For patients with both end-stage kidney disease and terminal bladder dysfunction, the standard of care has historically been kidney transplantation combined with urinary diversion, rerouting urine through segments of intestine, which brings risks of infection, metabolic disturbances, and reduced quality of life. A transplant that includes the bladder itself has been a surgical aspiration, but the technical challenges of harvesting, preserving, and anastomosing a fully vascularized bladder have kept it out of reach.
No longer.
A team of surgeons from the University of California, Los Angeles and the University of Southern California has performed the first-in-human combined deceased-donor bladder and kidney transplantation. The case is reported in the July 4, 2026 issue of The Lancet, and the results, more than six months of follow-up, are encouraging enough to mark a genuine surgical milestone.
The patient and the procedure
The recipient was a 41-year-old anephric male with end-stage kidney disease from hypertension (on peritoneal dialysis for 7 years) and concurrent end-stage bladder dysfunction. The donor was an ABO-compatible 35-year-old female with terminal anoxic brain injury.
The 8-hour surgery involved en bloc procurement of the kidney and bladder with their intact vascular pedicles, meaning both organs were removed from the donor as a single vascularized unit. The bladder was then transplanted as a vascularized composite allograft (VCA), with its own blood supply anastomosed directly to the recipient’s vasculature. This differs fundamentally from earlier approaches such as the “bladder patch technique,” where a non-vascularized segment of donor bladder was used as a scaffold rather than a living composite graft.
Outcomes
At more than six months post-transplant, the results are striking:
- Renal function: stable eGFR of 52–55 mL/min/1.73 m²
- Bladder capacity: 600 mL, within normal physiological range
- Continence: complete
- Spontaneous voiding: achieved, with maximum flow rate of 17 mL/s and negligible post-void residual
- Rejection: serial bladder biopsies negative for both cell-mediated and antibody-mediated rejection
- Immunosuppression: triple therapy with tacrolimus, mycophenolate mofetil, and prednisone (standard renal transplant regimen)
The case was not without complications. On postoperative day 25, the patient developed a urine leak from a suprapubic tube tract with wound breakdown, a Clavien-Dindo grade 4 complication requiring ICU management. This was managed surgically with good recovery, and no further graft-threatening events occurred in the follow-up period.
Why this matters
The significance of this case extends beyond the individual patient. Historically, patients with combined bladder and kidney failure faced two options: kidney transplant alone with permanent urinary diversion (requiring intestinal segments and external bags) or lifelong dialysis. The VCA bladder approach offers the possibility of normal urinary function without the morbidity of intestinal interposition.
The trial is structured under the IDEAL framework for surgical innovation (McCulloch et al., The Lancet, 2009), which provides ethical guardrails for first-in-human procedures. Importantly, eligibility is restricted to patients already requiring or eligible for immunosuppression as kidney transplant candidates, minimizing the incremental risk of the combined procedure.
The case is part of an ongoing phase 0 feasibility trial (registered at ClinicalTrials.gov NCT06337942 and NCT05462561), and senior author Nima Nassiri of UCLA’s Kidney and Bladder Transplant Programs and Inderbir S. Gill of USC’s Genitourinary VCA Transplant Program describe it as a technical proof-of-concept rather than a broadly applicable therapy, at least for now.
What’s next
The immediate question is whether the results can be replicated across a larger cohort, the trial is actively enrolling. Longer-term questions include the durability of bladder graft function over years rather than months, the incidence of chronic rejection in the bladder component (which may differ from the kidney), and whether the VCA approach can be extended to other pelvic organs.
For the moment, the field has a new data point and a new direction: a fully vascularized, functional bladder can be transplanted alongside a kidney and sustain normal capacity, continence, and sensation at six months. That is not yet a cure for every patient with bladder failure. But it is a path where before there was none.
Funding: American Urological Association Research Scholar Award, National Kidney Registry, OneLegacy, UCLA Department of Urology.
Source
Nassiri, N. and Gill, I.S. “Combined bladder–kidney transplantation: first-in-human feasibility trial.” The Lancet 408(10549), 31–37 (2026). DOI: 10.1016/S0140-6736(26)00718-X00718-X)