Abstract
Purpose
To contribute to establishing donor selection criteria based on our experience with two successful living-donor human uterus transplantations (UTx) and an aborted attempt.
Methods
This interventional study included three patients with uterine agenesis, aged 23, 34, and 23 years, scheduled for UTx, and their uterus-donating mothers, aged 46, 61, and 46 years, respectively. Interventions included preoperative investigations, donor surgery, back-table preparation, and recipient surgery. Preoperative imaging, surgical data, histopathology, menstrual pattern, and uterine blood flow were the main outcome measures.
Results
In the first case (46-year-old mother/23-year-old daughter), donor/recipient surgery took 12.12/5.95 h. Regular spontaneous menstruations started 6-week post-transplantation, continuing at 24–28-day intervals throughout the 6-month observation period. Repeated follow-up cervical biopsies showed no signs of rejection. In the second case (61-year-old donor), surgery lasted 13.10 h; attempts to flush the retrieved uterus failed due to extreme resistance of the left uterine artery (UA) and inability to perfuse the right UA. Transplantation was aborted to avoid graft vessel thrombosis or insufficient blood flow during potential pregnancy. Histopathology revealed intimal fibrosis and initial sclerosis (right UA), extensive intimal fibrosis (parametric arterial segments), and subtotal arterial stenosis (myometrial vascular network). In the third case (46-year-old mother/23-year-old daughter), donor/recipient surgery took 9.05/4.52 h. Menstruations started 6-week post-transplantation. Repeated cervical biopsies showed no signs of rejection during the initial 12-week follow-up period.
Conclusions
Meticulous preoperative evaluation of potential living uterus donors is essential. This may include selective contrast-enhanced UA angiograms and limitation of donor age, at least in donors with risk factors for atherosclerosis.
Clinical trial registration
ClinicalTrials.gov Identifier: NCT03048396.
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Discover the latest articles, news and stories from top researchers in related subjects.Abbreviations
- ACE:
-
Angiotensin-converting enzyme
- AUFI:
-
Absolute uterine factor infertility
- BMI:
-
Body mass index
- CMV:
-
Cytomegalovirus
- CT:
-
Computed tomography
- EBV:
-
Epstein Barr virus
- HbA1c:
-
Glycated hemoglobin
- HC2:
-
Hybrid Capture 2
- HDL:
-
High-density lipoprotein
- HLA:
-
Human leukocyte antigen
- HPV:
-
Human papilloma virus
- HRT:
-
Hormone replacement therapy
- HTK:
-
Histidine-tryptophan-ketoglutarate (solution)
- IFCC:
-
International Federation for Clinical Chemistry
- IVF:
-
In vitro fertilization
- LDL:
-
Low-density lipoprotein
- MRA:
-
Magnetic resonance angiography
- MRKHS:
-
Mayer–Rokitansky–Küster–Hauser syndrome
- Pap:
-
Papanicolaou (smear)
- UA:
-
Uterine artery
- UTx:
-
Uterus transplantation
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SYB: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. MB: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. FAT: data collection or management, data analysis, and manuscript writing/editing. KR: data collection or management, data analysis, and manuscript writing/editing. KN: data collection or management, and manuscript writing/editing. MN: data collection or management, and manuscript writing/editing. NK: data collection or management, and manuscript writing/editing. PD-K: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. DW: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. All other authors: performance of the research and critical revision of the draft manuscript. All authors: final approval of the manuscript version to be published.
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Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study. All patients gave their written informed consent for publication.
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Brucker, S.Y., Brännström, M., Taran, FA. et al. Selecting living donors for uterus transplantation: lessons learned from two transplantations resulting in menstrual functionality and another attempt, aborted after organ retrieval. Arch Gynecol Obstet 297, 675–684 (2018). https://doi.org/10.1007/s00404-017-4626-z
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DOI: https://doi.org/10.1007/s00404-017-4626-z