Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Wilson, Nicole K.; Schulz, Philipp; Wall, Anji; Parrott, Megan E; Testa, Giuliano; Johannesson, Liza; Sam, Teena

doi:10.1097/tp.0000000000004437

Cited by 7 publications

(2 citation statements)

References 50 publications

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“…Almost all UTX recipients receive an induction therapy with basiliximab or thymoglobulin + steroids together with a triple-drug maintenance therapy with tacrolimus, mycophenolate, and steroids. Mycofenolate is usually discontinued at the time of the first embryo transfer due to its teratogenicity and replaced with azatiophrine [2,60]. At our center, UTx recipients usually receive an induction with thymoglobulin + steroids and a maintenance therapy with tacrolimus, mycophenolate, and steroids.…”

Section: Recipientmentioning

confidence: 99%

Living-Donor Uterus Transplantation: A Clinical Review

Veroux,

Scollo,

Giambra

et al. 2024

JCM

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Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother’s sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer–Rokitansky–Küster–Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.

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Section: Recipientmentioning

confidence: 99%

Living-Donor Uterus Transplantation: A Clinical Review

Veroux,

Scollo,

Giambra

et al. 2024

JCM

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“…De fato, Wilson et al (2022), ao avaliar a imunossupressão em 14 pacientes submetidas ao transplante de útero, encontraram lesão renal aguda em 5 receptoras e onze episódios de infecções em 7 receptoras, com tratamento bem-sucedido em todos os casos (Wilson, 2023). Contribuciones a Las Ciencias Sociales, São José dos Pinhais, v.17 Os dados acerca da gestação ainda são escassos, mas a maioria das pacientes transplantadas relatadas na literatura, cursaram com complicações gestacionais, sendo que 37,5% resultou em partos prematuros tardios (Daolio, 2020).…”

Section: Imunossupressãounclassified

Transplante uterino: implicações reprodutivas, aplicabilidades clínicas e a experiência com nascidos vivos

Grespan,

Lopes,

Grespan

et al. 2024

CLCS

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Nos últimos anos, houve notáveis avanços no tratamento da infertilidade. No entanto, a infertilidade absoluta por fator uterino ainda é uma problemática sem solução definida, sendo o transplante de útero (TU) uma nova perspectiva a essa condição. Essa terapêutica é revolucionária do ponto de vista técnico, mas suscita debates sobre as naturezas éticas, legais e psicológicas envolvidas no procedimento. O impacto socioeconômico e cultural do TU também merece análise cuidadosa, especialmente em relação à acessibilidade e equidade no acesso a essa tecnologia inovadora. Esta revisão bibliográfica busca atualizar o conhecimento sobre o TU, resumindo estudos sobre critérios de seleção de doadoras e receptoras, procedimentos, possíveis complicações e aspectos materno-fetais. Apesar de algumas controvérsias em torno do procedimento, os resultados são promissores e representam uma opção inovadora para a concepção. A colaboração interdisciplinar entre médicos, cientistas, éticos, legisladores e membros da comunidade é essencial para garantir uma abordagem abrangente e responsável no avanço do transplante de útero como uma opção viável de tratamento para a infertilidade. A conscientização pública e o apoio financeiro para pesquisas nessa área são igualmente importantes para impulsionar o progresso e superar os desafios restantes.

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Uterus Transplant in Women With Absolute Uterine-Factor Infertility

Testa,

McKenna,

Wall

et al. 2024

JAMA

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ImportanceUterus transplant in women with absolute uterine-factor infertility offers the possibility of carrying their own pregnancy.ObjectiveTo determine whether uterus transplant is feasible and safe and results in births of healthy infants.Design, Setting, and ParticipantsA case series including 20 participants with uterine-factor infertility and at least 1 functioning ovary who underwent uterus transplant in a large US tertiary care center between September 14, 2016, and August 23, 2019.InterventionThe uterus transplant (from 18 living donors and 2 deceased donors) was surgically placed in an orthotopic position with vascular anastomoses to the external iliac vessels. Participants received immunosuppression until the transplanted uterus was removed following 1 or 2 live births or after graft failure.Main Outcomes and MeasuresUterus graft survival and subsequent live births.ResultsOf 20 participants (median age, 30 years [range, 20-36]; 2 Asian, 1 Black, and 16 White), 14 (70%) had a successful uterus allograft; all 14 recipients gave birth to at least 1 live-born infant. Eleven of 20 recipients had at least 1 complication. Maternal and/or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (2 [14%]), cervical insufficiency (2 [14%]), and preterm labor (2 [14%]). Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications.Conclusions and RelevanceUterus transplant was technically feasible and was associated with a high live birth rate following successful graft survival. Adverse events were common, with medical and surgical risks affecting recipients as well as donors. Congenital abnormalities and developmental delays have not occurred to date in the live-born children.Trial RegistrationClinicalTrials.gov Identifier: NCT02656550

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Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Cited by 7 publications

References 50 publications

Living-Donor Uterus Transplantation: A Clinical Review

Living-Donor Uterus Transplantation: A Clinical Review

Transplante uterino: implicações reprodutivas, aplicabilidades clínicas e a experiência com nascidos vivos

Uterus Transplant in Women With Absolute Uterine-Factor Infertility

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