Tuesday, May 20, 2025

First human bladder transplant performed at UCLA

Historic surgery, the result of years of research by UCLA and USC surgeons, opens the door for improved treatment of non-functioning bladders

University of California - Los Angeles Health Sciences

B-roll and stills available at link below

Surgeons from UCLA Health and Keck Medicine of USC have performed the world’s first-in-human bladder transplant.

The surgery was successfully completed at Ronald Reagan UCLA Medical Center on May 4, 2025. It was a joint effort by Dr. Nima Nassiri, a urologic transplant surgeon and director of the UCLA Vascularized Composite Bladder Allograft Transplant Program, and Dr. Inderbir Gill, founding executive director of USC Urology.

"Bladder transplantation has been Dr. Nassiri's principal academic focus since we recruited him to the UCLA faculty several years ago," said Dr. Mark Litwin, UCLA Urology Chair, "It is incredibly gratifying to see him take this work from the laboratory to human patients at UCLA, which operates the busiest and most successful solid-organ transplant program in the western United States."

“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 tumor 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 for it,” Nassiri said.

Nassiri, formerly a urology resident with the Keck School and now assistant professor of urology and kidney transplantation at UCLA, and Gill worked together for several years at the Keck School to develop the new surgical technique, design clinical trials and secure the necessary regulatory approvals.

Nassiri and Gill collaborated for several years to develop the surgical technique. Numerous pre-clinical procedures were performed at USC and OneLegacy, Southern California’s organ procurement organization, to prepare for the first human bladder transplant.

The recovery of the kidney and bladder from the donor was performed at OneLegacy. All parts of the procedure, including surgery and post-surgical monitoring during the transplantation, were aligned with the highest current clinical and research standards.

During the complex procedure, the surgeons transplanted the donated kidney, following that with the bladder. The new kidney was then connected to the new bladder using the technique that Nassiri and Gill pioneered. The entire procedure lasted approximately eight hours.

“The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately,” Nassiri said. “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.”

Millions of people around the globe experience some degree of bladder disease and dysfunction. Some develop terminal bladders that are either non-functioning and/or cause constant pain, repeated infections and other complications. Current treatment for severe terminal cases of bladder dysfunction or a bladder that has been removed due to various conditions includes replacement or augmentation of the urinary reservoir. These surgeries use a portion of a patient’s intestine to create a new bladder or a pathway for the urine to exit the body.

While these surgeries can be effective, they come with many short-and long-term risks that compromise a patient’s health such as internal bleeding, bacterial infection and digestive issues.

“A bladder transplant, on the other hand, results in a more normal urinary reservoir, and may circumvent some short- and long-term issues associated with using the intestine,” Nassiri said.

As a first-in-human attempt, there are naturally many unknowns associated with the procedure, such as how well the transplanted bladder will function immediately and over time, and how much immunosuppression will ultimately be needed.

“Despite the unknowns, our goal is to understand if bladder transplantation can help patients with severely compromised bladders lead healthier lives,” Gill said.

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.

The two surgeons also undertook several non-robotic trial runs of bladder recovery at OneLegacy, allowing them to perfect the technique while working closely with multi-disciplinary surgical teams.

The bladder is strictly within the domain of urologists. At UCLA, kidney transplantation is also housed within the department of urology. This is why the combined kidney and bladder transplant was ultimately performed at UCLA, which has the necessary infrastructure, clinical expertise, and multidisciplinary support to carry out the procedure and manage the patient from pre-transplant evaluation through post-transplant care, all within the one department.

The procedure was performed as part of a UCLA clinical trial. Nassiri and Gill hope to perform more bladder transplants in the near future.

UCLA Urology has long been at the frontier of urologic transplantation, with pioneering research in kidney transplantation and now, bladder transplantation.

Credits for Bladder Transplant B-Roll and Stills

Photos: Nick Carranza/UCLA Health

Videos: Cesar Sarmiento Blanco/UCLA Health

https://downloads.uclahealth.org/mediarelease/PressKit-BladderTransplant.zip

\The Keck Medicine of USC surgical team evaluates the integrity of a bladder during the research and development stage of bladder transplantation.

