Living Donor Uterus Transplantation: A Single Center’s Observations and Lessons Learned From Early Setbacks to Technical Success

Abstract

Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper, we analyze the first five cases of living donor uterus transplantation performed in the United States. The first three recipients lost their uterus grafts at days 14, 12, and 6, respectively, after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, at 6 and 3 mo, respectively, after transplant, have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique, and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on knowledge in the evolving field of uterus transplantation.

Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations

“…2 years (47-58). Thrombotic or ischemic causes of early graft removal in the LD context were also described by the Gothenburg (Sweden) and Dallas (USA) teams 2,12. Partial laceration of the right ureter upon its crossing with common iliac vessels occurred during dissection of the ovarian vein.…”

“…10.7 days(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The mean surgical time for the UTx was 245 minutes (210-300 minutes).…”

Gynecologic cancers and solid organ transplantation

“…83 This report was followed by a report of 2 other live births after uterine transplantation in Sweden. 86 Several centers in the United States have active clinical trials (NCT03307356, NCT02656550, and NCT02573415) studying this treatment for uterine factor infertility. 85 Although these reports provide proof of concept for the procedure, only a very small number of cases have been performed thus far.…”

Starting a uterus transplantation service: notes from a small island

“…Successful transplantation of a uterus that is unable to bear children defeats the very purpose of UTx. Recent experience from other centres suggests that initial transplants are commonly associated with failure . While this implies that any programme must be prepared for initial disappointment and a possibly protracted course before achieving success, it does raise questions as to why these other centres have failed to replicate the Swedish experience.…”

“…Unfortunately, that graft did not survive owing to fungal sepsis necessitating a hysterectomy . More recently, the Dallas group reported its centre's experience with the performance of five cases of living donor uterus transplantation, with the first three recipients losing their transplants within the first two post‐operative weeks because of vascular complications; the remaining two had functioning grafts with regular menstruation at 3 and 6 months after transplantation . No pregnancies have yet been reported in this series.…”