Bladder Transplantation Research Articles

Urinary bladder transplantation in humans — current status and future perspectives

Urinary bladder transplantation in humans — current status and future perspectives

Bladder and Kidney Transplantation En Bloc: Review of Experience and Prospects for Development.

Although urine bladder transplantation is currently being conducted, the procedure is an incompletely resolved problem in clinical transplantology. A small number of en bloc bladder and kidney transplants from pediatric donors to adult recipients in humans have been reported. A small number of bladder transplants with and without combinations with kidneys have also been performed in experiments on different animal models. Here, we aimed to highlight the experiences of various scientists in bladder transplantation in humans and animals. We also presented our small experience in conducting transplant of 1 kidney, ureters, and a segment of the bladder in an experiment on pigs in 2023 (5 cases), which is a promising direction for further successful development of this technology in humans. In 2024, we plan to conduct another 10 transplants of a single block ofthe kidney and bladderin pigs, results of which will be published after the completion of the experimental work.

Strategies of Bladder Reconstruction after Partial or Radical Cystectomy for Bladder Cancer.

The standard strategy is to reconstruct bladder by use of bowel segments as material in bladder cancer with radical cystectomy clinically. Both natural derived and non natural derived materials are investigated in bladder reconstruction. Studies on mechanical bladder, bladder transplantation and bladder xenotransplantation are currently limited although heart and kidney transplantation or xenotransplantation are successful to a certain extent, and bone prostheses are applied in clinical contexts. Earlierlimited number of studies associated with bladder xenograft from animals to humans were notparticular promisingin results. Although there have beeninvestigations on pig to human cardiac xenotransplantation with CRISPR Cas9 gene editing, theCRISPR Cas techniqueisnot yet widelyresearchedin porcinebladder related gene editingfor the potential of human bladder replacementfor bladder cancer. The advancement of technologies such as gene editing, bioprinting and induced pluripotent stem cells allow further research into partial or wholebladder replacement strategies. Porcine bladder is suggested as a potential source material for bladder reconstruction due to its alikeness to human bladder. Challenges thatexist with all these approaches need to be overcome. This paper aims to review gene editing technology such as the CRISPR Cas systems as tools in bladder reconstruction, bladder xenotransplantation and hybrid bladder with technologies of induced pluripotent stem cells and genome editing, bioprinting for bladder replacement for bladder reconstruction and to restore normal bladder control function after cystectomy for bladder cancer.

BLADDER TRANSPLANTATION: THE NEW FRONTIER IN ABDOMINAL ORGAN TRANSPLANTATION.

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.

Robotic Bladder Autotransplantation: Preclinical Studies in Preparation for First-in-human Bladder Transplant.

Human urinary bladder transplantation has never been performed. From a technical standpoint, challenges include the complex deep pelvic vascular anatomy, limited intraoperative visualization, and high procedural complexity. In preparation for a first-in-human clinical trial, we report preclinical studies to develop the technique of robotic retrieval and autotransplantation of vascularized composite bladder allograft. Institutional Animal Care and Use Committee, Institutional Review Board, and UNOS (United Network for Organ Sharing) approvals were obtained, and IDEAL (Idea, Development, Exploration, Assessment, Long-term Study) Reporting Guidelines were followed. Robotic vascularized composite bladder allograft recovery, back-table graft preparation, and robotic autotransplantation were performed in 3 vascularized model settings: living porcine (n=3), pulsatile human cadavers (n=2), and heart-beating brain-dead deceased research human donors (n=5). Our primary objective was to develop a reproducible technique for robotic vascularized composite bladder allograft transplantation. Technical success was defined by adequate, sustained vascularized composite bladder allograft reperfusion. Secondary objectives were intraoperative parameters, including operative time, graft ischemia time, and blood loss. Successful robotic vascularized composite bladder allograft autotransplantation was achieved in 2 porcine, 1 cadaver, and 3 brain-dead research donors. In the heart-beating research donors, console time decreased with successive surgeries, and visual inspection revealed healthy revascularized autografts with prompt, global indocyanine green immunofluorescence uptake. In 1 heart-beating donor who was hemodynamically maintained for 12 hours postoperatively, reinspection confirmed excellent maintained global vascularized composite bladder allograft vascularity and bladder mucosal integrity. To our knowledge, the first preclinical experience of bladder autotransplantation in vascularized models is reported, including robotic vascularized composite bladder allograft recovery, back-table reconstruction, and autotransplantation. This experience represents the essential preclinical work required to build toward the first-in-human trial of bladder transplantation, performed under a UNOS-approved genitourinary vascularized composite bladder allograft program (NCT No. 05462561).

