First US uterus transplant attempt ends in disappointment

March 8, 2016

Surgeons at the Cleveland Clinic performed the procedure in hopes of "curing" absolute uterine-factor infertility, but announced on March 9 that the organ had had to be removed.

Editor's note: This article has been updated. A Cleveland Clinic statement released on Wednesday, March 9 read: 

“We are saddened to share that our patient, Lindsey, recently experienced a sudden complication that led to the removal of her transplanted uterus. 

 

On February 25, Cleveland Clinic announced the first uterus transplant as part of a clinical study for women who suffer from uterine factor infertility. At this time, the circumstance of the complication is under review and more information will be shared as it becomes available.

 

There is a known risk in solid organ transplantation that the transplanted organ may have to be removed should a complication arise. The medical team took all necessary precautions and measures to ensure the safety of our patient.

 

While this has been difficult for both the patient and the medical team, Lindsey is doing well and recovering.

 

The study, which has been planned to include 10 women, is still ongoing with a commitment to the advancement of medical research to provide an additional option for women and their families.”

 

Below is the article as it appeared on March 8.

At a history-making press conference on March 7, the first recipient in the United States of a uterus transplant thanked the team at Cleveland Clinic that performed the procedure.

“I would like to take a moment to express the immense gratitude I feel towards my donor’s family. They have provided me with a gift that I will never be able to repay,” said the 26-year-old patient, named Lindsey, who was wheeled into the event by her husband, Blake. (The couple has asked that their last name and other details about them not be revealed in an effort to protect their privacy and that of their 3 adopted children.) 

At age 16, Lindsey was told that she would never have children due to congenital absence of the uterus. “From that moment on,” she said, “I have prayed that God would allow me the opportunity to experience pregnancy. And here we are today at the beginning of that journey. I am so thankful to this amazing team of doctors, all of the nurses and staff who have worked around the clock to ensure my safety.” 

The surgical team poses with the transplant recipient and her husband.

The Cleveland Clinic team is building on the success of Mats Brännström, MD, PhD, and his team in Sweden, who have seen 5 babies born to mothers with transplanted uteruses. The women in the Swedish trial received uterus transplants from living relatives (most often their mothers; notably, the oldest donor was 60). The Cleveland group is using uteruses from deceased donors.

See also: Transplantation: The end of absolute uterine-factor infertility?

 

NEXT: More details and next steps >>

 

The surgical team included Bijan Eghtesad, MD; Tommaso Falcone, MD, chairman of the Cleveland Clinic Transplant Center; Ruth M Farrell, MD; Rebecca Flyckt, MD; John Fung, MD, PhD; Uma Perni, MD; and Andreas Tzakis, MD, who was the primary investigator for the study.

Asked by a Contemporary OB/GYN editor at the press conference to what extent the team’s work built upon the accomplishments of the Swedish surgeons, Dr Tzakis said, “We worked with Dr Brännström in research long before the first clinical trial in different species of animals ... We definitely benefitted tremendously from that collaboration and we’re eternally grateful to them for their support over the years. We are in contact with them because sometimes questions come up and we want to use [their] experience as much as possible for the benefit of our patients.”

The surgery lasted 9 hours and was completed by a team of 2 transplant surgeons, 2 gynecological surgeons, multiple nurses and anesthesiologists, and other support staff.

 

Video courtesy of Cleveland Clinic

After about a year, the patient will undergo IVF, necessitated by the fact that she does not have Fallopian tubes. Embryos that were produced before the transplantation will be implanted one at a time. If a pregnancy occurs, the patient will be followed by a high-risk obstetric group in Cleveland Clinic's Ob/Gyn & Women's Health Institute. 

The uterus is an “ephemeral” transplant, intended to last only as long as is necessary to produce 1 or 2 children, who will be delivered by cesarean. The uterus will then be surgically removed or anti-rejection medication will be halted, allowing the uterus to dissipate.