A World First: Six-Month Outcomes of Vascularized Bladder Transplantation Published in The Lancet

KEY FINDINGS

• A world first: A vascularized bladder with its own independent blood supply was transplanted into another human being; unlike standard bladder reconstruction with a bowel segment, the organ was transferred with its own vascular structures.
• The case: The operation, performed at UCLA Health in May 2025, was carried out as a simultaneous kidney and bladder transplant in a 41-year-old patient who had been on dialysis for 7 years and had a non-functioning bladder.
• Six-month outcomes: The patient can hold 600 mL of urine - equivalent to a normal adult bladder capacity - voids spontaneously, is fully continent, and shows no histopathological findings suggestive of rejection.
• Publication: The results were published in The Lancet on 23 June 2026; the team has performed 3 combined kidney-bladder transplants to date.

Study Design and Background

The current standard approach in patients with end-stage bladder disease is urinary reconstruction using bowel segments (ileal conduit, orthotopic neobladder or continent reservoir). While effective, this method carries significant disadvantages such as metabolic disturbances, recurrent urinary infections and long-term mucus/stone complications.

To overcome these limitations, the team led by Dr Nima Nassiri (UCLA Health, urological transplant surgeon) and his mentor Dr Inderbir Gill (USC Keck Medicine, founding director of the USC Department of Urology) developed an approach that transplants the bladder not from bowel but as a vascularized composite allograft preserving its own vascular structures. Before clinical application, robotic bladder retrieval and robotic transplantation techniques were rehearsed repeatedly in recently deceased donors whose cardiac function was maintained with ventilator support.

The first case was a 41-year-old man with end-stage renal failure secondary to hypertension and a non-functional bladder, who had been on dialysis for 7 years. The simultaneous kidney and bladder transplant from an ABO-compatible deceased donor was performed in May 2025 as part of a multicentre feasibility study (NCT06337942 and NCT05462561). The operation, lasting approximately 8 hours, was completed without intraoperative complications and both grafts showed excellent perfusion.

Key Results

During the patient's course, one major (grade 4) complication developed on day 25 in the form of urine leakage and wound dehiscence originating from the suprapubic catheter tract; after surgical repair (abdominal washout, wound debridement, closure of the cystotomy and removal of the suprapubic catheter) the patient recovered without further grade ≥3 complications. On the basis of this experience the team removed the use of a back-up suprapubic catheter from the protocol in subsequent cases. Immunosuppression was maintained with tacrolimus, mycophenolate mofetil and prednisone.

"We learn something from every procedure. Our hope is to be able to help many more patients with end-stage bladder disease, particularly those who had little hope of a normal life."
- Nima Nassiri, MD, UCLA Health, Urological Transplant Surgeon, Lead Author of the Study

The team has performed a total of 3 combined kidney-bladder transplants to date. The first patient (the case described above) is living a healthy and active life at one year of follow-up. In the second patient the kidney graft was successful, but the bladder graft had to be removed because of a complication; the patient recovered and the team plans a second bladder transplant attempt at a later date. The third patient can void unaided without the need for a catheter approximately 2 months after surgery.

Implications for Clinical Practice

Although this study represents phase 0 feasibility data from a single case with short follow-up, it opens a paradigm-shifting door in urological oncology and reconstructive surgery. In selected patients who already require immunosuppression for a kidney transplant and who have concurrent end-stage bladder disease, vascularized bladder transplantation may emerge as an alternative to bowel-based reconstruction - particularly given its potential to reduce metabolic and infectious complication risks.

From the perspective of robotic surgical practice, the notable point is that the team rehearsed robotic bladder retrieval and robotic transplantation techniques repeatedly in a deceased donor model before clinical application; this shows that advanced robotic experience plays a critical role in safely bringing such procedures, which require complex vascular anastomoses, into practice. In addition, the graft loss in the second patient and the subsequently planned "re-transplantation" attempt provide instructive data on the salvage potential of this technique.

That said, for these findings to translate widely into clinical practice, long-term immunological and functional outcomes, optimal immunosuppression protocols, graft rejection grading criteria and the potential for bladder reinnervation need to be clarified in much larger patient series. In patient counselling it is important to convey in a balanced way that this technology is still experimental, but that it opens a promising horizon for patients with end-stage bladder disease.

Conclusion

The six-month outcomes achieved in the first human application of vascularized bladder allograft transplantation show that the technique is technically feasible in selected patients and offers reassuring early functional and immunological findings. Although a single case and short follow-up are important limitations, the 3 transplants performed by the UCLA Health team to date and the new cases planned indicate that this field is turning into a rapidly maturing line of research. As it is supported by long-term data, this development at the intersection of uro-oncology and reconstructive urology is expected to find its place in clinical practice more clearly.

References

• Nassiri N, Gill IS, et al. Combined bladder-kidney transplantation: first-in-human feasibility trial. The Lancet. 2026;408(10549):31-37. doi:10.1016/S0140-6736(26)00718-X - thelancet.com
• Clarke H. First-in-human bladder transplant demonstrates sustained function at 6 months. Urology Times. 20 July 2026. - urologytimes.com
• McCartney G. UCLA Health study documents successful one-year outcome following first-ever bladder transplant. UCLA Newsroom. 24 June 2026. - newsroom.ucla.edu
• UCLA Health. World's first human bladder transplant performed at UCLA. - uclahealth.org
• Keck Medicine of USC. USC and UCLA team up for the world's first-in-human bladder transplant. - keckmedicine.org