Perfusion preparation of the rat bladder decellularized scaffold

IntroductionBladder reconstruction is a huge challenge in the field of urology. In recent years, perfusion methods have brought promising results in the field of tissue engineering. We prepared bladder decellularized scaffolds by improved perfusion, which may be suitable for bladder reconstruction. MethodsWe prepared decellularized scaffolds of rat bladder by perfusion of SDS (0.5% sodium dodecyl sulfate), SDS-SDC (0.5% sodium dodecyl sulfate +0.5% sodium deoxycholate). Histological characteristics of bladder decellularized scaffolds were assessed by Hematoxylin and eosin, Masson, and DAPI staining. Moreover, we also prepared a murine bladder transplantation model to evaluate the regenerative potential of scaffolds. ResultsHematoxylin and eosin, Masson, and DAPI staining indicated almost no cellular component residues in the SDS-SDC group. Histological analysis (hematoxylin and eosin staining, Masson staining), CD31 and F4/80 staining analysis, one month after implantation, revealed that the decellularized scaffolds had regenerative characteristics, and the SDS-SDC scaffold had better regenerative properties than the SDS scaffold. ConclusionsWe successfully prepared the decellularized scaffold for the rat bladder by perfusion. Our results showed that the SDS-SDC scaffold had better decellularization efficiency and reconstruction ability than the SDS scaffold, which provides a new perspective on bladder reconstruction materials.

V08-01 ROBOTIC BLADDER AUTOTRANSPLANTATION IN A BRAIN-DEAD HEART-BEATING DECEASED DONOR: WET RUN BEFORE A FIRST-IN-HUMAN CLINICAL TRIAL

You have accessJournal of UrologyCME1 Apr 2023V08-01 ROBOTIC BLADDER AUTOTRANSPLANTATION IN A BRAIN-DEAD HEART-BEATING DECEASED DONOR: WET RUN BEFORE A FIRST-IN-HUMAN CLINICAL TRIAL Nima Nassiri, Giovanni Cacciamani, David Ginsberg, Evgeniy Kreydin, Andre Abreu, Mihir Desai, Monish Aron, Yasir Qazi, Yuri Genyk, and Inderbir Gill Nima NassiriNima Nassiri More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , David GinsbergDavid Ginsberg More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , Andre AbreuAndre Abreu More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Yasir QaziYasir Qazi More articles by this author , Yuri GenykYuri Genyk More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder transplantation has not yet been successfully performed. Technical challenges include complicated deep pelvic vascular anatomy, limited visualization, and procedural complexity. In preparation for a first-in-human clinical trial of bladder transplantation (NCT05462561), we performed a robotic vascularized composite bladder allograft (VCBA) autotransplantation in a brain-dead heart-beating research donor. METHODS: An appropriate research donor was identified by our local organ procurement organization. VCBA autotransplantation was performed, including VCBA dissection, extracorporeal back-tabling, vascular reanastomoses, and vesicourethral anastomosis. A robotic approach was necessary to optimize visualization in the deep pelvis and maximally preserve allograft perfusion. The primary objective was to develop the stepwise procedure and gauge its technical success, defined by autograft perfusion by direct visual inspection and indigo-cyanine green (ICG) fluorescence. Secondary objectives included intraoperative parameters (operative times, warm ischemia time, and EBL). IRB (HS-21-00162) approval was obtained. RESULTS: Technical success, defined by adequate autograft perfusion after vascular anastomosis, was achieved. In the brain-dead heart beating donor, the technical maneuvers were well tolerated, with intra-operative hemodynamic stability (Table 1). Operative time was 670 min. Visual inspection revealed a pink, healthy bladder and patent vascular anastomoses, with diffuse ICG uptake. CONCLUSIONS: This is the first documented case of robotic bladder autotransplantation, performed in a brain-dead heart-beating research donor as a necessary preclinical step towards a first-in-human trial of bladder transplantation (NCT05462561). Technical feasibility was demonstrated, and vascular viability was confirmed by ICG uptake. The robotic approach was necessary for fine vascular dissection in the deep pelvis. Source of Funding: This study has been supported by a clinical research grant from the OneLegacy Foundation. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e748 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nima Nassiri More articles by this author Giovanni Cacciamani More articles by this author David Ginsberg More articles by this author Evgeniy Kreydin More articles by this author Andre Abreu More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Yasir Qazi More articles by this author Yuri Genyk More articles by this author Inderbir Gill More articles by this author Expand All Advertisement PDF downloadLoading ...

