Twelve Live Births After Uterus Transplantation in the Dallas UtErus Transplant Study

Abstract

OBJECTIVE: To describe aggregated pregnancy outcomes after uterus transplantation from a single, experienced center. METHODS: This prospective study reports on live births among 20 women who received a uterus transplant from 2016 to 2019 at Baylor University Medical Center at Dallas. These live births occurred between November 2017 and September 2020. The main measures were live birth, maternal complications, and fetal and newborn outcomes. RESULTS: There were six graft failures (four surgical complications and two with poor perfusion postoperatively). Of the 14 technically successful transplants, at least one live birth occurred in 11 patients. Thus far, the live birth rate per attempted transplant is 55%, and the live-birth rate per technically successful transplant is 79%. Ten uteri were from nondirected living donors and one uterus was from a deceased donor. In vitro fertilization was performed to achieve pregnancy. Ten recipients delivered one neonate, and one recipient delivered two neonates. One organ rejection episode was detected during pregnancy and was resolved with steroids. The median birth weight was 2,890 g (range 1,770–3,140 g [median 68th percentile]). Maternal weight gain was higher than Institute of Medicine recommendations. Maternal medical complications were observed in five recipients (elevated creatinine level, gestational diabetes, gestational hypertension [n=2], and preeclampsia). In five recipients, maternal medical or obstetric complications led to an unplanned preterm delivery (elevated creatinine level, preeclampsia; preterm labor [n=3]). The median gestational age at delivery was 36 6/7 weeks (range 30 6/7–38 weeks). All neonates were liveborn, with Apgar scores of 8 or higher at 5 minutes. CONCLUSION: Over the first 3 years, our program experienced a live-birth rate per attempted transplant of 55% and a live-birth rate per technically successful transplant of 79%. In our experience, uterus transplantation resulted in a third-trimester live birth in all cases in which pregnancies reached 20 weeks of gestation. Maternal medical and obstetric complications can occur; however, these were manageable by applying principles of generally accepted obstetric practice. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02656550.

Deceased Donation Uterus Transplantation: A Review

“…In December 2017, the first livebirth was achieved by a team at the University of São Paolo, Brazil, and provided proof of concept that a transplanted uterus from a deceased donor could successfully carry a foetus to birth [5]. The second live birth occurred at the Cleveland Clinic, USA, in 2019 [6] and was followed by IKEM, Czech Republic [8]; Penn Medicine, USA [8,26]; and Baylor, USA [7].…”

“…Five births following DD UTx have been reported in the literature. These took place in Brazil; Cleveland, USA; Dallas, USA; the Czech Republic; and Pennsylvania, USA [5][6][7][8]. While an International Registry for Uterus Transplantation (IRUTx) has been established [9], it is increasingly apparent that there is a strong need for publication of public-facing reports that collate and report uterus transplants and outcomes [10], as further procedures and livebirths have been reported in the media but have not yet been reported in peer reviewed publications (including Belgium, Sweden and Turkey).…”

Uterine transplantation and donation in transgender individuals; proof of concept

“…In 2014, the first live birth from a woman who received a living donor UTx in the Gothenburg trial was announced (Brännström et al, 2015). Subsequently, Baylor University Medical Center in Dallas, Texas, USA reported a 55% live-birth rate per attempted UTx and a 79% live-birth rate per technically successful UT (Johannesson et al, 2021). In 2016, a Brazilian team reported a successful UTx from a deceased donor (Ejzenberg et al, 2019).…”

Motivations and Psychological Characteristics of Nondirected Uterus Donors From The Dallas UtErus Transplant Study

“…1 Interest in uterus transplantation appears strong, during the course of our center's research trial, the Dallas UtErus Transplant Study (DUETS), over 1500 women expressed interest in receiving a uterus, and ∼700 expressed interest in donating their uterus. 2 With clinical trials showing success, 1 questions regarding how uterus transplant should transition from an experimental to standard clinical procedure must be addressed. A critical element is an evidence regarding the experience of living uterus donors.…”