Surgeons from UCLA Health It has successfully implemented the first-ever human bladder transplant, a potentially game-changing procedure for people suffering from bladder dysfunction and pain.
The historic surgery completed at Ronald Reagan UCLA Medical Center on May 4th was led by UCLA Urology Transplant Surgeons Dr. Nima Nasiri With support from Dr. Inderville Gill, Founded Executive Director of USC Urology. The two surgeons worked together for years to develop and refine new techniques.
“This first attempt at bladder transplant has been around for over four years,” says Nasiri, who directs UCLA's vascularized combined bladder allograft program and associate professor of urology and kidney transplantation. “It's exciting to be able to offer new potential options for well-selected patients.”
How the first bladder transplant was performed
Transplant recipient, 41 years old Oscar LaRainserfather of four, Previously, he lost most of his bladder during the tumor removal process, and the rest was too small to compromise. Both his kidneys were then removed due to cancer and end-stage kidney disease, and he was on dialysis for seven years.
Nick Carranza/UCLA Health
The Oscar Larinzer transplant recipient, whose bladder was not working, had previously removed both kidneys but was resting in a UCLA hospital bed before surgery.
The complex procedure involved implanting both new bladder and new kidneys recovered from the donor. The surgeon first transplanted the kidney, followed by the bladder. The kidneys were then connected to the new bladder using pioneering techniques. The entire procedure lasted about 8 hours. The results were immediately clear, according to Nassiri.
“The kidneys quickly produced a large amount of urine, and the patient's kidney function quickly improved,” he said. “There was no need for post-surgery dialysis and the urine was properly drained into the new bladder.”
There are unclearities related to the procedure, such as how well the transplanted bladder works over time, and how much immunosuppression is required to prevent rejection of the transplanted organ. Until now, Larainzer has been stable.
Why has there been no bladder transplantation done up until now?
As part of their research and development, Nasiri and Gill performed numerous medical surgeries at USC's Kek Medical Center, including the first ever robotic bladder recovery and implantation.
Still from a video by Cesar Sarmiento/UCLA Health
Before successful bladder transplant surgery, Dr. Nima Nasiri, director of UCLA's vascularized combined bladder allograft implant program (left) with transplant patient Oscar Lalanzal.
Bladder implantation has not been performed previously, they said, due to the complex vascular structures of the pelvic area and the technical complexity of the procedures. Current treatments include replacing or enhancing the urine reservoir. This is the procedure for creating a route for a “new” bladder or urine to leave the body using a portion of the patient's intestine. Although these surgeries are effective, there are many short- and long-term risks that can damage the patient's health, including internal bleeding, bacterial infections, and digestive problems.
“Bladder grafts, on the other hand, can result in a more normal urinary reservoir and avoid some short- and long-term problems associated with intestinal use,” he said.
The procedure was performed as part of a UCLA Clinical Trial Designed by Nassiri and Gill. Gill hopes to have more bladder implants in the near future.
UCLA, the national leader in transplant surgery, has proven the best location for a combination of kidney bladder transplant surgery, as the university's kidney transplant program is housed in the urology department. This provided the necessary infrastructure, clinical expertise, and interdisciplinary support, performed the procedures and managed patients from pre-transplant assessment through pre-transplant care.
