BACKGROUND: Uterus transplantation (UTx) is a novel type of transplantation to treat infertility in women with an absent or nonfunctioning uterus. The International Society of Uterus Transplantation (ISUTx) has developed a registry to monitor worldwide UTx activities while serving as a repository for specific research questions. METHODS: The web-based registry has separate data fields for donor, recipient, surgeries, immunosuppression, rejections, pregnancies with live birth(s), and transplant hysterectomies. Data are prospectively registered. RESULTS: A total of 45 UTx procedures have been registered; the majority (78%) of those procedures were live donor (LD) transplants. Median age of the LDs, deceased donors, and recipients were 50 y (range 32-62), 38.5 y (19-57), and 29 y (22-38), respectively. The duration of LD surgery was approximately twice as long as the recipient surgery. Postoperative complications of any Clavien-Dindo grade were registered in 20% of LDs and 24% of recipients. Rejection episodes were more frequent (33%) early after transplantation (months 1-5) compared with later time points (months 6-10; 21%). Healthy neonates were delivered by 16 recipients, with 3 women giving birth twice. The total live birth rate per embryo transfer was 35.8%. Median length of pregnancy was 35 gestational weeks. Twelve uteri were removed without childbirth, with 9 transplant hysterectomies occurring during the initial 7 mo post-UTx. CONCLUSIONS: A mandatory registry is critical to determine quality and process improvement for any novel transplantation. This registry provides a detailed analysis of 45 UTx procedures performed worldwide with a thorough analysis of outcomes and complications.

Department of Obstetrics and Gynecology Department of Women's health University Hospital Tuebingen Eberhard Karls University Tuebingen Tuebingen Germany

Department of Obstetrics and Gynecology Ghent University Ghent Belgium

Department of Obstetrics and Gynecology Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Göteborg Sweden

Department of Obstetrics and Gynecology Keio University School of Medicine Tokyo Japan

Department of Obstetrics and Gynecology Reproductive Endocrinology and Infertility University Hospitals Cleveland Medical Center Cleveland OH

Department of Obstetrics and Gynecology Xijing Hospital The 4th Military Medical University Xi'an People's Republic of China

Department of Obstetrics Gynecology and Reproductive Medicine Hopital Foch Suresnes France

Department of Transplantation Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Digestive Organs Transplant Division Gastroenterology Department University of São Paulo School of Medicine FM USP São Paulo Brazil

Division of Gynecology and Obstetrics Maternal and Child Department Cannizzaro Hospital Catania Italy

Division of Transplant Surgery Brigham and Women's Hospital Harvard Medical School Boston MA

Institute Clinic of Gynecology Obstetrics and Neonatology Hospital Clinic de Barcelona Institute dÍnvestigacions Biomèdiques August Pi i Sunyer Universitat de Barcelona Barcelona Spain

Zobrazit více v PubMed

Sieunarine K, Zakaria FB, Boyle DC, et al. Possibilities for fertility restoration: a new surgical technique. Int Surg. 2005;90:249–256.

Hur C, Rehmer J, Flyckt R, et al. Uterine factor infertility: a clinical review. Clin Obstet Gynecol. 2019;62:257–270.

Fageeh W, Raffa H, Jabbad H, et al. Transplantation of the human uterus. Int J Gynaecol Obstet. 2002;76:245–251.

Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet. 2015;385:607–616.

Brännström M, Johannesson L, Dahm-Kähler P, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril. 2014;101:1228–1236.

Ejzenberg D, Andraus W, Baratelli Carelli Mendes LR, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet. 2019;392:2697–2704.

Taran FA, Schöller D, Rall K, et al. Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study. Fertil Steril. 2019;111:186–193.

Brännström M, Enskog A, Kvarnström N, et al. Global results of human uterus transplantation and strategies for pre-transplantation screening of donors. Fertil Steril. 2019;112:3–10.

Leonhardt H, Thilander-Klang A, Båth J, et al. Imaging evaluation of uterine arteries in potential living donors for uterus transplantation: a comparative study of MRA, CTA and DSA. Europ Radiol. 2021;32:2360–2371.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.

Brännström M, Dahm-Kähler P, Kvarnström N, et al. Reproductive, obstetric and long-term health outcome after uterus transplantation: results of the first clinical trial. Fertil Steril . 2022;118:576–585.

Brännström M, Belfort MA, Ayoubi JM. Uterus transplantation worldwide: clinical activities and outcomes. Curr Opin Organ Transplant. 2021;26:616–626.

Kristek J, Johannesson L, Testa G, et al. Limited availability of deceased uterus donors: a transatlantic perspective. Transplantation. 2019;103:2449–2452.

Brännström M, Dahm-Kähler P, Kvarnström N, et al. Livebirth after robotic-assisted live donor uterus transplantation. Acta Obstet Gynecol Scand. 2020;99:1222–1229.

Brännström M, Bokström H, Dahm-Kähler P, et al. One uterus bridging three generations; first live birth after mother-to-daughter uterus transplantation. Fertil Steril. 2016;107:261–266.

Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus. J Pathol. 2015;235:288–297.

Kisu I, Umene K, Adachi M, et al. Allowable warm ischemic time and morphological and biochemical changes in uterine ischemia/reperfusion injury in cynomolgus macaque: a basic study for uterus transplantation. Hum Reprod. 2017;32:2026–2035.

Brännström M, Kvarnström N, Groth K, et al. Evolution of surgical steps in robotics-assisted donor surgery for uterus transplantation: results of the eight cases in the Swedish trial. Fertil Steril. 2020;114:1097–1107.

Wei L, Xue T, Tao KS, et al. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril. 2017;108:346–356.e1.

De Geyter C, Wyns C, Calhaz-Jorge C, et al. 20 years of the European IVF-monitoring Consortium registry: what have we learned? A comparison with registries from two other regions. Hum Reprod. 2020;35:2832–2849.

Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med. 2009;360:236–243.

Deceased Donor Uterus Transplantation: A Narrative Review of the First 24 Published Cases

A Multi-Institutional Report of Intermediate-Term Kidney Outcomes in Uterus Transplant Recipients

Reproducibility of Rejection Grading in Uterus Transplantation: A Multicenter Study