News
First human bladder transplant performed at UCLA
Surgeons from UCLA Health and Keck Medicine of USC have performed the world’s first-in-human bladder transplant. The surgery, which was successfully completed at Ronald Reagan UCLA Medical Center, was a joint effort by Dr. Nima Nassiri, a urologic transplant surgeon and director of the UCLA Vascularised Composite Bladder Allograft Transplant Programme, and Dr. Inderbir Gill, founding executive director of USC Urology. “This surgery is a historic moment in medicine and stands to impact how we manage carefully selected patients with highly symptomatic ‘terminal’ bladders that are no longer functioning,” said Gill, who is also chair and Distinguished Professor of Urology and Shirley and Donald Skinner chair in Urologic Cancer Surgery with the Keck School of Medicine of USC. “Transplantation is a lifesaving and life-enhancing treatment option for many conditions affecting major organs, and now the bladder can be added to the list.” “This first attempt at bladder transplantation has
been over four years in the making,” Nassiri said. “For the appropriately selected patient, it is exciting to be able to offer a new potential option.” The patient had lost most of his bladder during a tumour removal, leaving the remainder too small and compromised to work. Both of his kidneys were also subsequently removed due to renal cancer in the setting of pre-existing end-stage kidney disease. As a result, he was on dialysis for seven years.
The biggest risks of organ transplantation are the body’s potential rejection of the organ and side-effects caused by the mandatory immune suppressing drugs given to prevent organ rejection. “Because of the need for long-term immunosuppression, the best current candidates are those who are already either on immunosuppression or have an imminent need
GIRFT announces new guidance on MRSA screening
Guidance to help standardise MRSA screening in hospitals is now available, aiming to reduce delays in the surgical pathway and helping to manage demand for preoperative assessment (POA) services. The guidance has been developed by
for it,” Nassiri said. “The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately. There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.” “Despite the complexity of the case, everything went according to plan and the surgery was successful,” Gill added. “The patient is doing well, and we are satisfied with his clinical progress to date.”
Bladder transplants have not been done
previously, in part because of the complicated vascular structure of the pelvic area and the technical complexity of the procedure. As part of the research and development stage, Nassiri and Gill successfully completed numerous practice transplantation surgeries at Keck Medical Center of USC, including the first-ever robotic bladder retrievals and successful robotic transplantations in five recently deceased donors with cardiac function maintained on ventilator support.
GIRFT in collaboration with the National Perioperative Collaborative, with input from NHS England’s national clinical directors for perioperative medicine and critical care, and infection prevention and control. The new guidance comes in response to feedback that supplementary guidance would help standardise practice. It is especially important as we move to new models for elective care, such as surgical hubs and mutual aid. The three suggested actions in the guidance outline: which patients should be screened for MRSA (e.g. those having surgery in a high-risk specialty, such as neurosurgery, or where the procedure involves the insertion of prosthetic material); which sites should be swabbed (the nose and groin/perinium by default, with additional sites screened on a case-by-case basis); and the duration of validity of an MRSA screen (at least three months for major surgery and up to six months or potentially longer). The guide also summarises current guidance on suppression therapy and offers advice regarding patients who test positive and negative for MRSA.
Scan here to download the guidance at: https://
tinyurl.com/wkdtbrtr
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