Surgeons have successfully performed the world’s first human bladder transplant. This procedure can potentially be life-changing for those with debilitating bladder conditions.
Two surgeons from the University of Southern California and the University of California, Los Angeles, performed the surgery earlier this month.
The patient, Oscar Larrainzar, had lost a significant portion of his bladder capacity after undergoing treatment for bladder cancer.
He once described himself as “a ticking time bomb,” but now says he has hope for the future.
Before the surgery, the father of four had been battling end-stage renal cancer and kidney disease. He was also a bladder cancer survivor and had previously undergone a partial bladder removal, which left him with very little of the organ remaining.
He had undergone years of dialysis, but it had started to fail, meaning fluid was accumulating inside his body.
That was when he was told there was a potential bladder match for him.
The surgeons who did the procedure plan on performing four additional bladder transplants in other patients, as part of a new clinical trial. This will give them a better sense of outcomes, such as potential graft complications and bladder capacity, before expanding its use.
Dr. Inderbir Gill, who did the groundbreaking operation with Dr. Nima Nassiri, described it as “the realization of a dream” for patients with life-changing inflammation, pelvic pain, and chronic infections.
Until now, patients who had their bladders removed typically needed a section of their intestine to be repurposed to help pass urine.
Some individuals also receive an ileal conduit, which allows them to empty urine into an exterior bag. Others are given a neobladder, a pouch located inside the body that allows individuals to urinate more normally.
While effective, however, bowel tissue is inherently contaminated with bacteria. When introduced to the sterile urinary tract, this can increase the chances of complications, such as reduced kidney function or electrolyte imbalances, by up to 80 percent.
The loss of intestinal tissue can also cause digestive issues for the patient.
With the advances of transplant medicine, however, doctors no longer have to risk these complications.
Dr. Nassiri and Dr. Gill had begun to brainstorm approaches back in 2020, when the former was in his final year of residency.
After Dr. Nassiri began a fellowship in kidney transplantation, the two continued collaborating to test both manual and robotic techniques, starting with pigs, then moving on to human cadavers, and eventually to human research donors who no longer had brain activity but still had a heartbeat.
One of the biggest challenges of performing a bladder transplant was the organ’s complex vascular infrastructure. To preserve the blood vessels, they had to work deep inside the pelvis, which proved to be difficult.
They also had to conjoin the arteries on the right and left, in addition to the veins, all while the organ was sitting on ice.