Credit

Photo courtesy of USC Urology

USC, UCLA team up for the world’s first-in-human bladder transplant

Historic surgery, the result of years of research at Keck Medicine of USC and UCLA Health, opens the door for improved treatment of non-functioning bladders

University of Southern California - Health Sciences

image:
Inderbir Gill, MD (L) and Nima Nassiri, MD (C) perform the world’s first-in-human bladder transplant.
view more
Credit: Photo courtesy of Nick Carranza, UCLA Health

LOS ANGELES — Surgeons from Keck Medicine of USC and UCLA Health have performed the world’s first-in-human bladder transplant. The surgery was successfully completed at Ronald Reagan UCLA Medical Center on May 4, 2025, in a joint effort by Inderbir Gill, MD, founding executive director of USC Urology, and Nima Nassiri, MD, urologic transplant surgeon and director of the UCLA Vascularized Composite Bladder Allograft Transplant Program.

Groundbreaking moment in medical history

“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.”

Nassiri, formerly a urology resident with the Keck School and now assistant professor of urology and kidney transplantation at UCLA, and Gill worked together for several years at the Keck School to develop the new surgical technique, design a clinical trial and secure the necessary regulatory approvals.

Numerous pre-clinical procedures were performed both at Keck Medical Center of USC and OneLegacy, Southern California’s organ procurement organization, to prepare for this first-in-human bladder transplant.

A complicated yet successful surgery

The patient had been dialysis-dependent for seven years. He lost the majority of his bladder during surgery to resect cancer over five years ago, leaving the remainder of his bladder too small and compromised to function appropriately. Both of his kidneys were subsequently removed due to renal cancer.

To address these deficits, Drs. Gill and Nassiri performed a combined kidney and bladder transplant, allowing the patient to immediately stop dialysis and produce urine for the first time in seven years. First the kidney, then the bladder, were transplanted. The new kidney was then connected to the new bladder. The entire procedure took approximately eight hours.

“The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately,” Nassiri added. “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,” said Gill. “The patient is doing well, and we are satisfied with his clinical progress to date.”

The recovery of the kidney and bladder from the donor was performed at OneLegacy’s Transplant Recovery Center in Azusa, Calif. All parts of the procedure, including surgery and post-surgical monitoring during the transplantation, were aligned with the highest current clinical and research standards.

How a bladder transplant may benefit patients

“While these surgeries can be effective, they come with many short-and long-term risks that compromise a patient’s health such as recurrent infections, compromised kidney function and digestive issues,” said Gill.

“A bladder transplant, on the other hand, delivers a more ‘normal’ urinary reservoir and may circumvent some of the challenges associated with using the intestine,” said Nassiri.

The biggest risks of organ transplant are the body’s potential rejection of the organ and side-effects caused by the mandatory immunosuppressive drugs given to prevent organ rejection.

“Because of the need for long-term immunosuppression, the best current candidates are those with a pre-existing organ transplant or those who need a combined kidney and bladder transplant,” said Nassiri.

“Despite the unknowns, our goal is to understand if bladder transplantation can help patients with severely compromised bladders lead healthier lives,” said Gill.

Collaborative research and development leading to the transplant

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, Gill and Nassiri 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.

Several non-robotic trial runs of bladder recovery were performed at OneLegacy by Gill and Nassiri, allowing them to perfect the technique while working alongside multidisciplinary surgical teams.

The bladder transplant was done as part of a UCLA clinical trial. Gill and Nassiri hope to perform more bladder transplants together in the near future.

Under Gill’s leadership, USC Urology has rapidly established itself as a pioneer and world leader in the most advanced robotic urologic oncologic surgeries for kidney, bladder, prostate, testicular and penile cancers, and has achieved important milestones leveraging machine learning and artificial intelligence to optimize patient outcomes.

UCLA Urology has long been at the frontier of urologic transplantation, with pioneering research in kidney transplantation and, now, bladder transplantation.

###

For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

Nima Nassiri, MD (L) and Inderbir Gill, MD (R) collaborated on years of clinical research to prepare for the historic surgery.

Credit

Photo courtesy of Nick Carranza, UCLA Health

Climate change increases severity of obstructive sleep apnea

American Thoracic Society

image:
Bastien Lechat, PhD, is a senior research fellow at FHMRI: Sleep Health at Flinders University.
view more
Credit: Bastien Lechat, PhD

Session: A109—Smoke, Snooze, and ICU Blues: The Influence of Environmental Exposures and Critical Care Conditions on Sleep

Rising Temperatures Are Associated with Increased Burden of Obstructive Sleep Apnea

ATS 2025, San Francisco – Rising temperatures increase the severity of obstructive sleep apnea (OSA), according to a large new study published at the ATS 2025 International Conference. The study also found that, under the most likely climate change scenarios, the societal burden of OSA is expected to double in most countries over the next 75 years.

In addition to highlighting the critical importance of limiting global warming, the findings also emphasize the immediate need for strategies to alleviate the health and economic impacts of OSA as it becomes more common and severe, researchers said.

