The first Australian uterus transplantation procedure: A result of a long‐term Australian‐Swedish research collaboration

Abstract

Aims The aim is to report the results of Australia's first uterus transplantation (UTx). Methods Following long‐standing collaboration between the Swedish and Australian teams, Human Research Ethics approval was obtained to perform six UTx procedures in a collaborative multi‐site research study (Western Sydney Local District Health 2019/ETH13038), including Royal Hospital for Women, Prince of Wales Hospital, and Westmead Hospital in New Souh Wales. Surgeries were approved in both the live donor (LD) and deceased donor models in collaboration with the inaugural Swedish UTx team. Results This is the first UTx procedure to occur in Australia, involving a mother donating her uterus to her daughter. The total operative time for the donor was 9 h 54 min. Concurrently, recipient surgery was synchronised to minimise graft ischaemic time, and the total operative time for the recipient was 6 h 12 min. Surgery was by laparotomy in the LD and recipient. The total warm ischaemic time of the graft was 1 h 53 min, and the cold ischaemic time was 2 h 17 min (total ischaemic time 4 h 10 min). The patient's first menstruation occurred 33 days after the UTx procedure. Conclusion Twenty‐five years of Swedish and Australian collaboration has led to Australia's first successfully performed UTx surgery at The Royal Hospital for Women, Sydney, Australia.

Miracles of science: Birth after uterus transplantation

“…UTx is a new concept in the field of infertility treatment, and transplant centers are expanding globally. Programs for UTx have been or will be launched in Australia, 42 Japan, 43 the United Kingdom, 44 the Netherlands, 45 South Korea, 35 Singapore, 35 Taiwan, 35 Egypt, 35 Mexico, 35 Colombia, and Argentina 35 …”

Deceased donor availability for uterus transplantation in Australia

“…It is not possible to define the exact number of women who would desire a uterus transplant in Australia; however, this team has initiated clinical trials and has received an expression of interest from a total of 32 individuals over the same five-year period. 21 Furthermore, other international uterus transplant teams are conducting between one and ten procedures annually, although this represents cases performed largely in the research phase. 1,2 Results from this data indicate that, assuming all families consented to uterine donation, more than 20 potential donors meet many of the available inclusion criteria each year.…”

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.…”

“…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].…”