Introducing a novel experimental model of bladder transplantation in mice

Wang, Jun; Wu, Jianxuan; Moris, Demetrios; Hayes, Byron K.; Abraham, Soman N.; Cendales, Linda C.

doi:10.1111/ajt.15912

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…More recent experimental studies have investigated pedicled bladder grafts, such as the combined kidney and bladder transplant in swine conducted by Torino from the University of Rome in 2013 23 . However, these have encountered varying success rates, with some animals requiring exploratory laparotomy within days due to graft thrombosis, presumably from rejection 26 .…”

Section: Introductionmentioning

confidence: 99%

Bladder Transplantation: The New Frontier in Abdominal Organ Transplantation

PIOVESAN,

ANDRAUS,

PELLANDA

et al. 2024

ABCD, arq. bras. cir. dig.

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Lower urinary tract abnormalities are directly implicated in the etiology of renal dysfunction in 6 to 24% of dialytic patients. These patients require bladder capacity and compliance readjustment before being considered viable candidates for renal transplantation. Vesical augmentation surgeries often involve the use of intestinal segments. Although these procedures can effectively restore bladder capacity and compliance, they present various issues related to maintaining mucous absorption and secretion capacity. Acidosis, recurrent urinary tract infections, and stone formation are extremely common, leading to frequent hospitalizations and graft function loss. Urinary tissue is certainly ideal for these reconstructions; however, bladder augmentation using ureter and renal pelvis are feasible only in a minority of cases. Experimental studies have been conducted to establish the groundwork for vascularized bladder transplantation. Last year, for the first time, this procedure was performed on a brain-dead patient. During this intervention, cystectomy was performed with preservation the vascular pedicle, followed by organ reimplantation. The graft remained viable for a period of 12 hours post-transplant. However, this intervention utilized a robotic platform, making it less reproducible in a multi-organ procurement setting as well as for most transplant centers. Moreover, it is debatable whether the benefits of exclusive bladder transplantation outweigh the risks associated with immunosuppression. For patients needing renal transplantation and requiring lower urinary tract reconstruction, however, utilizing the donor’s bladder may offer an attractive alternative, avoiding the inherent complications of enterocystoplasty without increasing immunological risk. Combined kidney and bladder transplantation has the potential to emerge as the next frontier in abdominal organ transplants.

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Section: Introductionmentioning

confidence: 99%

Bladder Transplantation: The New Frontier in Abdominal Organ Transplantation

PIOVESAN,

ANDRAUS,

PELLANDA

et al. 2024

ABCD, arq. bras. cir. dig.

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“…Vascularized composite allografts (VCAs) consist of anatomically distinct tissues such as skin, muscles, connective tissue, bones and neurovascular elements that are transplanted as a single unit ( 2 – 4 ). So far, VCAs have been used in various settings including transplantation of face, upper or lower extremity, abdominal wall and genitourinary organs ( 4 , 5 ) ( 1 ). As with other solid organ grafts, they are limited by immune mediated rejection and a concomitant requirement for immunosuppression ( 2 – 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Vascular composite allotransplantation is an evolving field in organ transplantation since it has emerged as a viable option to repair tissue defects resulting from traumatic or other injuries in selected patients (1). Vascularized composite allografts (VCAs) consist of anatomically distinct tissues such as skin, muscles, connective tissue, bones and neurovascular elements that are transplanted as a single unit (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Sensitization and Desensitization in Vascularized Composite Allotransplantation

Moris

Cendales

2021

Front. Immunol.

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Vascularized composite allotransplantation (VCA) is a field under research and has emerged as an alternative option for the repair of severe disfiguring defects that result from severe tissue loss in a selected group of patients. Lifelong immunosuppressive therapy, immunosuppression associated complications, and the effects of the host immune response in the graft are major concerns in this type of quality-of-life transplant. The initial management of extensive soft tissue injury can lead to the development of anti-HLA antibodies through injury-related factors, transfusion and cadaveric grafting. The role of antibody-mediated rejection, donor-specific antibody (DSA) formation and graft rejection in the context of VCA still remain poorly understood. The most common antigenic target of preexisting alloantibodies are MHC mismatches, though recognition of ABO incompatible antigens, minor histocompatibility complexes and endothelial cells has also been shown to contribute to rejection. Mechanistically, alloantibody-mediated tissue damage occurs primarily through complement fixation as well as through antibody-dependent cellular toxicity. If DSA exist, activation of complement and coagulation cascades can result in vascular thrombosis and infarction and thus rejection and graft loss. Both preexisting DSA but especially de-novo DSA are currently considered as main contributors to late allograft injury and graft failure. Desensitization protocols are currently being developed for VCA, mainly including removal of alloantibodies whereas treatment of established antibody-mediated rejection is achieved through high dose intravenous immunoglobulins. The long-term efficacy of such therapies in sensitized VCA recipients is currently unknown. The current evidence base for sensitizing events and outcomes in reconstructive transplantation is limited. However, current data show that VCA transplantation has been performed in the setting of HLA-sensitization.

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“…VCA consist of anatomically distinct tissues such as skin, muscles, connective tissue stroma, bones and neurovascular elements that are transplanted as functional complexes (2)(3)(4)(5). It can be applied to various body parts, such as the face, upper or lower extremity, the larynx, the abdominal wall, as well as intra-abdominal organs, such as the spleen, the adrenals or genitourinary organs (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Costimulation Blockade in Vascularized Composite Allotransplantation

2020

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Vascular composite allotransplantation (VCA) is a field under research and has emerged as an alternative option for the repair of severe disfiguring defects that result from infections or traumatic amputation in a selected group of patients. VCA is performed in centers with appropriate expertise, experience and adequate resources to effectively manage the complexity and complications of this treatment. Lifelong immunosuppressive therapy, immunosuppression associated complications, and the effects of the host immune response in the graft are major concerns in VCA. VCA is considered a quality of life transplant and the risk-benefit ratio is dissimilar to life saving transplants. Belatacept seems a promising drug that prolongs patient and graft survival in kidney transplantation and it could also be an alternative approach to VCA immunosuppression. In this review, we are summarizing current literature about the role of costimulation blockade, with a focus on belatacept in VCA.

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Introducing a novel experimental model of bladder transplantation in mice

Cited by 7 publications

References 20 publications

Bladder Transplantation: The New Frontier in Abdominal Organ Transplantation

Bladder Transplantation: The New Frontier in Abdominal Organ Transplantation

Sensitization and Desensitization in Vascularized Composite Allotransplantation

Costimulation Blockade in Vascularized Composite Allotransplantation

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