Surgeons have performed the first-in-human bladder transplant.
The procedure was performed in May at Ronald Reagan UCLA Medical Centre.
Dr Inderbir Gill, founding executive director of USC Urology, and Dr Nima Nassiri, director of the UCLA Vascularised Composite Bladder Allograft Transplant Programme, led the effort.
Dr Gill said: ‘This surgery is a historic moment in medicine and stands to impact how we manage carefully selected patients with highly symptomatic “terminal” bladders that are no longer functioning. Transplantation is a lifesaving and life-enhancing treatment option for many conditions affecting major organs, and now the bladder can be added to the list.’
Discussing the significance of the moment, Dr. Nassiri, a former resident in USC’s urology programme and now an assistant professor at UCLA, said: ‘This first attempt at bladder transplantation has been over four years in the making. For the appropriately selected patient, it is exciting to be able to offer a new potential option.’
The recipient, a dialysis-dependent patient for seven years, had previously undergone extensive bladder resection for cancer and bilateral nephrectomy due to renal malignancy.
The procedure involved a combined kidney and bladder transplant – a highly technical, eight-hour operation.
The surgical team first implanted the kidney, followed by the bladder, and anastomosed the new kidney to the neobladder.
Dr Nassiri said: ‘The kidney made a large volume of urine, and the patient’s kidney function improved immediately. There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.’
Dr Gill added: ‘Despite the complexity of the case, everything went according to plan and the surgery was successful. The patient is doing well, and we are satisfied with his clinical progress to date.’
The donor organs were recovered at OneLegacy’s Transplant Recovery Centre in Azusa, California, and all surgical and monitoring steps adhered to stringent clinical and research protocols.
Millions of people around the world suffer from debilitating bladder dysfunction. Until now, the standard of care for severely compromised or absent bladders has been urinary diversion or reconstruction using autologous intestinal segments. These approaches, while effective, pose long-term risks.
Dr Gill said: ‘While these surgeries can be effective, they come with many short- and long-term risks that compromise a patient’s health, such as recurrent infections, compromised kidney function and digestive issues. ‘
Dr Nassiri added: ‘A bladder transplant, on the other hand, delivers a more “normal” urinary reservoir and may circumvent some of the challenges associated with using the intestine.’
Given the immunologic demands of vascularised composite allografts, ideal candidates will initially be those already on immunosuppressive therapy, such as patients needing combined kidney-bladder transplants.
Dr Nassiri said: ‘Because of the need for long-term immunosuppression, the best current candidates are those with a pre-existing organ transplant or those who need a combined kidney and bladder transplant.’
Despite its promise, bladder transplantation remains a procedure with many unknowns, including long-term graft viability and functional durability under chronic immunosuppression.
The surgical strategy was refined over several years through collaborative work at Keck Medical Centre of USC and OneLegacy.
This included the development of a novel surgical approach, regulatory approvals, and dozens of practice procedures, including robotic retrievals and transplants in perfused cadavers.
Drs Gill and Nassiri were the first to successfully retrieve and transplant bladders robotically in brain-dead donors with maintained cardiac function, advancing minimally invasive transplant methodologies.
This first transplant was performed under a UCLA clinical trial protocol, and both institutions hope to expand the programme.
Photo caption - Nima Nassiri, MD (L) and Inderbir Gill, MD (R) collaborated on years of clinical research to prepare for the historic surgery.
