Uterus transplantation: state of the art in 2021

Abstract

Purpose To provide a comprehensive review of uterus transplantation in 2021, including a discussion of pregnancy outcomes of all reported births to date, the donor and recipient selection process, the organ procurement and transplant surgeries, reported complications, postoperative monitoring, preimplantation preparation, and ethical considerations. Methods Literature review and expert commentary. Results Reports of thirty-one live births following uterus transplantation have been published from both living and deceased donors. The proper selection of donors and recipients is a labor-intensive process that requires advanced planning. A multidisciplinary team is critical. Reported complications in the recipient include thrombosis, infection, vaginal stricture, antenatal complications, and graft failure. Graft rejection is a common occurrence but rarely leads to graft removal. While most embryo transfers are successful, recurrent implantation failures in uterus transplant patients have been reported. Rates of preterm delivery are high but appear to be declining; more data, including long-term outcome data, is needed. Conclusions Uterus transplantation is an emerging therapy for absolute uterine factor infertility, a condition previously without direct treatment options. It is paramount that reproductive health care providers are familiar with the uterus transplantation process as more patients seek and receive this treatment.

Case Report: Post-Partum SARS-CoV-2 Infection After the First French Uterus Transplantation

“…As with other UTx pregnancies ( 14 ), our patient experienced some adverse outcomes, including prematurity and inguinal hernia in the neonate. Obstetricians need to be aware that UTx patients do not feel contractions and so must be especially vigilant regarding the possibility of premature delivery.…”

“…We present a case of post-partum SARS-CoV-2 infection after UTx. Although SOT recipients have been reported to be at higher risk of severe SARS-CoV-2 infection, information is lacking regarding the risk of such infection in UTx patients ( 14 ). A recent meta-analysis confirmed that SARS-CoV-2 infection is associated with significantly increased risks of morbidity and mortality in SOT recipients ( 15 ), which may partially be explained by the higher incidence of comorbidities in this population.…”

Keio Uterus Transplantation Research: From Basic Research toward Future Clinical Application

“…born after these procedures. 37,38 Thus, UTx research is circulating worldwide and is starting to be recognized as a feasible medical treatment for patients with UFI. However, UTx is not a commonly known medical technique in Japan.…”

Primary Amenorrhea and Differences of Sex Development

“…In addition, births have been reported after uterus transplant in individuals with MRKH and there are several sites with active protocols for such an intervention around the world. 19 As patients with MRKH have functional ovaries, there is no need for sex hormone replacement.…”