Partial Bladder Transplantation with En Bloc Kidney Transplant—The First Case Report of a ‘Bladder Patch Technique’ in a Human

Abstract

Transplantation of the urinary bladder has not been reported in humans. We transplanted a portion of the donor bladder with an en bloc kidney graft in a 12-month-old girl. The child had a congenital hypoplastic single kidney with an ectopic ureteral opening into the vagina. Her native bladder was extremely small. Bilateral kidneys were transplanted en bloc with their ureters connected to a patch of the donor bladder, which encompassed the bilateral ureterovesical junctions (UVJs) (bladder patch technique). Approximately one-third of the donor bladder wall was used. The bladder patch reperfused well via blood supply from the ureters. Posttransplant cystoscopy with retrograde cystogram revealed a viable transplanted bladder with normal emptying of transplanted ureters. No reflux across the donor UVJs was seen in a voiding cystourethrogram. The child is doing well with normal renal function at 18-month follow-up.

En-bloc pediatric kidney transplantation together with a partial bladder segment: a case report

“…2 Implantation of en-bloc kidneys; bladder patch included the vesical trigone and ureters is a viable option. Performing two separate ureterovesical anastomoses is the other surgical alternative, with the potential of increasing postoperative morbidity [5]. Conservation of the trigone and both ureters with intact anti-reflux mechanism was the main goal in this case since the recipient had an end-stage renal failure because of a vesicoureteral reflux of a solitary kidney.…”

“…The need for the augmentation procedure before renal transplantation could be eliminated by using en-bloc pediatric kidneys together with a bladder segment [5]. Due to a compromised blood supply of short en-block kidney ureters, the incidence of urinary complications after the ureteroneocystostomy will increase.…”

“…Firstly, this technique has much less technical demands for the ureterovesical reconstruction. In pediatric recipients, separate ureterovesical anastomoses is grueling and it may be risky in terms of anastomotic leakages or strictures [5]. Bladder patch technique is a wide anastomosis, easy to perform, and well secured.…”

New surgical technique for pediatric en-bloc kidney and pancreas transplantation: the pancreas piggy-back

“…Another technical improvement reported is the bladder patch described by Kato et al. [4], where a partial bladder wall transplantation, including the donor’s ureters, is performed. This avoids the necessity of two ureterocystostomies in case of en‐bloc pediatric kidney transplantation.…”

The Transplantation Operation and Its Surgical Complications

“…In the mean time, the donor bladder wall served a purpose of bladder augmentation as well. (Kato et al, 2008). Since first report of DKT from an adult deceased donor in the United States was revealed in 1996, many centers now perform DKT using various organ selection criteria and surgical techniques, including the extra-or intraperitoneal bilateral placement of the two kidneys through two separate Gibson incisions or one midline incision.…”