MP65-05 ROBOTIC BLADDER AUTOTRANSPLANTATION: PRECLINICAL STUDIES IN PREPARATION FOR FIRST-IN-HUMAN TRIAL OF BLADDER TRANSPLANTATION

You have accessJournal of UrologyCME1 Apr 2023MP65-05 ROBOTIC BLADDER AUTOTRANSPLANTATION: PRECLINICAL STUDIES IN PREPARATION FOR FIRST-IN-HUMAN TRIAL OF BLADDER TRANSPLANTATION Nima Nassiri, Giovanni Cacciamani, David Ginsberg, Evgeniy Kreydin, Andre Abreu, Mihir Desai, Monish Aron, Yasir Qazi, Yuri Genyk, and Inderbir Gill Nima NassiriNima Nassiri More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , David GinsbergDavid Ginsberg More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , Andre AbreuAndre Abreu More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Yasir QaziYasir Qazi More articles by this author , Yuri GenykYuri Genyk More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder transplantation has not yet been successfully performed. Technical challenges include complicated deep pelvic vascular anatomy, limited visualization, and procedural complexity. In preparation for a first-in-human clinical trial of bladder transplantation (NCT05462561), we describe our pre-clinical experience with robotic vascularized composite bladder allograft (VCBA) autotransplantation. METHODS: VCBA autotransplantation was performed in three settings: living porcine, pulsatile human cadaver, and brain-dead heart-beating deceased research donor. A robotic approach was utilized to optimize visualization in the deep pelvis and maximally preserve allograft perfusion. The primary objective was development of the stepwise procedure and gauging its technical success, defined by autograft perfusion by direct visual inspection and indigo-cyanine green (ICG) fluorescence. Secondary objectives included intraoperative parameters (operative times, warm ischemia time, and EBL). IACUC (21277) and IRB (HS-21-00162) approval were obtained. The IDEAL Reporting Guidelines were followed. RESULTS: VCBA procurement and autotransplantation was performed in 3 pigs, 2 pulsatile-perfused cadavers, and 1 brain-dead, heart-beating deceased donor (Table 1). Technical success was achieved in two porcine, one cadaveric, and the brain dead deceased donor cases. Operative times in the porcine models ranged from 143-343 min, improving sequentially with each case. A similar finding was noted in the cadaveric model. In the brain-dead heart beating donor, the surgery was well tolerated, with intra-operative hemodynamic stability. Operative time was 670 min. Visual inspection revealed a pink, healthy bladder and patent vascular anastomoses, with diffuse ICG uptake. CONCLUSIONS: Porcine and cadaveric models were used to develop a protocol for VCBA procurement and transplantation. This protocol was applied to the first brain-dead heart-beating donor, documenting technically feasibility. The robotic approach facilitates the fine vascular dissection in the deep pelvis. The above cases are necessary preclinical steps towards a first-in-human trial of bladder transplantation. Source of Funding: This study has been supported by a clinical research grant from the OneLegacy Foundation. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e892 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nima Nassiri More articles by this author Giovanni Cacciamani More articles by this author David Ginsberg More articles by this author Evgeniy Kreydin More articles by this author Andre Abreu More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Yasir Qazi More articles by this author Yuri Genyk More articles by this author Inderbir Gill More articles by this author Expand All Advertisement PDF downloadLoading ...

