Surgeons in southern California have made the first human bladder transplant, introducing a new procedure potentially that changes life for people with bladder weakening conditions.
The operation was carried out earlier this month by a couple of surgeons from the University of California, Los Angeles, and the University of Southern California with a 41 -year -old man who had lost much of his capacity for leaves of treatments for a rare form of cancer.
“It was a time bomb,” said the patient, Oscar Larainzar, on Thursday a follow -up appointment with his doctors. “But now I have hope.”
Doctors plan to perform bladder transplants in four more patients as part of a clinical trial to have a sensation of results such as bladder capacity and graft complications before performing a larger trial to expand its use.
Dr. Inerbir Gill, who performed surgery along with Dr. Nima Nassiri, described him as “the realization of a dream” to treat thousands of patients with paralyzing pelvic pain, inflammatory and recurrent infections.
“There is no doubt: a potential has been opened for these people who did not exist before,” said Dr. Gill, president of the Urology Department of the USC
Pushing the envelope
Until now, most patients undergoing leaves have a part of their reused intestine to help them pass the urine. Some receive an ileal duct, which empties the urine in a bag outside the abdomen, while others give a call called Neobladder called, or a hidden bag inside the body that adheres to the urethra and allows the firm to urinate more traditionally.
But the intestinal tissue, full of bacteria, is “inherently contaminated”, Dr. Ir. Gill said, and the introduction of the “inherently sterile” urinary tract “leads to complications in up to 80 percent of patients, ranging from electrolytic imbalances to a slow reduction in renal function. The loss of the intestinal segment can also cause new digestive problems.
Dr. Discina Daskalaki, transplant surgeon at the Tuftts Medical Center that did not participate in the new procedure, said advances in transplant medicine (from critical support of life support, such as hearts and livers, to other parts of the body, such as faces, uteri and Tyteri debt. “
“They ask:” Why do we have to endure all complications? Why don’t we try to give this person a new sheet? Dakalaki said.
At the end of 2020, Dr. Nassiri was in his fourth year of residence at the University of Southern California when he and Dr. Gill sat in the hospital cafeteria to start making a rain of ideas. After Dr. Nassiri began a communion on the kidney transplant in UCLA, the two surgeons continued to work together in all institutions to test robotic and manual techniques, first practicing in pigs, then human corpses and, finally, human research donors who no longer had brain activity but maintained a beat.
One of the transplantation challenges of a bladder was the complex vascular infrastructure. Surgeons needed to operate deeply into the donor’s pelvis to capture and preserve a rich supply of blood vessels so that the organ could prosper inside the recipient.
“When we remove a magazine due to cancer, we basically cut them. We do it in less than an hour on an almost daily base,” said Dr. Gill. “For a sheet donation, that is a significant order of technical intensity.”
The surgeons also chose to join the right and left arteries, as well as the right and left veins, while the organ was on ice, so only two connections were needed in the recipient, instead of four.
When their strategy was perfect in 2023, the two developed plans for a clinical trial, which would be possible to the first recipient of the world: Oscar.
An ideal candidate
When Mr. Larrainzar entered the clinic of Dr. Nassiri in April 2024, Dr. Nassiri recognized him. Almost four years earlier, Mr. Larrainzar, husband and father of four children, had been sailing for renal disease in the terminal stage and renal cancer, and Dr. Nassiri helped eliminate both kidneys.
But Mr. Larinzar had also survived the adenocarcinoma of Urachal, a strange type of leaf cancer and surgery to resect the tumor of the leaf had Hef Heft “without a great magazine,” said Dr. Nassiri. A normal bladder may contain more than 300 cubic centimeters of fluid; Mr. Larrainzar could have 30.
Now, years of dialysis had begun to fail; The fluid was accumulating inside his body. And with so much scars in the abdominal region, it would have a difficult bone to find enough length or intestine usable to look for another option.
“Hi appeared casually,” said Dr. Nassiri, “but he was the son of an ideal candidate for this.”
On a Saturday night earlier this month, Dr. Nassiri received a call on a possible bladder match for Mr. Larrainzar. He and Dr. Gill directly led to the Headquarters of OneElegacy, an organ acquisition organization, in Azusa, California, and joined a team of seven surgeons who work during the night in a variety of organizers of a donor.
The two brought the kidney and bladder to UCLA, then stopped at home for a shower, breakfast and a short nap. They complete eight -hour surgery to give Mr. Larrainzar a new leaf and kidney later that day.
Dr. Nassiri said that kidney transplants can sometimes take a week to process urine, but when the kidney and leaf were connected within Mr. Larrainzar, there was a great connection: “immediate exit”, and its creatinine level, which measures renal function, began to improve immediately. Mr. Larrainzar has already lost 20 pounds of liquid weight since surgery.
The greatest risks of organ transplantation are the potential rejection of the body of the organ and the captive side effects by mandatory immune suppression medications given to prevent the rejection of the organs. That is why, for Dr. Rachel Forbes, a transplant surgeon at the Vanderbilt University Medical Center that did not participate in the procedure, the emotion is more temperate.
“It is obviously a technical advance,” he said, but “we already have existing options for people without veins, and without the disadvantage of requiring immunosuppression.” Unless a patient is, like Mr. Larrainzar, being in those medications anyway, “I would be a bit nervous to establish some complications for others,” he said.
A new leaf transplant does not have nerve connections in the recipient, so, although it works well as a storage organization, doctors did not know if Mr. Larrainzar could ever feel a complete lEADOR, and much less hold it and empty it naturally. They talked about catheters, abdomen maneuvers and any vally that develops a leaf stimulator to order to help with release.
But in a monitoring appointment on Thursday morning, only two days after Mr. Larainzar was discouraged from the hospital, Dr. Nassiri withdrew the catheter and gave him liquids, and Mr. Larrainzar immediately felt he could urinate.
Dr. Nassiri called him a miracle, then called Dr. Gill, who was in an operating room of the USC, and exclaimed two words: “He is urinated!”
“In no way! What the hell?” Dr. Gill said. “My jaw is on the floor.”
After finishing surgery, Dr. Gill directly drove Ucla and saw Mr. Larrainzar again.
“Or of course, this is very, very early. Let’s see how everything goes,” warned Dr. Gill. “But it is the first time he has been able to urinate in seven years. For all of us, this is huge.”
Mr. Larrainzar, exhausted, smiled, and Dr. Nassiri brought him a bottle or mineral water to celebrate.
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