Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility – The Lancet

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Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility – The Lancet

Summary

Background

Uterus transplantation from live donors became a reality to treat infertility following
a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes
worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge,
been successfully achieved, raising doubts about its feasibility and viability, including
whether the womb remains viable after prolonged ischaemia.

Methods

In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser
[MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University
of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor
was 45 years old and had three previous vaginal deliveries. The recipient had one
in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved
blastocysts.

Findings

The recipient showed satisfactory postoperative recovery and was discharged after
8 days’ observation in hospital. Immunosuppression was induced with prednisolone and
thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until
5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation
occurred 37 days post-transplantation, and regularly (every 26–32 days) thereafter.
Pregnancy occurred after the first single embryo transfer 7 months post-transplantation.
No blood flow velocity waveform abnormalities were detected by Doppler ultrasound
of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth
impairments during pregnancy. No rejection episodes occurred after transplantation
or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational
week 36. The female baby weighed 2550 g at birth, appropriate for gestational age,
with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the
mother remains healthy and developing normally 7 months post partum. The uterus was
removed in the same surgical procedure as the livebirth and immunosuppressive therapy
was suspended.

Interpretation

We describe, to our knowledge, the first case worldwide of livebirth following uterine
transplantation from a deceased donor in a patient with MRKH syndrome. The results
establish proof-of-concept for treating uterine infertility by transplantation from
a deceased donor, opening a path to healthy pregnancy for all women with uterine factor
infertility, without need of living donors or live donor surgery.

Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo and Hospital das Clínicas, University
of São Paulo, Brazil.

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Article Info

Publication History

Published: December 04, 2018

IDENTIFICATION

DOI: 10.1016/S0140-6736(18)31766-5

Copyright

© 2018 Elsevier Ltd. All rights reserved.

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