transplant option was considered.
The surgery lasted 15 hours and was planned almost four years prior to the procedure. It was performed by a team led by Dr. Jesse C. Selber from MD Anderson and Dr. A. Osama Gaber from Houston Methodist Hospital on May 22, 2015 at the Houston Methodist Hospital.
Dr. Selber was the one who had the idea of transplanting the scalp and skull during the same transplant surgery of the other organs. “When I first met Jim, I made the connection between him needing a new kidney and pancreas and the ongoing anti-rejection medication to support them, and receiving a full scalp and skull transplant at the same time that would be protected by those same medications,” explained Dr. Selber in a news release. “This was a truly unique clinical situation that created the opportunity to perform this complex transplant.”
“With the Houston Methodist transplant resources, we had the perfect opportunity to help Mr. Boysen,” noted Dr. Gaber. “I was pleased that, despite the difficult nature of the procedure, the donor and recipient surgeries worked flawlessly. The two surgeries spanned over 24 hours and required multiple Houston Methodist Hospital and MD Anderson physicians and Houston Methodist nursing teams to complete. Our nurses and transplant coordinators fell in love with Jim and were excited to see him do so well.” In total, more than 50 healthcare professionals were involved in the process.
“While it was incredibly exciting to bring together two of the Texas Medical Center’s leading institutions to collaborate and leverage their expertise for this first-ever transplant, the most meaningful result is what the successful surgery will mean for Jim,” said Dr. Selber. “This was an ideal clinical situation that allowed us to transplant all these tissues from one patient, and Jim’s patience, courage and enthusiasm for the idea were vital.”
Boysen was the first patient to be submitted to a simultaneous craniofacial tissue transplant and solid organ transplants. “This has been a long journey, and I am so grateful to all the doctors who performed my transplants,” said Boysen. “I’m amazed at how great I feel and am forever grateful that I have another chance to get back to doing the things I love and be with the people I love.”
Boysen was discharged on June 4 and is currently recovering at Nora’s Home with specialized follow-up care from both institutions.