Uterus transplantation: a rescue technique to save the viability and functionality of the graft after intra-operative outflow thrombosis

Abstract

ObjectiveTo Study a surgical approach to venous vascular thrombosis after Uterus transplantation (UTx). UTx is the only treatment for uterine factor infertility when conventional therapies are not possible. One of the major limitations of UTx is the high incidence of vascular thrombosis that in most series reaches approximately 20%. DesignCase report SubjectsWe report here a technique used in a 30-year-old female with congenital absence of the uterus who developed intraoperative thrombosis after a UTx from a brain-dead donor. InterventionThe UTx was performed by revascularizing the graft through bilateral donor internal iliac vessels (artery and vein) anastomosed end-to-side to the external iliac vessels of the recipient. The superior uterine veins were not anastomosed and were left unreconstructed. An end-to-end graft to the recipient vaginal anastomosis was performed. After uterus reperfusion, congestion of the organ was noted and bilateral venous thrombosis of the internal iliac veins of the graft was found. A “Y-shaped” venous jump graft was used to restore venous outflow of the left superior uterine vein and the internal iliac vein of the graft after thrombectomy. Main Outcome MeasuresViability and functionality of the uterus graft after intraoperative bilateral venous thrombosis ResultsThe post-operative course was uneventful, and this Utx resulted in the delivery of a healthy baby. ConclusionThis is the first successful rescue technique utilized to restore venous outflow and save the viability and functionality of a transplanted uterus. We demonstrated that a transplanted uterus from a deceased donor with a monolateral outflow could succeed in pregnancy and delivering of a healthy baby.