Living donor uterus transplant in the UK: A case report

Living-Donor Uterus Transplantation: A Clinical Review

“…However, an open procedure has a higher incidence of postoperative surgical complications and graft failure [27]. A total of 59 living-donor hysterectomies have been reported in the literature (Table 1), including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach [6,15,16,20,22,[44][45][46][47][48][49][50][51][52][53][54][55][56][57]. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother's sisters), while in three cases, the relationship was not reported.…”

“…The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother's sisters), while in three cases, the relationship was not reported. The mean recipient age was 28.8 ± 4.5 years, and the MRKH syndrome was the most common indication for uterus transplant (52 patients), while 2 patients required UTx after hysterectomy for myomectomy and 1 patient following hysterectomy for cervical cancer [6,15,16,20,22,[44][45][46][47][48][49][50][51][52][53][54][55][56][57]. With the open technique, a subumbilical midline incision is used while five working ports are used in robotics.…”

“…Robotic living-donor hysterectomy had the longest operative time (11 h 45 min ± 2 h 21 min) compared to the laparoscopic approach (3 h 30 min ± 0 h 33 min) and laparotomic surgical technique (8 h 10 min ± 30 min). Blood loss was significantly lower in robotic hysterectomy (202.22 ± 469 mL) compared with a laparotomic procedure (720.31 ± 566.89 mL), and postoperative stay was lower for robotic hysterectomy compared with a laparotomic procedure (5.13 ± 2.7 vs. 7.1 ± 2.6, days, respectively) [6,15,16,20,22,[44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Two retrieved grafts were not transplanted because of poor venous outflow and the failure to provide adequate flow through uterine arteries during back-table preparation [22,57].…”

“…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].…”

INvestigational Study Into Transplantation of the Uterus (INSITU): a cross-sectional survey among women with uterine factor infertility in the UK assessing background, motivations and suitability

“…The first living donor case was performed in the UK in 2023, with the commencement of embryo transfers anticipated in 2024. 10 The INvestigational Study Into Transplantation of the Uterus (INSITU) is a clinical trial involving a cohort of 10 women, who will undergo UTx using donation following brainstem death. 11 The selection process entails multiple stages, including an initial prescreen, which involves the completion of a detailed questionnaire assessing the key background information required to determine suitability to proceed, in line with the selection criteria for the study.…”