USC and UCLA Surgeons Perform Rare Combined Kidney and Bladder Transplant on Dialysis Patient

“This surgery is a historic moment in medicine and stands to impact how we manage carefully selected patients with highly symptomatic 'terminal' bladders that are no longer functioning,” said Dr. Gill, Chair and Distinguished Professor of Urology and Shirley and Donald Skinner Chair in Urologic Cancer Surgery with the Keck School of Medicine of USC. “Transplantation is a lifesaving and life-enhancing treatment option for many conditions affecting major organs, and now the bladder can be added to the list.”

“This first attempt at bladder transplantation has been over four years in the making,” said Dr. Nassiri. “For the appropriately selected patient, it is exciting to be able to offer a new potential option.”

Drs. Nassiri and Gill worked together for several years at the Keck School to develop the surgical technique, design a clinical trial, and secure necessary regulatory approvals. Numerous pre-clinical procedures were performed at both Keck Medical Centre of USC and OneLegacy, Southern California's organ procurement organization, to prepare for the procedure.

The patient had been on dialysis for seven years. More than five years ago, he underwent surgery for cancer that resulted in the removal of most of his bladder. The remaining portion was too small and compromised to function. Both kidneys were later removed due to renal cancer.

To address these deficits, the surgical team performed a combined kidney and bladder transplant. First, the kidney was transplanted, followed by the bladder. The new kidney was then connected to the new bladder. The entire procedure lasted approximately eight hours.

“The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately,” said Dr. Nassiri. “There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.”

“Despite the complexity of the case, everything went according to plan and the surgery was successful,” added Dr. Gill. “The patient is doing well, and we are satisfied with his clinical progress to date.”

The donor organs were recovered at OneLegacy’s Transplant Recovery Centre in Azusa, California. All parts of the procedure, including surgery and post-surgical monitoring, were aligned with current clinical and research standards.

Millions globally experience bladder disease and dysfunction. In severe cases, terminal bladders may be non-functioning or associated with constant pain, infections, and complications. Current treatment for such patients typically involves using a portion of the intestine to construct a new bladder or urinary diversion.

“While these surgeries can be effective, they come with many short- and long-term risks that compromise a patient’s health such as recurrent infections, compromised kidney function and digestive issues,” said Dr. Gill.

“A bladder transplant, on the other hand, delivers a more ‘normal’ urinary reservoir and may circumvent some of the challenges associated with using the intestine,” said Dr. Nassiri.

Immunosuppression and the risk of organ rejection remain key challenges. “Because of the need for long-term immunosuppression, the best current candidates are those with a pre-existing organ transplant or those who need a combined kidney and bladder transplant,” said Dr. Nassiri.

“As a first-in-human attempt, there are naturally many unknowns associated with the procedure, such as how well the transplanted bladder will function immediately and over time, and how much immunosuppression will ultimately be needed,” added Dr. Gill. “Despite the unknowns, our goal is to understand if bladder transplantation can help patients with severely compromised bladders lead healthier lives.”

Bladder transplantation has not previously been done in humans, partly due to the complex pelvic vasculature and surgical challenges. As part of their preparatory work, Drs. Gill and Nassiri conducted multiple practice transplants at Keck Medical Centre of USC, including robotic bladder retrievals and transplantations in recently deceased donors with maintained cardiac function. They also performed several non-robotic trial runs at OneLegacy, working with multidisciplinary surgical teams to refine their technique.

The transplant was part of a clinical trial at UCLA. Drs. Gill and Nassiri plan to perform more such procedures in the future.