HQ Team
May 19, 2025: US surgeons have performed the world’s first successful human bladder transplant on a 41-year-old patient who lost most of his bladder during a tumour removal process.
Oscar Larrainzar, the transplant recipient, a father of four, was left with a bladder too small and compromised to work, according to urologic transplant surgeons from the University of California, Los Angeles and the University of Southern California’s Institute of Urology.
Both of his kidneys were also subsequently removed due to cancer and end-stage kidney disease, and he had been on dialysis for seven years.
The two surgeons, Dr. Nima Nassiri and Dr. Inderbir Gill, the founding executive director of the USC Institute of Urology, had collaborated for years to develop and refine the new technique. They operated on May 4, according to a joint statement.
The potentially game-changing procedure for people suffering from crippling bladder dysfunction and pain, took place at Ronald Reagan UCLA Medical Center.
‘Four years in the making’
“This first attempt at bladder transplantation has been over four years in the making,” said Nassiri, who directs UCLA’s Vascularized Composite Bladder Allograft Transplant Program and is an assistant professor of urology and kidney transplantation. “For the appropriately selected patient, it is exciting to be able to offer a new potential option.”
The complex procedure involved the transplantation of both a new bladder and a new kidney, recovered from a donor.
Nassiri and Gill, assisted by a surgical team, first transplanted the kidney, followed by the bladder. Then they connected the kidney to the new bladder using the technique they had pioneered. The entire procedure lasted approximately eight hours. The results, they said, were quickly evident.
“The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately,” Nassiri said. “There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.”
“Despite the complexity of the case,” Gill said, “everything went according to plan and the surgery was successful. The patient is doing well, and we are satisfied with his clinical progress to date.”
Immunosupression
There are unknowns associated with the procedure, including how well the transplanted bladder will function over time and how much immunosuppression will be needed to prevent rejection of the transplanted organs. To date, Larrainzer has been stable, according to the statement.
“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 Gill, who is also a distinguished professor and chair of urology at 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.”
As part of their research and development, Nassiri and Gill conducted numerous practice surgeries, including the first robotic bladder retrievals and transplantations, as well as non-robotic trial runs of bladder recovery, allowing them to perfect the technique.
Complexity of procedure
Bladder transplants have not been done previously, they said, in part because of the complicated vascular structure of the pelvic area and the technical complexity of the procedure.
Current treatments include the replacement or augmentation of the urinary reservoir — a procedure that uses part of a patient’s intestine to create a “new” bladder or a pathway for urine to exit the body.
While these surgeries can be effective, they come with many short- and long-term risks that compromise a patient’s health, such as internal bleeding, bacterial infection and digestive issues.
“A bladder transplant, on the other hand,” Nassiri said, “results in a more normal urinary reservoir and may circumvent some short- and long-term issues associated with using the intestine.”
