American surgeons have transplanted a bladder from a dead donor into a patient for the first time in the world. At the same time, he underwent a kidney transplant, the press service of the University of California in Los Angeles reports.
In cases of cancer, severe infections, and other terminal bladder dysfunctions, the bladder must be removed. To ensure that urine then flows from the ureters to the urine bag, patients usually have an artificial reservoir created from a piece of intestine. Since this tissue is poorly suited for such functions, up to 80 percent of them subsequently experience complications such as repeated infections, kidney dysfunction, and digestive problems.
To help such patients, urologists Inderbir Gill and Nima Nassiri began developing donor bladder transplants more than four years ago at the University of Southern California. The procedure is technically challenging because of the complex blood supply to the pelvic organs. The doctors developed the technique first in pigs, then in human cadavers and brain-dead donors, continuing their work after moving to UCLA. In their experiments, they decided to connect the right and left arteries and veins of the donor bladder to reduce the number of vessels that had to be stitched together during the operation.
The first recipient of the organ was 41-year-old Oscar Larrainzar, whose bladder was removed due to a rare tumor - adenocarcinoma of the urachus, after which only a fragment of about 30 milliliters remained. Some time later, both of his kidneys were also removed due to cancer and terminal renal failure. It was impossible to perform bladder plastic surgery using a fragment of intestine due to numerous postoperative scars in the abdominal cavity. For seven years, the patient was on dialysis, the effectiveness of which began to decrease sharply, and severe edema appeared.
When a suitable donor was found on May 4, Gill and Nassiri helped remove the kidney and bladder for transplant. They were transplanted into Larrainzar that same day using an experimental technique developed. The operation lasted about eight hours. The kidney immediately began producing a large volume of urine, which flowed freely into the bladder, and the patient's condition began to improve. After the operation, he did not need dialysis, and his creatinine levels began to decrease rapidly. During his postoperative rehabilitation, his body weight decreased by nine kilograms due to the removal of excess fluid. Nine days after the operation, the man was discharged home.
Because the transplanted bladder lacked innervation, doctors did not expect the patient to be able to feel its filling, and considered using catheters, abdominal manipulation, and electrical stimulation to ensure urine flow. However, when Nassiri removed the catheter and offered Larrainzar a drink of water at a visit two days after discharge, Larrainzar reported that he wanted to urinate and felt like he could. To the urologists’ surprise, he began to do so on his own. However, it is unclear how long-term urinary function will be, or how much immunosuppression the patient will need.
The experimental procedure was carried out as part of a pilot clinical trial initiated by Gill and Nassiri, which is planned to involve five people. Because it is difficult to weigh the potential benefits of a donor bladder against the risks associated with immunosuppressive therapy, the intervention is currently being considered primarily as a means of helping patients who already require immunosuppression due to a transplant of another organ.
Urinary tract stents and catheters, which are necessary for many urological patients, have to be changed frequently due to the deposition of salt crusts on their walls and the formation of bacterial biofilms. Swiss and American researchers have developed a self-cleaning technology for such devices using biomimetic cilia that resemble ciliated epithelium and are activated by ultrasound.