Donor Bladder Inclusion in Kidney Transplantation: A Review of the Literature and our Clinical Experience

This review examines bladder inclusion as a reconstructive option in kidney transplantation, particularly when incorporated as part of a pediatric en bloc kidney transplant. With careful patient selection, partial or complete bladder transplant can be performed safely. The technique is relatively straightforward and provides a functionally reliable method of urinary reconstruction and donor ureteral implantation. For decades, bladder transplantation was considered technically challenging because of the complex pelvic vascular anatomy, the difficulty of maintaining adequate blood supply, and challenges related to nerve regeneration and function voiding. Despite these obstacles, several attempts of bladder transplantation have been reported in the literature with varying functional outcomes. Notably, one case described transplantation of the entire bladder with sustained function up to 17 years after transplantation. Donor bladder inclusion in pediatric en bloc kidney transplantation offers a reliable and technically straightforward approach to ureteral and urinary tract reconstruction in complex kidney transplant recipients. The technique is reproducible, avoids vascular reconstruction, and may have expanded indications in patients requiring at the same time a neobladder or bladder augmentation.