“This study really highlights the societal burden associated with the increase in OSA prevalence due to rising temperatures,” said Bastien Lechat, PhD, a senior research fellow at FHMRI: Sleep Health at Flinders University.

Previous cross-sectional studies identified a link between ambient temperature and OSA severity. However, this is the first to explain and describe that connection in detail.

For the study, researchers analyzed a consumer database of more than 116,000 worldwide users of an under-mattress sensor validated to estimate OSA severity. The dataset included around 500 repeat measurements per user. Researchers then analyzed this data against 24-hour ambient temperatures extracted from climate models.

Overall, higher temperatures were associated with a 45 percent increased likelihood of a sleeper experiencing OSA on a given night. However, these findings varied by region, with people in European countries seeing higher rates of OSA when temperatures rise than those in Australia and the United States.

“We were surprised by the magnitude of the association between ambient temperature and OSA severity,” Dr. Lechat said.

Researchers then sought to estimate how burdensome the increase in OSA prevalence due to rising temperature is to society in terms of wellbeing and economic loss. They conducted modeling including disability-adjusted-life-years, productivity losses, and health economics to estimate the OSA burden under several climate scenarios.

They found that any scenario that involved temperatures rising 2 degrees Celsius or higher would result in a 1.5-fold to 3-fold increase to the OSA burden by the year 2100. They estimated that climate change has already increased the OSA burden by 50 percent to 100 percent since the year 2000.

In addition to providing further evidence of the major threat of climate change to human health and wellbeing, Dr. Lechat said the study highlighted the importance of developing effective interventions to diagnose and manage OSA.

“The high prevalence undiagnosed and untreated OSA amplifies the effect of global warming on the societal burden associated with OSA,” he said. “Higher rates of diagnosis and treatment is likely to reduce the health and productivity burden due to rising temperature and increased OSA prevalence.”

Next, the team plans to develop intervention studies looking at strategies to mitigate the effects of temperature on OSA. They also hope to study the physiological mechanisms linking OSA severity to temperature.

###

VIEW ABSTRACT

You may also be interested in these abstracts.

Waitlist deaths dropped under new lung transplant allocation system

American Thoracic Society

image:
First author Mary Raddawi, MD.
view more
Credit: Mary Raddawi, MD

ATS 2025, San Francisco – Two years ago the United Network for Organ Sharing implemented new allocation guidelines for lung transplants that prioritize medical urgency. Now new research published at the 2025 ATS International Conference shows that waitlist outcomes significantly improved under the new system.

Waitlisted patients had a lower risk of death or delisting under the new Composite Allocation Score (CAS) than they did before the guidelines were implemented, researchers said. They also found that the sickest patients on the waitlist saw the largest benefit.

“We always want to make sure that any time we make a change to the allocation system that we’re improving outcomes, especially for our sickest patients,” said first author Mary Raddawi, MD. “This provides confirmation that we’re on the right track.”

Donor lungs were previously allocated based on geographical proximity, with local patients receiving priority access. After a lawsuit in 2017 the allocation radius was expanded to a wider area, and UNOS began working on new guidelines.

Implemented in 2023, the CAS system is based on a compilation of points that prioritizes medical urgency, along with other patient factors.

For the new study, researchers compared outcomes for waitlisted patients before 2017, after the geographic radius was expanded in 2017, and after the CAS was implemented in 2023.

Across the board, they found that 11.2 percent of patients died or were delisted while waiting for a transplant before 2017. That number declined slightly to 8.4 percent when the geographical area was extended in 2017 but dropped to 4.1 percent after CAS.

Improvements were even more dramatic for the patients with the top 5 percent of waitlist urgency scores. These patients were three times more likely to die on the waitlist before 2017 than they were after the implementation of CAS.

Dr. Raddawi said the results were encouraging, but not surprising. “When you think about the fact that now we’re focusing on many different factors, including medical urgency, it makes sense that the waitlist mortality would go down for our sicker patients — but it is nice to see the actual numbers,” she said.

The findings highlight the importance of providers advocating for their sickest patients and ensuring that their medical urgency is reflected in their scores, she added. “We’re seeing that it really does make a difference for them,” she said.

Researchers plan to follow up on the study by looking at outcomes in greater detail, such as analyzing whether certain biological factors considered in CAS scores are linked to better outcomes among the critically ill.

###

VIEW ABSTRACT

You may also be interested in these abstracts.

