Uterus Transplantation - Evolution Of The Field Of Transplant From Saving Lives To Fertility Treatment
Giuliano Testa, *E. Colin Koon, *Greg J McKenna, *Robert T Gunby, Jr., *Johanna Bayer, *Anji E Wall, *Richard Ruiz, *Nicholas Onaca, *Amar Gupta, *Eric J Martinez, *Anthony R Gregg, *Liza Johannesson
Baylor University Medical Center, Dallas, TX
Uterus transplantation (UTx) is the newest field in transplantation, and enables women with absolute uterine factor infertility (AUFI) to give birth after carrying their own pregnancies. We present the largest single center UTx experience in the world.
From Sep 2016 – Aug 2019, both deceased (DD) and living donor (LD) UTx were performed in 20 women of gestational age, having AUFI from either congenital or acquired causes. The uterus was transplanted in orthotopic position with anastomoses to the iliac vessels. Embryo transfer occurred 4 – 6 months post UTx. Immunosuppression was calcineurin inhibitors and antimetabolites. Graft hysterectomy was performed after completing 1 or 2 pregnancies, allowing immunosuppression discontinuation.
14/20 UTx were technically successful. To date, 12/14 women achieved pregnancy and 6 have delivered children. There were no surgical complications in any of the mothers or children of successful UTx. Two LD had ureteral injury (Clavien Grade II) treated conservatively.
|Case #||Recipient Age||Recipient BMI||Cause of AUFI||Donor Type||Donor Surgery||Donor Age||Graft Outcome||Failed embryo transfer||Pregnancy||Miscarriage||Delivery|
|4||29||25||MRKH||NDLD||LAP||34||Removed after delivery||0||1||0||1|
|5||27||23||MRKH||NDLD||LAP||36||Viable||0||4||2||1, Current pregnancy|
|6||36||22||MRKH||DD||Multiorgan retrieval||30||Viable||3||1||1||Current pregnancy|
|15||31||26||Myomectomy /subtotal hysterectomy||NDLD||LAP||43||Viable||1||1||0||Current pregnancy|
|MRKH, Mayer-Rokitansky Kuster Hauser; NDLD, Non Directed Living Donor; DD, Deceased Donor, DLD, Directed Living Donor, LAP, Laparotomy; RA, Robotic assisted|
UTx is a transplant solution to AUFI. After the initial learning curve, 5 of the 6 graft failures occurred in the first 10 cases, in the last 10 recipients only 1 graft failed, 90% technical success rate, with a pregnancy and delivery rate projected to match other infertility treatments. Transplantation has overcome the final barrier to fertility, once thought impossible, providing the experience of pregnancy and motherhood to women with AUFI.
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