SOURCE :- THE AGE NEWS
By Emily Baumgaertner Nunn
Los Angeles: Surgeons have performed the first human bladder transplant, introducing a new, potentially life-changing procedure for people with debilitating conditions.
The operation was performed this month by a pair of surgeons from UCLA and the University of Southern California (USC) on a 41-year-old man who had lost much of his bladder capacity from treatments for a rare form of cancer.
“I was a ticking time bomb,” the patient, Oscar Larrainzar, said last week during a follow-up appointment with his doctors. “But now I have hope.”
Oscar Larrainzar, recipient of the first-ever human bladder transplant, waits to be discharged.Credit: Kyle Grillot/The New York Times
The doctors plan to perform bladder transplants in four more patients as part of a clinical trial before pursuing a larger trial.
Dr Inderbir Gill, who performed the surgery along with Dr Nima Nassiri, called it “the realisation of a dream” for treating thousands of patients with crippling pelvic pain, inflammation and recurrent infections.
The surgery earlier this month.Credit: Nick Carranza/UCLA Health/The New York Times
“There is no question: a potential door has been opened for these people that did not exist earlier,” said Gill, chair of the urology department at USC.
Most patients who undergo a bladder removal have a portion of their intestine repurposed to help them pass urine.
But bowel tissue, riddled with bacteria, was “inherently contaminated”, Gill said, and introducing it to the “inherently sterile” urinary tract led to complications in up to 80 per cent of patients.
Larrainzar, whose kidneys had both been removed almost four years earlier, also received a kidney transplant. Nassiri said that kidney transplants could sometimes take up to a week to process urine, but that when the kidney and bladder were connected inside Larrainzar, there was “immediate output”, and his creatinine level, which measures kidney function, started to improve immediately.
The biggest risks of organ transplantation are the body’s potential rejection of the organ and side-effects caused by the immune-suppressing drugs given to prevent organ rejection. That is why, for Dr Rachel Forbes, a transplant surgeon at Vanderbilt University Medical Centre who was not involved in the procedure, the excitement is more tempered.
Surgeons Inderbir Gill, left, chair of the urology department at USC, and Nima Nassiri, assistant clinical professor of urology at UCLA’s David Geffen School of Medicine.Credit: Nick Carranza/UCLA Health /The New York Times
“It’s obviously a technical advance,” she said, but “we already have existing options for people without bladders, and without the downside of requiring immunosuppression”.
Unless a patient was, like Larrainzar, going to be on those medications anyway, “I would be a little bit nervous that you would be exchanging some complications for others”, she said.