Conservation leaders challenge global economic systems that value ‘dead’ nature over living planet

Taylor & Francis Group

From cut flowers to felled timber, and from caught fish to butchered meat, we value nature most when it’s dead. But if we can change economic systems and mindsets in support of nature, our planet may start to recover – this is the message from a global team of experts.

The authors warn that a lack of an economic and market value for the living natural world has given free rein for the exploitation and destruction of the environment, at a huge cost for animals, plants, Indigenous Peoples, and ultimately, all life on Earth.

A forthcoming book, called Becoming Nature Positive, is co-authored by a group of nature advocates representing a wide range of sectors and geographies, who have examined these global ‘market failures’ and their impacts on the natural world. The lead author is Marco Lambertini, convener of the Nature Positive Initiative, a coalition of 27 of the world’s largest conservation organisations, institutes, standard-setters, and business and finance groups.

‘Nature Positive’ is defined as a world in which there is more nature in 2030 than there was in 2020 – and then ensuring that nature continues to recover after that – as agreed by all countries in the landmark Kunming-Montreal Global Biodiversity Framework in 2022.

The book sets out nature’s ‘great decline’ and charts the start of a ‘great awakening’ – where people are timidly waking up to fact that exceeding planetary limits will impact the systems that support life, and that the entire planet may irreversibly shift to an unstable and unpredictable state. The authors say that this is a huge cultural shift and is perhaps what’s most needed to embrace the deep systemic change we need to see in our societies and economies.

Lambertini explains how nature only really attains economic value once it has been destroyed: “Trees gain a market value when they are cut for lumber, and not for the oxygen they produce, the soil erosion they prevent, the water regulation and purification function they provide while alive.

“Fish, meanwhile, are valued when caught and sold to feed humans – or our farmed animals – not for contributing to the health of rivers and seas which in turn generate immensely positive services to our economy, society and individual wellbeing.

“And water gains some value after it has been extracted and used for agriculture, industries and households, most likely being polluted as a result – not for sustaining all life on Earth.

“Even flowers gain value when they are cut and sold for our anniversaries and other special occasions, or are grown for our gardens and flats, not for their beauty and ecological function when living wild in meadows or forests.

“We have failed to account for the value of living nature in economic decision-making. This blindness to the values of nature has led to overexploitation, degradation and destruction of the natural world which, in turn, is beginning to affect our economy and society.”

The authors call for a ‘great transition’ to a ‘nature positive’ world, before setting out a series of ways in which this can be achieved. These include coordinated messaging that saving nature is also about saving people; learning from Indigenous groups; igniting self-interest as a motivator for pro-environmental behaviour; radically rethinking food systems; and spurring leadership in the business, investment and political realms.

They suggest the answer must include shifting from a system based on Gross Domestic Product to one which considered the Gross Ecosystem Product, accounting for the economic costs of nature loss, but also for nature’s contributions to the economy.

Businesses wanting to contribute to a nature-positive economy should not delay, they urge, as if they wait until the path to nature positivity is clearly marked, it will be too late. It’s ‘now for nature’, says Eva Zabey of Business for Nature. And writing in the chapter about finance, Dorothy Maseke of the African Natural Capital Alliance suggests that creating the right environment through regulation and market mechanisms is essential, and that establishing a taxonomy and transparency is critical.

Lambertini warns: “We have all it takes to avert the worst consequences: the intellectual, financial, technological ability. It is simply about choices and resolve. And in this lies, absurdly and tragically, the greatest threat: to think that someone or something else will save us from the destabilisation of the Earth systems.”

The book, prefaced by global sustainability leader and Roche board vice-chair André Hoffmann, contains a broad range of contributions and views from the global Nature Positive Initiative and beyond. Fellow leading co-authors are Dr Joseph W. Bull for the science perspective; Leroy Little Bear and Harvey Locke with Éliane Ubalijoro, Brigitte Baptiste and Fuwen Wei for the society perspective; Eva Zabey on business; Dorothy Maseke on finance; and Carlos Manuel Rodríguez and Sonja Sabita Teelucksingh with the governance perspective.

These chapters are complemented by a suite of reflections from a wide range of sustainability thought leaders across different sectors and geographies – ranging from Yana Gevorgyan of the Group on Earth Observations and Akanksha Khatri of the World Economic Forum’s Nature Action Agenda, to leading sustainability scientist Johan Rockström of the Potsdam Institute for Climate Impact Research, Tony Goldner of the Taskforce on Nature-related Financial Disclosures, and David Atkin of the UN’s Principles for Responsible Investment. Together they sketch out a landscape scan of the role that science, society, business, finance, government, multilateral organizations, NGOs and citizens can play in making the nature-positive transition happen.

