Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant

Özkan, Ömer; Özkan, Özlenen; Doğan, Nasuh Utku; Bahçeci, Mustafa; Mendilcioğlu, İnanç; Boynukalin, K.; Ongun, Hakan; Kantarci, Abdul Mecit; Yaprak, Muhittin; Cengiz, Melike; Hadimioğlu, Necmiye; Kafadar, Yusuf Taner; Çelik, Kıymet

doi:10.1097/sla.0000000000005346

Cited by 27 publications

(33 citation statements)

References 32 publications

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“…Thus, determining the timing for uterine graft removal on an individual basis is a complex process involving not only medical considerations such as immunosuppression, rejection, maternal and obstetrical complications, and RGT, but also the preferences and priorities the uterus recipient and her partner may have [ 17 , 18 ]. While RGT in UTx patients is currently limited generally to about 5–7 years in most UTx trials [ 17 , 21 ], it can be considerably longer as in the case of a surgically successful deceased-donor UTx reported from Turkey in 2011, in which the recipient experienced multiple embryo transfer failures and miscarriages, before delivering a healthy child 9 years after UTx [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)

Brucker

Krämer

Abele

et al. 2022

Arch Gynecol Obstet

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Purpose To limit the burden of long-term immunosuppression (IS) after uterus transplantation (UTx), removal of the uterine allograft is indicated after maximum two pregnancies. Hitherto this has required graft hysterectomy by laparotomy. Our objective was to demonstrate, as a proof of concept, the feasibility of less traumatic transplantectomy by total laparoscopic hysterectomy (TLH). Patient A 37-year-old woman with uterovaginal agenesis due to Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS) who had undergone neovaginoplasty at age 19 years prior to living-donor (LD) UTx in 10/2019 at age 35 years gave birth to a healthy boy by primary cesarean section in 06/2021. During pregnancy, she developed impaired renal function, with bilateral hydronephrosis, necessitating early allograft removal in 09/2021 to prevent chronic kidney disease, particularly during a potential second pregnancy. Methods Transplantectomy by TLH essentially followed standard TLH procedures. We paid meticulous attention to removing as much donor tissue as possible to prevent postoperative complications from residual donor tissue after stopping IS, as well as long-term vascular damage. Results TLH was performed successfully without the need to convert to open surgery. Surgical time was 90 min with minimal blood loss. No major complications occurred intra- or postoperatively and during the subsequent 9-month follow-up period. Kidney function normalized. Conclusions To our knowledge, we report the first successful TLH-based removal of a uterine allograft in a primipara after LD UTx, thus demonstrating the feasibility of TLH in uterus recipients with MRKHS.

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Section: Discussionmentioning

confidence: 99%

Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)

Brucker

Krämer

Abele

et al. 2022

Arch Gynecol Obstet

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“…The first technically successful human UTx was performed in Turkey in 2011 using a deceased donor, and a live birth was reported 9 years after transplant [34][35][36][37]. The first human clinical trial was established in Sweden in 2012, enrolling 10 donor-recipient pairs [38], within which context the first live birth after UTx occurred in 2014 [39].…”

Section: Introductionmentioning

confidence: 99%

How Surgical Research Gave Birth to a New Clinical Surgical Field: A Viewpoint from the Dallas Uterus Transplant Study

et al. 2023

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Background: Uterus transplantation (UTx) has come of age in the 21st Century, building on the 20th Century developments in vascular anastomosis and effective immunosuppressive protocols enabling solid organ transplantation to become the life extending and life improving treatment option we know today. However, UTx has the goal of enabling reproduction, meaning that research focused on establishment of pregnancy and healthy live birth in addition to surgical technique and immunosuppression. Summary: The Dallas UtErus Transplant Study (DUETS), established at Baylor University Medical Center in 2015 is one of four UTx programs in the United States, and holds the distinction of being home not only to the first U.S. live birth, but also the highest volume UTx program worldwide, with 23 uterus transplants performed to date, resulting in 15 live births. Innovations pioneered at our center span all aspects of the Utx process, seeking to improve success in terms of achieving pregnancy and live birth, while also minimizing the burden on donors and recipients. The have included: 1) a deceased donor hysterectomy approach that allows the uterus to be procured prior to cross-clamp; 2) proof of concept with use of only superior uterine veins after procuring both the superior and inferior uterine veins during the donor surgery, enabling the choice of the best option in terms of size and location for outflow, while also preserving ovary viability in living donors; 3) contribution to robot assisted technique/minimal invasive technique with vaginal extraction of the uterus graft for living donor surgeries, shortening donor recovery times; 4) developing a robot-assisted technique for graft hysterectomies, improving recovery times for recipients at the end of their UTx journey; 5) refining immunosuppression protocols to enable embryo transfer 3 months after induction therapy, increasing recipients’ chances for achieving up to two live births during the 5 years post-transplant the UTx protocol specifies; and 6) building on our clinical trial experience to now offer UTx in the U.S. outside of a clinical study. Key Messages: Our center along with others throughout the world have demonstrated that UTx can be reproducible, result in live births from both living and deceased donors, and safely introduced as a clinical option. Due to the complexity of UTx as well as the need for long-term multidisciplinary care, centers implementing UTx should have an established abdominal transplant program, gynecologic surgery program, high-risk obstetric and neonatal care, and institutional support and oversight, and should partner with established UTx programs for protocol development and operative proctoring.