A new heterotropic vascularized model of total urinary bladder transplantation in a rat model

This study developed a new procedure of urinary bladder transplantation on a rat model (n = 40). Heterotopic urinary bladder transplantation (n = 10) in the right groin vessels was performed. Direct urinary bladder examination, microangiography, histological analysis, and India ink injection were performed to evaluate the proposed method's functionality. Observation time was four weeks. One week after the procedure, the graft survival rate was 80%, two urinary bladders were lost due to anastomosis failure. The rest of the grafts survived two weeks without any complications. Lack of transitional epithelium or smooth muscle layer loss and lack of inflammatory process development were observed. This study was performed in order to obtain the necessary knowledge about urinary bladder transplantation. The proposed technique offers a new approach to the existing orthotropic models.

Introducing a novel experimental model of bladder transplantation in mice.

Bladder dysfunction is a common clinical problem attributed to various conditions such as posterior urethral valves, neurogenic bladder, ureteral ectopy, or bladder exstrophy. Currently, the main therapeutic option for these dysfunctions is neobladder reconstruction with gastrointestinal tract segments. However, the latter was associated with significant long-term complications. To provide a new candidate of possible surgical solution for bladder dysfunction, we propose a novel orthotropic mouse bladder transplantation model. The donor bladder with abdominal aorta and inferior vena cava was isolated and orthotopically sutured to the recipient, whose bladder above the ureteral opening level was removed. The recipient mice showed more than 80% 6-month survival rate and comparable body weight to control mice. At both 1 month and 6 months posttransplant, the urine voiding behavior of recipient mice and control mice was monitored by cystometry. We found that the recipient mice displayed similar bladder pressure and urine secretion ability compared to control mice especially at 6months posttransplant. Similarity of bladder structure between recipient and control mice was confirmed by histology. As a proof of principle, we tested our model in an allogeneic setting. Early acute rejection was noted after day 5 that was histologically more profound by day 10 posttransplant. These results indicate that the mouse bladder transplant is able to provide normal bladder function.

30 - A new heterotopic vascularized model of total urinary bladder transplantation in the rat

30 - A new heterotopic vascularized model of total urinary bladder transplantation in the rat

Improvement in bladder dysfunction after bladder transplantation of amniotic fluid stem cells in diabetic rats

To examine the effects of human amniotic fluid stem cells (hAFSCs) transplantation on bladder function and molecular changes in diabetic rats, 60 female Sprague-Dawley rats were used for study. Three groups were assigned including sham control rats, streptozotocin (STZ, 60 mg/kg)-induced diabetic rats and STZ-induced diabetic rats plus bladder hAFSCs transplantation. Compared to controls, diabetic rats had decreased body weight but increased bladder weight. Cystometries showed non-voiding contraction, residual volume, voided volume and intercontraction interval increased significantly in diabetic rats at week 4 and 12 after DM induction, but improved after hAFSCs transplantation. The immunoreactivities and mRNAs of nerve growth factor (NGF) decreased significantly in diabetic bladder at week 4 and 12 after DM induction, but recovered after hAFSCs transplantation. The immunoreactivities and mRNAs of M2 and M3 muscarinic receptor increased significantly in diabetic bladder at week 4 after DM induction but recovered after hAFSCs transplantation. The immunoreactivity of 8-hydroxy-20-deoxyguanosine increased significantly in diabetic bladder at week 4 and 12 after DM induction but reduced after hAFSCs transplantation. The present study showed bladder dysfunction in STZ-induced diabetic rats could be improved by hAFSCs transplantation into bladder, which may be related to the recovery of bladder NGF and muscarinic receptors.

Bladder Transplantation of Amniotic Fluid Stem Cell may Ameliorate Bladder Dysfunction After Focal Cerebral Ischemia in Rat.

