Outcome of Recipient Surgery and 6-Month Follow-Up of the Swedish Live Donor Robotic Uterus Transplantation Trial

Abstract

Uterus transplantation has proved to be a feasible treatment for uterine factor infertility. Herein, we report on recipient outcome in the robotic uterus transplantation trial of 2017–2019. The eight recipients had congenital uterine aplasia. The donors were six mothers, one sister, and one family friend. Donor surgery was by robotic-assisted laparoscopy. Recipient surgery was by laparotomy and vascular anastomoses to the external iliacs. The duration (median (ranges)) of recipient surgery, blood loss, measured (left/right) uterine artery blood flow after reperfusion, and length of hospital stay were 5.15 h (4.5–6.6), 300 mL (150–600), 43.5 mL/min (20–125)/37.5 mL/min (10–98), and 6 days (5–9), respectively. Postoperative uterine perfusion evaluated by color Doppler showed open anastomoses but restricted blood distribution in two cases. Repeated cervical biopsies in these two cases initially showed ischemia and, later, necrosis. Endometrial growth was not seen, and hysterectomy was later performed, with pathology showing partly viable myometrium and fibrosis but necrosis towards the cavity. The other six patients acquired regular menstrual cyclicity. Surgery was performed in two patients to correct vaginal stenosis. Reversible rejection episodes were seen in two patients. In conclusion, the rate of viable uterine grafts during the initial 6-months of the present study (75%) leaves room for improvement in the inclusion/exclusion criteria of donors and in surgical techniques. Initial low blood flow may indicate subsequent graft failure.

Operative and Clinical Outcomes of Minimally Invasive Living-Donor Surgery on Uterus Transplantation: A Literature Review

“…This review included 26 original articles ( Figure 2 ). Reports of living-donor uterus transplants from Saudi Arabia [ 3 ], Sweden [ 4 , 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], China [ 10 , 20 ], USA (Dallas) [ 8 , 21 , 22 , 23 , 24 ], Czech Republic [ 7 , 25 , 26 ], Germany [ 27 , 28 ], and India [ 9 , 29 ] were identified, and 51 living-donor UTx were incorporated. The surgical information and clinical data for each case are shown in Table 1 .…”

Operative and clinical outcomes of minimally invasive living-donor surgery on uterus transplantation: a literature review

“…2). Reports of living-donor uterus transplants from Saudi Arabia, 3 Sweden, 4,6,[11][12][13][14][15][16][17][18][19] China, 10,20 USA (Dallas), 8,[21][22][23][24] Czech Republic, 7,25,26 Germany, 27,28 and India 9,29 were identified, and 51 living-donor UTx were incorporated. The surgical information and clinical data for each case are shown in Table 1.…”

Human Uterus Transplantation from Living and Deceased Donors: The Interim Results of the First 10 Cases of the Czech Trial

“…In a subsequent Gothenburg study, 8 robot-assisted uterus retrievals from LDs andopen UTx have been carried out, with mid-term viability in 6/8 cases [ 29 ]. The interim outcomes in the 6 vital grafts are as follows: stenosis of vaginal anastomosis 2/6, graft rejection 2/6 (one grade 1 and one grade 2), rate of miscarriages 0/6, and livebirths 1/6 [ 30 ].…”