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

Abstract

Although uterus transplantation is still in the experimental stage, it has promising potential as a treatment for women with absolute uterine factor infertility based on the childbirths from living donor trials conducted in Sweden and the United States. We report the main characteristics and perioperative and postoperative courses of both recipients and donors following 4 deceased donor and 5 living donor uterus transplantations. Three main priorities differentiate this study from the previously reported uterus transplantations. First, clinical experience with the largest worldwide group of deceased donor uterine transplants is described. Second, in the majority of living donor uterine recipients, only 2 ovarian veins were used for venous blood outflow. All of these recipient procedures were surgically successful, and follow-up posttransplant ultrasound examinations revealed normal uterine blood supply and outflow. Third, in only one living and one deceased donor recipient, the transplanted uterus relied on only 2 uterine veins for venous outflow with a 50% surgical success rate. In all other recipients, 2 uterine and 2 ovarian veins were utilized. Although a successful pregnancy has not yet been achieved, the presented surgical and functional results of our trial are promising.

Human uterine transplantation: a review of outcomes from the first 45 cases

“…Of the UTx procedures reported so far, 80% ( n = 36) have been performed using living donors – in Saudi Arabia, Sweden, China, Czech Republic, the USA, Germany, and India . Other procedures have been performed in Serbia, Lebanon, and Belgium but remain unpublished.…”

“…Other procedures have been performed in Serbia, Lebanon, and Belgium but remain unpublished. Nine (20%) UTx procedures have used deceased donors – in Turkey, the USA, Brazil, and the Czech Republic . The mean age at donation is 44 years ( n = 45, range 20–62; SD 10.2).…”

“…Regarding donor surgical morbidity in the cases performed so far, as per the Clavien‐Dindo classification of surgical complications, 11.1% ( n = 4) of living donors suffered four Grade IIIb complications. Two donors suffered ureteric injuries that were repaired intra‐operatively during the retrieval, whereas one donor re‐presented postoperatively with a uretovaginal fistula . The other Grade IIIb complication was vaginal cuff dehiscence, which subsequently required surgical repair .…”

“…The other Grade IIIb complication was vaginal cuff dehiscence, which subsequently required surgical repair . Of the living donors, 27.8% ( n = 10) experienced Grade I–II complications including wound infection, bladder hypotonia, urinary tract infection ( n = 3), constipation, leg/buttock pain, depression, intubation‐related respiratory failure, and anaemia. The mean donor blood loss in reported cases so far has been 600 ± 581 ml ( n = 29; range 100–2400 ml).…”

“…The graft arterial supply is mostly anastomosed end‐to‐side with the recipient's external iliac vessels ( n = 42; 93.3%). Three procedures (6.6%) anastomosed the graft arteries to the internal iliac arteries, two of which used an end‐to‐end technique, ensuring exclusive arterial supply to the uterus …”