Graft Failure after Uterus Transplantation in 16 Recipients: A Review

Abstract

Uterus transplantation (UTx) is now an alternative to surrogacy and adoption for women with uterine factor infertility to have children; however, there are still unresolved clinical and technical issues. One of these is that the graft failure rate after transplantation is somewhat higher than that of other life-saving organ transplants, which is a critical concern. Herein, we summarize the details of 16 graft failures after UTx with living or deceased donors using the published literature in order to learn from these negative outcomes. To date, the main causes of graft failure are vascular factors (arterial and/or venous thrombosis, atherosclerosis, and poor perfusion). Many recipients with thrombosis develop graft failure within one month of surgery. Therefore, it is necessary to devise a safe and stable surgical technique with higher success rates for further development in the UTx field.

Living-Donor Uterus Transplantation: A Clinical Review

“…An echo-color doppler of the uterine vessels is finally performed before wound closure [33]. The most common complication in uterus transplantation is the graft failure: a recent review [17] reported an overall graft failure of 19.8% (19/96), 16.9% (12/71) from living donors and 28% (7/25) from deceased donors; however, some of the reports came from unpublished data, and it is likely that the rate of graft loss between LDs and DDs could be comparable [17]. Moreover, intravascular thrombosis was a more common cause of graft failure in UTx procedures from living donors than those from deceased donors [17].…”

“…Among the 59 LD UTx reported in the literature, a total of 11 grafts were lost (18.6%), leading to an overall surgical success of UTx of 71.4%: surgical success was achieved in 75% of laparotomic LD-UTx, which was lower than laparoscopic LD-UTx (100%) and robotic LD-UTx (90%). The main causes for graft loss included vascular thrombosis (eight grafts), recurrent infections (one graft), venous outflow obstruction (two grafts), and poor reperfusion after vascular declamping (one graft) [6,17,20,22,[42][43][44]48,49]. The mean time from transplant to graft failure was 50.3 ± 72 days [17].…”

“…The main causes for graft loss included vascular thrombosis (eight grafts), recurrent infections (one graft), venous outflow obstruction (two grafts), and poor reperfusion after vascular declamping (one graft) [6,17,20,22,[42][43][44]48,49]. The mean time from transplant to graft failure was 50.3 ± 72 days [17]. Although an overall higher technical success was reported with robotic hysterectomy, it should be highlighted that this may be misleading because all programs of living-donor hysterectomy started with the laparotomic approach and moved to the robotic approach after developing a sufficient comfort.…”

“…An interesting study from Japan [12] found that 32% of female respondents may well seek to become a donor if one's daughter suffered from UFI, while in Sweden, 80% of a population of women 30-39 years of age supported the UTx in UFI [13]. The first report of the Registry of the International Society of Uterus Transplantation [2] reported 45 UTx procedures with 19 newborns, most of which (78%) were performed from a living donor (LD), but with additional personal communications from all centers discussed at the Third International Congress of the International Society of Uterus Transplantation and the press release, a total of 91 UTx (71 LDs and 25 DDs) have been performed worldwide, resulting in 49 live births, 40 after LD UTx and 9 after DD UTx [14][15][16][17][18]. Living-donor 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 [1,11,19].…”