Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Abstract

Original Clinical Science-General Background. Uterus transplantation is a temporary transplant allowing women with absolute uterine factor infertility to experience pregnancy and childbirth. The degree of immunosuppression (IS) required to prevent rejection while minimizing toxicity to the recipient and fetus remains an area of investigation. Methods. In this article, we describe immunosuppressive therapy, rejection episodes, infections, and adverse events in 14 uterus transplant recipients. Induction consisted of antithymocyte globulin and methylprednisolone. Ten recipients (71%) received no steroids postoperatively, and 4 (29%) had steroids tapered off at 42 d. All received oral tacrolimus, either immediate release (n = 2, 14%) or extended release (n = 12, 86%). Mycophenolate was used in 4 cases (29%), de novo azathioprine in 9 (64%), and de novo everolimus in 1 (7%).Results. Sixteen clinically silent, treatment-responsive rejection episodes occurred in 10 recipients. Five recipients (36%) experienced acute kidney injury. In 3 recipients, IS was discontinued due to renal dysfunction. Eleven infection episodes were noted in 7 recipients. No babies had congenital abnormalities. Conclusions. Our experience demonstrates that safe IS regimens can be used for uterus transplant recipients before and during pregnancy.

Living-Donor Uterus Transplantation: A Clinical Review

“…Almost all UTX recipients receive an induction therapy with basiliximab or thymoglobulin + steroids together with a triple-drug maintenance therapy with tacrolimus, mycophenolate, and steroids. Mycofenolate is usually discontinued at the time of the first embryo transfer due to its teratogenicity and replaced with azatiophrine [2,60]. At our center, UTx recipients usually receive an induction with thymoglobulin + steroids and a maintenance therapy with tacrolimus, mycophenolate, and steroids.…”

Transplante uterino: implicações reprodutivas, aplicabilidades clínicas e a experiência com nascidos vivos

“…De fato, Wilson et al (2022), ao avaliar a imunossupressão em 14 pacientes submetidas ao transplante de útero, encontraram lesão renal aguda em 5 receptoras e onze episódios de infecções em 7 receptoras, com tratamento bem-sucedido em todos os casos (Wilson, 2023). Contribuciones a Las Ciencias Sociales, São José dos Pinhais, v.17 Os dados acerca da gestação ainda são escassos, mas a maioria das pacientes transplantadas relatadas na literatura, cursaram com complicações gestacionais, sendo que 37,5% resultou em partos prematuros tardios (Daolio, 2020).…”