The first bladder transplant in the world successfully performed

A group of surgeons in California has completed, after four years of work, The first bladder transplantation On a patient alive, a particularly complex intervention considered a goal for medicine. The recipient, a 41 -year -old who survived an aggressive form of urinary system cancer and condemned to dialysis, is well, has recovered renal function and is able to urinate alone, even if the risks connected to the intervention cannot be said to be passed.

The details and potential of the intervention for patients with serious and chronic problems for the bladder have been described in a press release from the University of California in Los Angeles.

Before becoming the perfect candidate to inaugurate a new transplant era, Oscar Larrainzar had lost most of his bladder in an intervention to remove a rare form of cancer. The remaining portion was too small and compromised to work: If an adult bladder, complete filling, can normally contain 300-400 milliliters of urine, that of Larrainzar came to keep just 30 milliliters of pee.

The man had also lost both kidneys due to an advanced renal disease and a tumor, and was on dialysis (a therapy to remove waste substances from the body when the kidneys have not worked) for seven years. Dialysis began to no longer effect and an excess of fluids was accumulating in its body. In addition, large quantities of scar tissue in the abdominal area prevented resorting to other solutions to replace the missing bladder.

Until today, for patients whose bladder had been surgically removed were foreseen urinary diversion proceduresthat is, solutions to divert the flow of urine from the bladder towards a new way out – or towards a skin opening (stoma) or towards an internal tank obtained by converting to a new purpose a portion of intestine.

Interventions of this type create complications in 80% of cases: among the most frequent there are urinary infections, progressive loss of renal function and new digestive problems given by the reduction of the intestinal tract. At the base, the fact that the microbiomes of intestine and urinary system could no longer be different.

The transplant took place in the UCLA (University of California, Los Angeles) Medical Center on May 4, thanks to a team led by Nima Nassiri, surgeon of the Urology Institute of the Center, and Replaceable Gill, director of the Urology Institute of the University of Southern California.

Before the operation, the two collaborated for years to develop and then perfect the technique.

In addition to a new bladder, Larrainzar has also received a new kidneyfrom the same donor. The team first transplanted the kidney and later the bladder, and then connect the two organs using the previously designed technique. The intervention lasted about 8 hours. The choice of the medical team to join some arteries and veins of the bladder before placing it made it possible to simplify the procedure a little.

The results were immediate. The kidney immediately started producing a large volume of urine and renal function, measured through the creatinine level, a waste product of a source of energy used by the muscles, immediately improved. There was no need for dialysis after the intervention, e The urine is correctly deflected in the new bladder. Two days after being discharged from the hospital, after removing the catheter, the patient managed to pee alone for the first time after seven years. However, the long -term effects of the intervention are not clear for the moment, nor how long the man will have to take on immunosuppressor medicines.

So far the bladder transplants had never been tempted due to the complicated vascular structure that feeds the organ And that is grafted deep into the pelvic area. If to remove a bladder, for example due to a tumor, these vases are simply terminated, for a bladder donation they must be preserved and the technical difficulty of the operation increases considerably.

Nassiri and repringer have trained the various stones for years, using both robotic and manual techniques, practicing on pigs, on corpses and patients who had donated their body to research and with absent brain activities, kept alive by the machines.

The Californian team is planning to operate the bladder transplantation On four other patientsas part of a clinical trial to evaluate the transplanted bladder capacity and any complications of the intervention, before asking for an expansion of the procedure in a wider clinical study. Ideally, An additional option opens, albeit of last instancefor patients whose bladder functionality has been irreparably compromised.