Uterus Transplantation

Abstract

Uterus transplantation (UTx) has been successfully introduced as a treatment option for women with absolute uterine factor infertility (AUFI). AUFI representing approximately 3% to 5% of the female general population is linked to either congenital uterine agenesis (Mayer-Rokitansky-Küster-Hauser syndrome), major congenital uterine malformation (hypoplastic uterus, fraction of bicornuate/unicornuate uterus), a surgically absent uterus, or an acquired condition (intrauterine adhesions, leiomyoma) linked to uterine malfunction that causes implantation failure or defect placentation. The world's first clinical uterus transplant was performed in 2000. However, a hysterectomy became necessary shortly after the surgery due to uterine necrosis. In 2011, a group in Turkey reported on a surgically successful deceased donor transplant; however, this procedure has, to date, not resulted in a healthy live birth, the ultimate goal of UTx. Building on an extensive experimental background in various animal models, including primates, the Gothenburg group led by Brännström reported on the first delivery of a healthy baby in a recipient of a live donor UTx in 2014. This event did not only show the feasibility of UTx, it also helped defining relevant areas of clinical and basic research. Use of a gestational surrogate carrier, is, at least in theory, an alternative for a woman with AUFI seeking genetic motherhood. However, in the clear majority of countries worldwide, gestational surrogacy is not practiced based on legal, ethical, or religious concerns. Of note, the overwhelming majority of surveyed women in the United Kingdom, a country which permits surrogacy, preferred UTx over gestational surrogacy and adoption. Moreover, randomly selected women of fertile age in Sweden preferred UTx over gestational surrogacy. A recent large survey in Japan with more than 3000 participants revealed that UTx had a twofold higher acceptance rate compared with gestational surrogacy. In a recent US survey exploring the potential of donating vascularized composite allografts, uterus donation achieved the highest priority. Thus, the acceptance of UTx as infertility treatment for women with AUFI is high, although the procedure remains in its infancy. Here, we provide an update of clinical activities, summarize achievements and challenges, and submit areas of research interests.

The Key Role of Warm and Cold Ischemia in Uterus Transplantation: A Review

“…Several UTx have also been published in the press, notably the first UTx with a live donor performed in France (March 2019, Paris). All procedures published through scientific publications are described in Table 2 [2,3,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61]. Ten failures of transplantations have been reported in publications: one in the Saudi Arabia [2]; two by the Swedish team of Pr.…”

“…Brännström performed a series of nine UTx. Seven of the grafts were viable and allowed the birth of eight healthy children between 2014 and 2017 [3,56]. Then, in 2017, the American team from Dallas performed a series of five transplantations.…”

“…There are two types of donors for UTx: living donors and brain-dead donors. Six teams work only with living donors [2,3,50,56,58] (Saudi Arabia, Sweden, China, Germany, Serbia and India) and three works solely with brain-dead donors [48,52,55] (Turkey, Cleveland and Brazil). There are also two teams working with both types of donors [61,62] (Dallas and Czech Republic).…”

Custodiol-N Is Superior to Custodiol® Solution in Experimental Rat Uterus Preservation

“…Uterus transplantation (UTx) is the first and only available treatment for absolute uterine factor infertility (AUFI). Up to 7% of women suffer from AUFI [1,2], which is linked to either congenital uterine agenesis (Mayer-Rokitansky-Küster-Hauser syndrome), major congenital uterine malformation (hypoplastic uterus, fraction of bicornuate/unicornuate uterus), a surgically absent uterus, or an acquired condition (intrauterine adhesions, leiomyoma) related to uterine malfunction that causes implantation failure or defect placentation [3].…”

Reprogramming of fibroblasts to uterine glandular epithelium by a chemical cocktail induction

“…Absolute uterine factor infertility (AUFI) affects 3–5% women and has multifactorial causes. Uterus transplantation is the main treatment option for AUFI 1 . Alternatively, artificial uterus can be used as an incubator for embryos.…”