DOI

10.4324/9781003474043

It’s a national treasure, but 13% of Australians can’t tell you where the Great Barrier Reef is located

University of South Australia

New research shows that Australians care deeply about the Great Barrier Reef (GBR) – one of the Seven Natural Wonders of the World – but 13% can’t tell you where it is located.

A social media survey canvassing Australians’ perceptions of the iconic tourism drawcard also revealed that while most people are aware of the threats facing the world’s largest coral reef, few can name many individual species inhabiting it.

The survey, conducted by University of South Australia (UniSA) researchers and recently published in Marine and Freshwater Research, underscores the need for a targeted public awareness campaign to address knowledge gaps about the fragile ecosystem, according to lead author Jarrah Taylor.

The UniSA environmental science master’s student says that 113 Australians recruited via social media were asked four open-ended questions about the Great Barrier Reef, including where it was located, what species lived in the reef, its importance to Australia, and the major threats facing it.

The survey’s key findings were:

Most participants (86.72%) correctly named the Queensland coastline as the home of the Great Barrier Reef, but a small number (13%) were either unaware of the location or stated the wrong State.
Participants commonly identified broad groups such as fish (37%), reptiles (12%) and corals (12%) occupying the GBR, and specific species like clownfish (3.9%), sea turtles and sharks (10%) were mentioned, but participants revealed limited knowledge of species at a more niche level.
The GBR’s environmental importance was recognised, with 48% of survey respondents citing it as a crucial habitat for various species, 27% naming it as a natural wonder of the world, 44% mentioning it as a major tourism drawcard, and 9% aware of its importance to the Australian economy.
Participants identified several threats, mostly caused by humans, including runoff, pollution and plastics (36%), climate change (33%), warming oceans (24%) and coral bleaching (34%). Of the 18 threats reported by participants, only three were naturogenic (crown-of-thorns starfish, natural disasters and sea urchins).

Taylor says it is not surprising that fish and coral topped the recognition list for marine life in the Great Barrier Reef.

“Images of both coral and fish have long been used in tourism campaigns dating back to the 1970s,” she says.

“We were not expecting participants to provide the scientific name for individual species, but we were interested to see if they could identify flora and fauna at a more niche level – for example reef sharks, manta rays, giant clams and potato cod. This was not the case.”

The most common specific species identified was the clownfish, most likely owing to media portrayals in Finding Nemo, a 2003 animated adventure film inspired by the Great Barrier Reef.

“This shows the power of digital media and popular culture in raising awareness of charismatic species, which can lead to conservation support,” Taylor says.

UniSA senior author Dr Brianna Le Busque says that only three species classified as endangered were identified by participants – the green turtle, staghorn coral, and the hammerhead shark – and fewer than 1% of respondents cited birds, despite the GBR supporting breeding populations of 20 seabird species.

“This finding highlights the need for more education of endangered and critically endangered species living in the Great Barrier Reef, which are under threat from human activities,” Dr Le Busque says.

“We know from a psychology perspective that people are more motivated to help conservation efforts if they feel personally connected to species and know more about them.

“The Great Barrier Reef supports more than 6000 different species and is the jewel in the crown of coral reefs worldwide. It is important to Australia environmentally, economically, culturally and scientifically, and we need to protect it for future generations.”

The researchers recommend expanding the study in future to include a larger, more representative sample of the Australian population. The current study comprised 70% women and 30% men, with participants from SA, Queensland, NSW and Victoria.

“Australians perceptions of species diversity of, and threats to, the Great Barrier Reef” is authored by University of South Australia researchers Jarrah Taylor, Associate Professor Carla Litchfield and Dr Brianna Le Busque. DOI: 10.1071/MF24109

DOI

10.1071/MF24109

Method of Research

Survey

Subject of Research

People

Article Title

Australians’ perceptions of species diversity of, and threats to, the Great Barrier Reef

LA REVUE GAUCHE - Left Comment

Tuesday, May 20, 2025

First human bladder transplant performed at UCLA

\The Keck Medicine of USC surgical team evaluates the integrity of a bladder during the research and development stage of bladder transplantation.

Credit

Photo courtesy of USC Urology

USC, UCLA team up for the world’s first-in-human bladder transplant

Credit

Climate change increases severity of obstructive sleep apnea

Waitlist deaths dropped under new lung transplant allocation system

Conservation leaders challenge global economic systems that value ‘dead’ nature over living planet

DOI

It’s a national treasure, but 13% of Australians can’t tell you where the Great Barrier Reef is located

DOI

Method of Research

Subject of Research

Article Title

About Me