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

Abstract

Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair.Tweetable abstract Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.

Uterus transplantation: Perspectives of Australian women with absolute uterine factor infertility regarding desirability and utility

“…In line with the international donor preference debate, this sample had mixed responses around their preference for either receiving a deceased or living donor uterus. Furthermore, even if the women wanted to use a living donor (relative or friend), only around a third of the women in this sample actually had an available live donor.…”

“…This is shown by the fact only 15% of patients who need kidney transplants receive a donation each year, with the mean waiting time being 4 years . Furthermore, only female donors, aged between 18 to 50 years with proven obstetric history would be considered, further reducing the available uteri . Seemingly both models have limitations and if UTx becomes viable there may be a need to utilise both avenues.…”

“…Furthermore, while UTx is still in the clinical research phase, there are significant psychological risks for the couple (and donor), especially if there are complications and/or graft failure. Despite this, more than 15 centres worldwide have now commenced clinical trials . Following Sweden’s initial trials and first live birth in 2014, a total of 18 live births post‐UTx have been reported in the media or literature .…”

“…Despite this, more than 15 centres worldwide have now commenced clinical trials . Following Sweden’s initial trials and first live birth in 2014, a total of 18 live births post‐UTx have been reported in the media or literature . Proof of concept now exists utilising both the live and deceased donor model …”

The changing paradigm of ethics in uterus transplantation: a systematic review

“…Foetal preterm surveillance for malformation, foetal growth and well-being 5. Aim to deliver at term hysterectomy in this population is unknown, although serious complications including reoperation have been reported [39]. However, uteruses are sourced from donors who no longer wish to childbear and, therefore, have exhausted their function.…”