BLADDER TRANSPLANTATION: THE NEW FRONTIER IN ABDOMINAL ORGAN TRANSPLANTATION

Area of Science:

• Urology
• Transplantation Surgery
• Nephrology

Background:

• Lower urinary tract abnormalities (LUTA) contribute to renal dysfunction in 6-24% of dialysis patients.
• Patients with LUTA need bladder reconstruction for renal transplantation, often using intestinal segments.
• Enterocystoplasty carries risks like acidosis, infections, and stone formation, leading to graft loss.

Purpose of the Study:

• To explore alternatives to enterocystoplasty for bladder reconstruction in renal transplant candidates.
• To evaluate the feasibility and potential of combined kidney and bladder transplantation.
• To address the limitations of current bladder augmentation techniques.

Main Methods:

• Review of current literature on bladder augmentation and renal transplantation.
• Discussion of a recent experimental vascularized whole bladder transplantation in a brain-dead donor.
• Analysis of the potential benefits and risks of combined organ transplantation.

Main Results:

• Enterocystoplasty, while effective, leads to significant complications and graft loss.
• Vascularized whole bladder transplantation is technically challenging and has limited reproducibility.
• Donor bladder utilization avoids enterocystoplasty complications and immunological risks.

Conclusions:

• Combined kidney and bladder transplantation offers a promising alternative for patients with LUTA needing renal transplants.
• This approach may circumvent the morbidity associated with intestinal augmentation.
• Donor bladder utilization could represent a significant advancement in abdominal organ transplantation.