The First Clinical Trial of Uterus Transplantation: Surgical Technique and Outcome.

Abstract

Uterus transplantation may become a treatment for uterine factor infertility, which affects > 200,000 women only in Europe. The only option for these women, with no functional uterus, to gain genetic motherhood is by a surrogate mother. The latter procedure is not allowed in most countries due to ethical, religious or legal reasons. Our team has developed a procedure for uterus transplantation from live donor, through extensive research in several animal species. In May 2012 we were granted human IRB approval for a clinical study of 9 human transplantation cases with the uterus from live donors. The recipients and donors had been investigated for >12 months before the trial. This included IVF treatment. The donors were mothers (n=5), close relatives (n=3) or family friend and the ages were 35-62 years. Eight recipients were born with no uterus (MRKH syndrome) and one had been hysterectomized 7 years prior to the study because of cervical cancer. The ages of the recipients were between 27 and 38 years. The surgery of the donor involved isolation of the uterus with vascular pedicles including the uterine vessels and segments of the internal iliac vessels. The surgery of the recipient involved bilateral end-to-side anastomosis to the external iliacs, vagino-vagino anastomosis and uterine fixation to several pelvic ligaments. The surgical procedures will be discussed in detail. Durations of donor and recipient surgery ranged from 10 to 13 h and 4 to 6 h, respectively. The recipients received standard induction and initial triple maintenance immunosuppression.The 2nd uterus donor was diagnosed with a uterovaginal fistula on postoperative day 10. All other donor surgeries went without complications. No immediate perioperative complication occured among the recipients. However, one uterus had to be removed around 72 h after surgery due to bilateral uterine vessel thrombosis. Another uterus was removed 3.5 months after surgery due to persistent intrauterine infection and later development of an intrauterine abscess. Menstruation started after around 1-2 months in 7 recipients. In conclusion, the results demonstrate the surgical feasibility of live uterus transplantation. It remains to be determined what the pregnancy potential is in a transplanted uterus. Pregnancy results of our study population are expected in 2014.