Why is it impossible to transplant a bladder? It seems strange to me that a heart can be transplanted and a bladder can’t.
In: Biology
I haven’t found any sources saying it’s impossible. There are other ways doctors have been able to form new “bladders” using the patient’s bowels or insert new ones that aren’t purely biological.
It’s probably better for the patient too because a bladder transplant would cause them to get on immunosuppressive drugs to prevent organ rejection.
The most common types of infection in otherwise health adults are bladder infections. We don’t transplant bladders BC it is already prone to infection, the surgery will increase infection risk (kinking of ureters/scar tissue) and then we are going to give immunosuppressive drugs which will increase the risk of infection even more! Plus the drugs have side effects that lower kidney function, diabetes, on top of immune suppression.
This is why we make bladder conduits from small bowel. No immunosuppressive drugs, still gets complicated by infection occasionally.
It’s not impossible, it’s a weighting of the positives and negatives of a procedure. Transplantation is drastic, dangerous, and life altering. The patient will have to take drugs that suppress their immune system for the rest of their life along with the many side effects that patients will now have to live with. So we generally only do it for stuff that’s either not prone to rejection that the patient won’t have to spend a lifetime on anti-rejection drugs (i.e. cornea) or for stuff where if the patient doesn’t have it they will die.
A heart? You can’t live without it. So transplanting easily edges out the risks and possible complications. A bladder? Not so much. Surgeons are good at fashioning bladders from bowel or small intestine, they can create urine accumulation pockets to be drained by cathater, they can route the ureters to a port on the body to be collected by a bag. These are a mere minor inconvenience compared to a lifetime on anti-rejection drugs and a weakened immune system.
The body have a very strong immune system which is designed to detect and destroy any foreign biological matter. That unfortunately includes functioning organs from other people. So transplant patients have to take medication for the rest of their lives to suppress their immune system which does leave them more open to infections and might even get complications from the medication themselves. So doctors will try to avoid doing transplants if they are not needed. In the case of the bladder it is a very simple organ that you can do without or with simple man made versions. So even in the rare cases where the bladder have to be removed the doctors will not transplant inn a bladder from someone else as the complications from a transplant is worse then the complications from having the bladder removed entirely. And depending on the exact reason for why the bladder had to be removed they can even just put in a plastic bladder instead as it will not be attacked by the immune system.
Neobladder reconstruction using part of one’s own ileum (terminal past of small bowel) is the answer. No need for lifelong immunosuppressants and complications (inclued higher risk of dying from COVID) associated with these.
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It also has to do with the neurologic control of the bladder.
From a neurologic point of view it’s not easy to control your bladder then decide to take a piss. It actually requires exquisite control and coordination by your nervous system. Almost all of this is happening at an unconscious level, just like digesting your food is a complex, coordinated activity that you don’t have to think about.
You can’t hook up the transplant recipient’s bladder to the nervous systemic a functional way, so the new bladder wouldn’t work like you would hope it would.
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Neobladder reconstruction using part of your ileum. Avoids all the usual transplant issues. BUT always advise patients and their family of the risk of electrolyte and even metabolic imbalances. https://pubmed.ncbi.nlm.nih.gov/8351484/
Metabolic acidosis leading to hyperkalemia is not uncommon, especially in those who have conditions making them already slightly acidic (ie all diabetics and kidney patients).
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