Uterine transplantation from deceased donor results in livebirth
In September 2013 in Sweden, the first birth following uterine transplantation from a living donor was recorded. A new report in The Lancet has documented another milestone in treatment for uterine infertility: the first successful live birth after uterine transplantation from a deceased donor.
The patient, a 32-year-old woman with congenital uterine absence, underwent the transplantation in Hospital das Clínicas, University of São Paulo, Brazil. She had been diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and presented with uterine agenesis, but no cardiac, renal, or bone structure dysfunctions.
The donor was a 45-year-old woman who had three vaginal deliveries and no signs of sexual disease. Her cause of death was Fischer 4 subarachnoid hemorrhage.
Surgical time from iliac and pelvic vessel preparation to uterus implantation was 2 hours. Immunosuppression followed the Swedish protocol including 1 intraoperative methylprednisolone and 1.5 mg/kg of thymoglobulin as induction therapy. It was continued via tacrolimus and mycophenolate mofetil (MMF) until 5 months post-transplantation, when MMF was replaced by azathioprine. Menstruation first occurred at 37 days post-transplantation and was regular (every 26-32 days) thereafter.
Prior to transplantation, the patient underwent in vitro fertilization, which yielded 16 eggs obtained from a single cycle that produced eight good-quality blastocysts for cryopreservation. At that time, Doppler ultrasound, regular menses and no signs of rejection indicated to the authors of the report that the organ remained in good condition.
The woman’s pregnancy proceeded normally until Week 32, when she presented with signs of pyelonephritis and was treated with ceftriaxone as an inpatient for 10 days. At 35 weeks and 3 days, the patient underwent cesarean delivery, which was in line with the protocol used by the Swedish transplant team. During delivery, the transplanted uterus was removed and the patient’s vaginal orifice was closed.
The newborn weighed 2550 g and measured 45 cm in length. Her Apgar scores were 9 at 1 minute, 10 at 5 minutes and 10 at 10 minutes. At 7 months and 20 days, when the authors wrote the article, the baby continued to breastfeed and had normal growth parameters.
The authors believe that the success of this transplant from a deceased donor and the ensuing live birth expands the options for childbirth among women with infertility attributable to uterine factors. While the Swedish study demonstrated success with assisted reproduction and uterine transplantation, the requirement for a live donor is a major limitation and, as such, donors are in short supply.
Uterine transplantation is still considered experimental by many countries, but the authors believe that this recent success shows that the procedure is promising. Future studies, they said, should continue to expand upon the existing research to improve and refine the technique so that women with uterine factor infertility can have the option of a healthy pregnancy.