Human Uterine Transplantation: A Review of Outcomes From the First 45 Cases

Abstract

(BJOG. 2019;126:1310–1319) Women with absolute uterine factor infertility (AUFI) cannot conceive or sustain pregnancy due to a dysfunctional uterus or absence of a uterus. Because adoption and surrogacy both have many limitations, researchers have developed uterine transplantation (UTx) as a potential solution for women with AUFI to conceive and deliver a genetically related child. After the first live birth following UTx occurred in 2014, obstetric researchers have published studies and collected detailed information on 45 different transplant cases, including 9 live births. This review compiles the data and outcomes from these 45 cases to note trends and make recommendations for best care practices.

Decisions on second pregnancy after uterus transplantation and timing for removal of the uterus—DUETS (Dallas UtErus Transplant Study)

“…Gestational diabetes occurs in about 5% of pregnancies and affected one of our recipients (case 7). 2,10 Although the risk of this complication may be lower in UTx recipients than in other solid organ recipients, 7,8 the risk can be associated with use of certain immunosuppressants such as steroids and calcineurin inhibitors in the setting of reduced glucose tolerance associated with pregnancy. 11 As a diagnosis of gestational diabetes is associated with up to a 60% lifetime risk of progression to type 2 diabetes, 12 we advised the recipient with gestational diabetes against having a second pregnancy.…”

“…Other antenatal complications that may exclude a second pregnancy are preterm premature rupture of the membranes, cervical incompetence and preterm labour. 2 Preterm labour complicates about 12% of all deliveries and has multiple aetiologies. In UTx recipients, where a short interval between pregnancies is encouraged due to the risk of immunosuppression exposure, a preterm delivery before planned delivery in the first pregnancy may be a contraindication for a second pregnancy.…”

“…Since the first live birth to a woman after uterus transplantation (UTx) was reported in 2014, 1 the number of UTx procedures has increased and births have occurred in multiple centers worldwide. 2 Despite the growth of UTx, it is a novel procedure, with most cases having been done under experimental protocols, and there remains much debate about the ethics of UTx. Centers have allowed recipients one or two pregnancies, limiting recipient-graft time (RGT), the time from UTx to hysterectomy, to 5 years.…”

Uterine Transplantation

“…At the time of publication of this paper, more than 70 procedures have been performed and 23 live births have been published, or reported in the media. [3][4][5] Following the development of the International Society of Uterine Transplantation and the establishment of teams performing the procedure globally, it is anticipated that UTx will transition from research concept to clinical care in the future.…”

“…The purpose of this Scientific Impact Paper is to summarise the pertinent published literature on UTx and to propose a framework for establishing a sustainable UTx programme in the UK. The data presented herein refer to the 45 cases, 5 and the 17 live births published in peer reviewed journals to date. This includes cases that have been performed in Saudi Arabia, Turkey, Sweden, Xian (China), Czech Republic, Cleveland (USA), Dallas (USA), Brazil, Germany and India.…”