‘Feasible’ uterus transplant associated with high live birth rate, surgical risks
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Key takeaways:
- Women with uterine factor infertility who underwent successful uterine transplant all went on to have at least one live birth.
- There were high rates of morbidity among donors and recipients.
Among a select group of women with uterine factor infertility, uterus transplant was feasible and associated with a high live birth rate after successful graft survival, data from a case series show.
In an analysis of the Dallas Uterus Transplant Study (DUETS), researchers also found that although adverse events were common, including complications requiring surgical intervention, infants born to women who received a uterine transplant had no congenital abnormalities or developmental delays, though follow-up of the cohort is ongoing.
“We show that uterus transplantation is not only feasible and safe, but also associated with a success rate that is comparable with and even favorable to other infertility treatments,” Liza Johannesson, MD, PhD, of the Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Center, told Healio. “[What is] important is that the children born after uterus transplant are healthy and developing normally.”
Study data
For the case series, researchers analyzed data from 20 women with uterine factor infertility and at least one functioning ovary who underwent uterus transplant from September 2016 to August 2019. The median age of women was 30 years; 16 participants were white. Before uterus transplant, all recipients underwent IVF. Participants received immunosuppression until the transplanted uterus was removed after one or two live births or after graft failure. Eligibility criteria for donors included being aged 25 to 65 years with at least one prior term live birth with no relevant medical or psychological comorbidities. The 18 living donors had a median age of 37 years and median parity of two; there were two deceased donors, aged 30 and 43 years.
Of the 20 women, 14 had a successful uterus allograft and all 14 recipients gave birth to at least one live-born infant.
Maternal and/or obstetrical complications occurred in half of the successful pregnancies. The most common complications were gestational hypertension (n = 2), cervical insufficiency (n = 2) and preterm labor (n = 2).
Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications.
“This is the first completed single-center cohort trial of uterus transplantation, where the participants are followed from transplant surgery, through delivery of one or two children to hysterectomy and cessation of immunosuppression,” Johannesson told Healio. “That means that for the first time, we can draw conclusions about how safe and efficient uterus transplantation is for the recipient, donor and the child. We need long-term follow-up of both the children born after uterus transplantation and the recipients to make sure that there are no long-term side effects.”
Morbidity concerns after transplant
In a related editorial published in JAMA, Jessica R. Walter, MD, MSCE, and Emily S. Jungheim, MD, MSCI, both of Northwestern University Feinberg School of Medicine, wrote that uterine transplant, while promising, is associated with high rates of morbidity by donors and recipients, noting that 22% of living donors experienced postoperative complications requiring surgical intervention and 55% of recipients had at least one complication.
“Aside from donors and recipients, the health of children born from uterus transplant must also weigh heavily in the calculus when considering the procedure,” Walter and Jungheim wrote. “Healthy children, not simply live birth, are the standard to which this treatment should aspire, and continued efforts to ensure the optimal health of offspring exposed to this unique intrauterine environment, immunosuppression and timing of delivery are paramount.”
The authors added that uterus transplant will likely mirror the experience of other solid organ transplants in time, with improved outcomes, decreased graft loss and morbidity.
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For more information:
Liza Johannesson, MD, PhD, can be reached at liza.johannesson@bswhealth.org; X (Twitter): @bswhealth_med.