The objective is to investigate whether human amniotic fluid stem cells (hAFSCs) grafting into the bladder may influence bladder functional and molecular changes in an animal stroke model. Female rats were divided into three groups: sham, middle cerebral artery occlusion (MCAO) alone, and MCAO plus 1 × 106 hAFSCs transplanting into bladder wall. Bladder function was analyzed by cystometry at days 3 and 10 after MCAO. The expressions of bladder nerve growth factor (NGF), M2‐muscarinic, M3‐muscarinic, and P2X1 receptors were measured by immunohistochemistry and real‐time polymerase chain reaction. When compared with sham‐operated group, MCAO alone rats had significant increase in residual volume and decrease in voided volume and intercontraction interval; however, these bladder dysfunctions were improved following hAFSCs transplantation. The immunoreactivities of NGF, M3, and P2X1 significantly decreased at days 3 and 10, but M2 increased at day 3 after MCAO. Following hAFSCs transplantation, the immunoreactivities of NGF and P2X1 significantly increased at day 3, and M2 increased at day 10 after MCAO. The mRNAs of NGF, M2, and M3 significantly increased at day 3, but NGF and M2 decreased at day 10 after MCAO. Following hAFSCs transplantation, there was significant decrease in M2 mRNA at day 3 and increase in P2X1 mRNA at days 3 and 10 after MCAO. Bladder dysfunction caused by MCAO can be improved by hAFSCs transplanting into bladder which may be related to the expressions of bladder NGF, and muscarinic and P2X1 receptors. Stem Cells Translational Medicine 2017;6:1227–1236

C141: Urinary bladder and kidney transplantation

C141: Urinary bladder and kidney transplantation

Trimethoprim-sulfamethoxazole and fluoroquinolones Resistant Escherichia Coli in Community-Acquired and Nosocomial Urinary Tract Infections in Rio De Janeiro, Brazil

To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of urinary tract infections (UTI) in patients attending a tertiary university hospital of Rio de Janeiro, Brazil. Antibiotic susceptibility testing was performed by the disk diffusion method. MDR, extensively-resistance (XDR) and pan-resistance (PDR) were defined by using recently described criteria. Retrospective analyses of clinical, microbiological and demographic features of outpatients and inpatients with UTI (n=416) were also performed. High antibiotic resistance rates for trimethoprimsulfamethoxazole - SXT-TMP (n=177; 46.7%) and fluoroquinolones - FQ [n=117; norfloxacin (27%) and ciprofloxacin (26.8%) – (FQ) were demonstrated for E. coli strains isolated from community and healthcare-onsets. Risk factors associated with UTIs due to MDR E. coli isolates included prior three-month hospitalization (OR: 2.4; CI 95%: 1.3-4.4; p<0.005), presence of neurogenic bladder (OR: 3.7; CI 95% :1.7-8.3; p<0.01 ) and kidney transplantation (OR: 3.1; CI 95%:1-0.5; p<0.04). A high prevalence of community-acquired and nosocomial urinary tract infections due SXT-TMP/ FQ resistant E. coli strains was observed in Rio de Janeiro metropolitan area, Brazil. According to IDSA Guidelines, initial empirical therapy for community-associated UTI with SXT-TMP and FQ should be avoided in Rio de Janeiro. Nitrofurantoin, amoxicillin/clavulanic, piperacillin/tazobactam or gentamicin associations were effective for the empiric therapy for community-acquired and healthcare-associated UTIs, respectively.

Combined Kidney and Vascularized Total Bladder Transplantation: Experience in an Animal Model

BackgroundFew reports have described a partial bladder graft with an en bloc kidney transplantation, mainly to facilitate reconstruction of the urinary tract, but also to augment the native bladder. The present study assessed the feasibility to graft vascularized total bladder in association with a renal transplantation. MethodsThe right kidney, in continuity with the ureter and the entire bladder, was retrieved from three female pigs weighing 20 g. The visceral bloc was transplanted to three recipient pigs of the same weight. The entire bladder was transplanted with its vascular connection to ensure a better blood supply. After 3 days of observation, one recipient was humanely killed to examine the bladder graft. Oxygen saturation in the bladder graft monitored for 8 hours was compared with the native bladder in the other two recipients. All three bladder grafts were examined by a pathologist. ResultsAll bladder grafts seemed to be macroscopically well-perfused upon removal of the vascular clamps. In case 1, the recipient was clinically well with good urinary output over the first 2 days of observation; is contrast, on day 3 the animal displayed an acute reduced urinary output. Laparotomy on day 3 of observation showed recent thrombosis of the bladder and renal graft vessels. In cases 2 and 3, oxygen saturations of the bladder graft were normal during the 8-hour observation period, without any difference between the graft and the native bladder. ConclusionsAccording to our results, vascularized total bladder transplantation is feasible. In combination with renal transplantation, it could be applied as an alternative to bladder augmentation or total bladder replacement.