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“…However, the 23year-old woman who in 2011 underwent a technically successful deceased donor uterus transplant is now also to be considered the first woman to deliver a child after a uterus transplant. 3 This report by Ozkan et al 3 in Annals of Surgery highlights the unique facet of uterus transplant compared with other solid organ transplants: success is not defined by an allograft's function per se, but rather by a live birth. The goal of uterus transplant is to restore fertility and gestational capability, and any uterus transplant that does not yield a birth of a live healthy baby cannot be considered successful.…”

mentioning

confidence: 99%

“…Until the report by Dr. Ozkan and his group, the first live birth following uterus transplant had been announced in 2014 by Brännström et al, 1 and the first birth after a deceased donor uterus transplant by Ejzenberg et al 2 in 2018. However, the 23- year-old woman who in 2011 underwent a technically successful deceased donor uterus transplant is now also to be considered the first woman to deliver a child after a uterus transplant 3 …”

mentioning

confidence: 99%

The History of Uterus Transplantation, Rewritten

2022

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U terus transplantation is a fertility treatment that allows women affected by absolute uterine infertility to experience pregnancy and give birth. Until the report by Dr. Ozkan and his group, the first live birth following uterus transplant had been announced in 2014 by Bra ¨nnstro ¨m et al, 1 and the first birth after a deceased donor uterus transplant by Ejzenberg et al 2 in 2018. However, the 23year-old woman who in 2011 underwent a technically successful deceased donor uterus transplant is now also to be considered the first woman to deliver a child after a uterus transplant. 3 This report by Ozkan et al 3 in Annals of Surgery highlights the unique facet of uterus transplant compared with other solid organ transplants: success is not defined by an allograft's function per se, but rather by a live birth. The goal of uterus transplant is to restore fertility and gestational capability, and any uterus transplant that does not yield a birth of a live healthy baby cannot be considered successful. Uterus transplant is not performed for the direct medical benefit of the recipient, but rather is a fertility treatment that allows the recipient to experience gestation and childbirth. in essence, uterus transplant is a temporary transplant, one that should be removed after completion of at least 1 live birth. The need to assure the long-term safety of the recipient dictates the temporality of uterus transplant. in fact, as in any other solid organ transplant, powerful immunosuppressive medications, with potential serious side effects, must be given to the recipient to avoid rejection.Ozkan et al should be congratulated for their success, but the story requires an acknowledgment of the clinical and ethical issues involved. Uterus transplant had been attempted only twice in the 75 years before the Turkish group's attempt-in 1936 in Germany and in 2000 in Saudi Arabia 4both times without success. it is noteworthy that none of the experimental work typical for a modern medical breakthrough and aligned with modern recommendations 5,6 was done by the Turkish group prior to the transplant attempt. 7 In contrast, the successful transplant by the Swedish group followed years of planning, research, coordination, and cooperation among multiple specialties, and this rigorous scientific preparation ultimately paved the way for the successful transplant and birth. Work done in small and large animal models by the group allowed for an understanding of immunosuppression, the characteristics and incidence of rejection, the design of transplant operative techniques, and the peculiarities of gestation and delivery in a transplanted uterus. All of this was done before any attempt was made to perform a uterus transplant in humans. [8][9][10] The subsequent uterus transplant programs worldwide that followed 11,12 have built upon this hefty groundwork laid out by the Swedish group, and this approach has allowed a rapid and unprecedented growth of the uterus transplant field.Even more important has been the ethical analysis undertaken as the ...

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Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant

Cited by 27 publications

References 32 publications

Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)

Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)

How Surgical Research Gave Birth to a New Clinical Surgical Field: A Viewpoint from the Dallas Uterus Transplant Study

The History of Uterus Transplantation, Rewritten

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