Uterine Transplant From Deceased Donor Results in Successful Childbirth

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The donor was a 45-year-old woman who died of subarachnoid hemorrhage.
The donor was a 45-year-old woman who died of subarachnoid hemorrhage.

In the first case of its kind, a successful live birth was reported in a patient with congenital uterine absence following uterus transplantation from a deceased donor, establishing proof-of-concept for treating infertility by transplantation from deceased donors, according to research published in The Lancet.

A team of investigators from São Paulo School of Medicine in São Paulo, Brazil, reported on a 32-year-old patient with Mayer-Rokitansky-Küster-Hauser syndrome and uterine agenesis but no cardiac, renal, or bone structure abnormalities who underwent uterine transplantation. The donor was a 45-year-old woman who had 3 previous vaginal deliveries and died of brain death due to subarachnoid hemorrhage. No sexually transmitted diseases were reported.  The donor was matched to the patient by blood type only (O Rh factor-positive).

Four months prior to transplantation, the patient underwent 1 in-vitro fertilization cycle that resulted in 8 cryopreserved blastocysts. Following transplantation the patient recovered satisfactorily and was discharged from the hospital 8 days after the procedure.

During the first 5 months following transplantation, prednisolone and thymoglobulin were used to induce immunosuppression and were continued with tacrolimus and mycophenolate mofetil (MMF); MMF was replaced with azathioprine 5 months after transplantation.

The first menstruation occurred 37 days after surgery and continued regularly thereafter. At 7 months post-transplantation, pregnancy occurred following a single embryo transfer; no uterine artery, fetal umbilical, or middle cerebral artery irregularities were detected by Doppler ultrasound. In addition, no fetal growth impairments were reported during pregnancy and no rejection episodes occurred after transplantation or during gestation.

At 36 weeks' gestation, an infant girl was delivered via cesarean delivery. Apgar score was 9 at 1 minute, 10 at 5 minutes, and 10 at 10 minutes; the neonate weighed 2550 g at birth. The uterus was removed in the same delivery procedure and immunosuppressive treatments were stopped. The infant was reported to be developing normally 7 months after delivery; the mother was also found to be healthy at that time.

“To our knowledge, this is the first livebirth reported worldwide from a uterus transplanted from a deceased donor, and the first uterine transplantation in Latin America,” the researchers wrote. “Previous successful childbirths from transplanted uteri were restricted to those from uteri of living donors,” they continued.

“The results provide proof-of-concept for a new treatment option for absolute uterine factor infertility, enabling pregnancy even for those women without living uterine donors—making uterine transplantation a therapeutic option for those women who until now had only adoption or surrogacy as options,” they concluded.

Reference

Ejzenberg D, Andraus W, Mendes LRBC, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility [published online December 4, 2018]. Lancet. doi: 10.1016/S0140-6736(18)31766-5

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