First birth from a deceased donor uterus in the United States: from severe graft rejection to successful cesarean delivery

Flyckt, Rebecca; Falcone, Tommaso; Quintini, Cristiano; Perni, Uma; Eghtesad, Bijan; Richards, Elliott G.; Farrell, Ruth M.; Hashimoto, Koji; Miller, Charles M.; Ricci, Stephanie; Ferrando, Cecile A.; D’Amico, Giuseppe; Maikhor, Shana; Priebe, Debra; Chiesa‐Vottero, Andres; Heerema-McKenney, Amy; Mawhorter, Steven D.; Feldman, Myra K.; Tzakis, Andreas G.

doi:10.1016/j.ajog.2020.03.001

Cited by 76 publications

(108 citation statements)

References 26 publications

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“…Antenatal complications were observed in Recipients 1 and 3, who presented with preterm prelabor rupture of membranes and oligohydramnios, respectively, necessitating delivery at gestational weeks 35 + 1 and 35 + 6. Other research groups reported 3 cases of pre-eclampsia, 2 cases of cholestasis, and 1 case each of preterm prelabor rupture of membranes, pyelonephritis, and subchorionic hematoma between weeks 13 and 22 of gestation, and central placenta previa with accreta at week 21 of gestation [29,[33][34][35][36].…”

Section: Antenatal Complications and Obstetric Outcomesmentioning

confidence: 98%

“…The Swedish study by Mölne and colleagues [24] reported 9 mild rejection episodes in 5 recipients, while Flyckt et al [29] observed a single severe rejection episode in one patient. The severe rejection episodes reported by Chmel et al [21] and Flyckt et al [29] were managed by aggressive immunosuppressive regimens targeted at both cellular and humoral rejection and achieved complete clearance of rejection in both recipients. All reported rejection episodes, including those observed in the present study, were clinically asymptomatic and were revealed by cervical biopsies [21,22].…”

Section: Rejection Episodesmentioning

confidence: 98%

“…The Czech study by Chmel et al described 7 mild rejection episodes in 3 recipients, and one episode of severe rejection [21]. The Swedish study by Mölne and colleagues [24] reported 9 mild rejection episodes in 5 recipients, while Flyckt et al [29] observed a single severe rejection episode in one patient. The severe rejection episodes reported by Chmel et al [21] and Flyckt et al [29] were managed by aggressive immunosuppressive regimens targeted at both cellular and humoral rejection and achieved complete clearance of rejection in both recipients.…”

Section: Rejection Episodesmentioning

confidence: 99%

“…However, the infants' subsequent development was unremarkable at the routine 9-and 12-month checkups, with both children achieving catch-up growth in weight, length, and head circumference. Deliveries after UTx reported to date have all occurred between gestational week 31 + 6 and week 37, and all children were delivered by cesarean section [29,[33][34][35][36]. During pregnancy, tacrolimus has so far been the immunosuppressant of choice, be it as a monotherapy or in combination with AZA and/or prednisolone.…”

Section: Antenatal Complications and Obstetric Outcomesmentioning

confidence: 99%

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Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births

Brucker

Strowitzki

Taran

et al. 2020

JCM

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Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conclude that parameters crucial to successful transplantation, pregnancy, and childbirth include careful selection of donor/recipient pairs, donor organ quality, meticulous surgical technique, a multidisciplinary team approach, and comprehensive follow-up. Surgery duration and blood vessel selection await further optimization, as do the choice and duration of immunosuppression, which are crucial to timing the first embryo transfer. Data need to be collected in an international registry due to the low prevalence of MRKHS.

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Section: Antenatal Complications and Obstetric Outcomesmentioning

confidence: 98%

Section: Rejection Episodesmentioning

confidence: 98%

Section: Rejection Episodesmentioning

confidence: 99%

Section: Antenatal Complications and Obstetric Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births

Brucker

Strowitzki

Taran

et al. 2020

JCM

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“…It resulted in the first ever live birth after UTx in 2014 [14]. Thereafter, a restricted number of live births have been reported both after live donor and deceased donor UTx trials, albeit with no successful UTx procedure reported from the Middle East region [15][16][17]. Since then, a second Swedish trial, including robotically assisted donor surgery has been performed with births achieved [18,19].…”

Section: Introductionmentioning

confidence: 99%

First live birth after uterus transplantation in the Middle East

Akouri

Maalouf

Abboud

et al. 2020

Middle East Fertil Soc J

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Background The first live birth after uterus transplantation took place in Sweden in 2014. It was the first ever cure for absolute uterine factor infertility. We report the surgery, assisted reproduction, and pregnancy behind the first live birth after uterus transplantation in the Middle East, North Africa, and Turkey (MENAT) region. A 24-year old woman with congenital absence of the uterus underwent transplantation of the uterus donated by her 50-year-old multiparous mother. In vitro fertilization was performed to cryopreserve embryos. Both graft retrieval and transplantation were performed by laparotomy. Donor surgery included isolation of the uterus, together with major uterine arteries and veins on segments of the internal iliac vessels bilaterally, the round ligaments, and the sacrouterine ligaments, as well as with bladder peritoneum. Recipient surgery included preparation of the vaginal vault, end-to-side anastomosis to the external iliac arteries and veins on each side, and then fixation of the uterus. Results One in vitro fertilization cycle prior to transplantation resulted in 11 cryopreserved embryos. Surgical time of the donor was 608 min, and blood loss was 900 mL. Cold ischemia time was 85 min. Recipient surgical time was 363 min, and blood loss was 700 mL. Anastomosis time was 105 min. Hospital stay was 7 days for both patients. Ten months after the transplantation, one previously cryopreserved blastocyst was transferred which resulted in viable pregnancy, which proceeded normally (except for one episode of minor vaginal bleeding in the 1st trimester) until cesarean section at 35 + 1 weeks due to premature contractions and shortened cervix. A healthy girl (Apgar 9-10-10) weighing 2620 g was born in January 2020, and her development has been normal during the first 6 months. Conclusions This is the first report of a healthy live birth after uterus transplantation in the MENAT region. We hope that this will motivate further progress and additional clinical trials in this area in the Middle East Region, where the first uterus transplantation attempt ever, however unsuccessful, was performed already three decades ago.

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The First 5 Years of Uterus Transplant in the US

et al. 2022

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terus transplant is a treatment for women affected by absolute uterine-factor infertility (AUFI), previously considered untreatable. AUFI is a major cause of female infertility, reported to affect 1 in 500 women. 1,2 Primary care clinicians are typically the front line of care when AUFI is suspected or diagnosed. Given the lifeframing nature of the diagnosis, appropriate counseling is challenging. Many are told that family-building options are limited to use of a gestational carrier or adoption. 3 Uterus transplant uniquely restores reproductive ability and enables gestation and childbirth. 4 Increased data regarding outcomes following uterus transplant are essential to coun-sel individuals with AUFI to evaluate all available pathways to parenthood.The United States Uterus Transplant Consortium (USUTC)

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First birth from a deceased donor uterus in the United States: from severe graft rejection to successful cesarean delivery

Cited by 76 publications

References 26 publications

Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births

Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births

First live birth after uterus transplantation in the Middle East

The First 5 Years of Uterus Transplant in the US

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