Partial Bladder Transplantation with En Bloc Kidney Transplant—long-term, 17 years, outcome of a ‘Bladder Patch Technique’

Abstract

A transplant of a portion of bladder with en bloc kidney from a 2-year-old donor was previously reported in a 12-month-old girl due to extremely small bladder. Bilateral kidneys were transplanted en bloc with their ureters connected to a patch of the donor bladder (bladder patch technique). Long-term outcomes and complications of this technique have not been documented. Here, we report a long-term, 17 years, follow of this patient with evaluation of whole bladder functions at 18 years of age. The patient has had no episode of urinary tract infection. Cystoscopy showed a viable transplanted bladder with well perfused mucosa. We observed the native bladder has stretched over time forming more than half of the bladder wall. Urodynamic studies showed preserved bladder compliance at 43 mL/cmH2O and native bladder contractility was preserved. Prolonged voiding time and post-void residual urine were also observed. These findings were suggestive of detrusor underactivity. No reflux across the donor ureterovesical junctions was observed. The recipient was instructed to continue timed voiding and double voiding to empty the bladder. In conclusion, en bloc kidney transplantation with bladder patch is a feasible and safe option in kidney transplant recipients with a small bladder capacity.