Healthcare (Commonwealth Union) – UCLA Health surgeons have successfully completed the first-ever human bladder transplant, which might revolutionize treatment for those with bladder pain and dysfunction.
The bladder acts as a temporary reservoir for urine. This ability to store waste allows humans to control when and where they urinate, offering a critical component of bodily autonomy and dignity.
Dr. Inderbir Gill, the founding executive director of the USC Institute of Urology, assisted UCLA urologic transplant surgeon Dr. Nima Nassiri in performing the historic procedure, which was finished on May 4 at Ronald Reagan UCLA Medical Center. For years, the two doctors had worked together to create and perfect the novel method.
“This first attempt at bladder transplantation has been over four years in the making,” explained Nassiri, who is directing UCLA’s Vascularized Composite Bladder Allograft Transplant Program and is an assistant professor of urology and kidney transplantation. “For the appropriately selected patient, it is exciting to be able to offer a new potential option.”
The recipient of the transplant, 41-year-old Oscar Larrainzar, a father of four, had lost the majority of his bladder during surgery to remove a tumor. What remained was too damaged and undersized to function properly. Additionally, both of his kidneys had been removed due to cancer and advanced kidney failure, forcing him to rely on dialysis for the past seven years.
The intricate surgery involved implanting both a donor kidney and a donor bladder. Surgeons began by placing the kidney, then followed with the bladder, carefully linking the two using a method they had developed over years of research. The entire operation took about eight hours to complete. According to Dr. Nassiri, the outcome was apparent almost immediately.
He pointed out that the kidney began producing a significant amount of urine right away, and the patient’s kidney function showed immediate improvement. Dialysis was no longer necessary after the operation, and the urine flowed correctly into the newly transplanted bladder.
How effectively the transplanted bladder will work over time and how much medication will be required to prevent organ rejection are two unknowns related to the treatment. Larrainzer has remained steady thus far.
To improve the technology, Nassiri and Gill performed a number of practice procedures at USC’s Keck Medical Center, including the first robotic bladder retrievals and transplants. They also conducted non-robotic bladder recovery trial runs as part of their research and development.
They stated that the technical difficulty of the technique and the complex vascular system of
the pelvic region are two reasons why bladder transplants have not been performed before. The replacement or augmentation of the urinary reservoir, which involves using a portion of the patient’s intestine to construct a “new” bladder or a channel for pee to leave the body, is one of the current treatments.
Internal bleeding, bacterial infections, and digestive problems are only a few of the short- and long-term hazards associated with these operations, despite their potential for success.
“A bladder transplant, on the other hand,” explained Nassiri, “results in a more normal urinary reservoir and may circumvent some short- and long-term issues associated with using the intestine.”
The operation was carried out as part of a UCLA clinical trial developed by Nassiri and Gill, who aim to perform additional bladder transplants in the near future.
UCLA, recognized as a national leader in transplant procedures, was an ideal location for the combined kidney and bladder transplant due to its kidney transplant program being integrated within the Department of Urology. This structure offered the essential resources, specialized knowledge, and collaborative support needed to execute the complex surgery and oversee the patient’s care from initial evaluation through post-transplant recovery.