Bladder cancer cell in co-culture induces human stem cell differentiation to urothelial cells through paracrine FGF10 signaling

Fibroblast growth factor 10 (FGF10) is required for embryonic epidermal morphogenesis including brain development, lung morphogenesis, and initiation of limb bud formation. In this study, we investigated the role of FGF10 as a lead induction factor for stem cell differentiation toward urothelial cell. To this end, human multipotent stem cell in vitro system was employed. Human amniotic fluid stem cells were co-cultured with immortalized bladder cancer lines to induce directed differentiation into urothelial cells. Urothelial markers, uroplakin II, III, and cytokeratin 8, were monitored by RT-PCR, immunocytochemistry, and Western blot analysis. Co-cultured stem cells began to express uroplakin II, III, and cytokeratin 8. Targeted FGF10 gene knockdown from bladder cancer cells abolished the directed differentiation. In addition, when FGF10 downstream signaling was blocked with the Mek inhibitor, the co-culture system lost the capacity to induce urothelial differentiation. Exogenous addition of recombinant FGF10 protein promoted stem cell differentiation into urothelium cell lineage. Together, this report suggests that paracrine FGF10 signaling stimulates the differentiation of human stem cell into urothelial cells. Current study provides insight into the potential role of FGF10 as a lead growth factor for bladder regeneration and its therapeutic application for bladder transplantation.

Transplantation of en bloc pediatric kidneys with a partial bladder segment in an adult recipient

The success of transplantation of the urinary bladder en bloc with pediatric kidneys remains undetermined. We transplanted a large portion of the bladder with en bloc kidney allografts from a 13-month-old donor into a 45-year-old adult male. The recipient, who was on long-term hemodialysis, had a small urinary bladder consistent with long-standing anuria. Informed consent was given and bilateral kidneys were transplanted en bloc with both ureters and bladder. The patient's bladder was augmented with the donor bladder and bilateral ureteroneocystotomies of small ureters was avoided. At 3 and 18 months post-transplantation, cystoscopies revealed a viable bladder with new vessels and normal donor bladder. Cystogram revealed no reflux. The bladder segment was reperfused via blood supply from both ureters and then from the recipient's bladder. It seems that bladder transplantation en bloc with pediatric kidneys is a viable option for augmentation of a small recipient bladder that allows avoidance of very small bilateral ureteroneocystotomies.

Long-Term Outcome of Bladder Augmentation Using Living-Related Partial Bladder Transplantation in Rats

Long-term histopathologic changes after bladder augmentation (BA) in rats using living-related partial bladder transplantation (LPBTx) or conventional ileocystoplasty (ICP) were compared. In this study, BA (n = 37), LPBTx (n = 18), and ICP (n = 19) were performed in 16-wk-old Lewis rats. Five donors and seven nontransplanted normal Lewis rats (controls) were also studied. Rats that survived >10 mo after BA were killed after blood biochemistry and neobladder imaging. Harvested bladders were examined with hematoxylin and eosin and proliferating cell nuclear antigen (PCNA). When the rats were killed, there were 16 rats in the LPBTx group and 12 rats in the ICP group; ICP rats were significantly smaller than LPBTx rats (p < 0.05). Mean duration of follow-up for the LPBTX group was 17.3 mo, for the ICP group was 13.7 mo, for the donor group was 16.1 mo, and for the control group was 19.7 mo. Mean serum pH in the LPBTx group was 7.41 +/- 0.78 and in the ICP group was 7.25 +/- 0.38. Mean base excess in the ICP group was significantly lower than in the LPBTx group (p < 0.05). Incidence of bladder calculi in the LPBTx group (6.3%) was significantly lower than in the ICP group (33.3%; p < 0.05). There was no dysplasia/malignancy/increase in PCNA in the LPBTx group. PCNA increased in the ICP group, compared with controls (p < 0.05); two (16.7%) of 12 of ICP rats had dysplasia with mitosis. Bladder capacity increased in LPBTx and ICP compared with controls (both p < 0.05). We hope to show that BA using LPBTx may result in a neobladder with fewer complications than BA using ICP; LPBTx may also decrease the risk for malignancy.

30 Functional and histological results of bladder transplantation in the rat

30 Functional and histological results of bladder transplantation in the rat