Uterus transplantation is the surgical treatment for absolute uterine factor infertility (AUFI), a congenital or acquired condition characterized by the absence of a uterus. More than 80 transplants have been performed worldwide, resulting in more than 30 live births, originating both from living and deceased donors. The collection of published articles on deceased donor uterus transplantations was performed in PubMed and SCOPUS by searching for the terms "Uterus transplantation" AND "deceased donor"; from the 107 articles obtained, only case reports and systematic reviews of deceased donor uterus transplantations and the resulting live births were considered for the present manuscript. The extracted data included the date of surgery (year), country, recipient (age and cause of AUFI) and donor (age and parity) details, outcome of recipient surgery (hysterectomy), and live births (date and gestational age). The search of peer-reviewed publications showed 24 deceased donor uterus transplantations and 12 live births (a birth rate of 66%) with a 25% occurrence of graft loss during follow-up (6 of 24). Among this series, twelve transplants were performed in the USA (seven births), five in the Czech Republic (one birth), three in Italy (one birth), two in Turkey (two births), and two in Brazil (one birth). The median recipient age was 29.8 years (range 21-36), while the median donor age was 36.1 years (range 20-57). Of 24 recipients, 100% were affected by MRKH (Mayer-Rokitanski-Kuster-Hauser) syndrome. Two live births were reported from nulliparous donors. Deceased donor uterus transplantation birth rates are very similar to the living donor rates reported in the literature, but ethical implications could be less important in the first group. It is necessary to register every case in the International Registry for Uterus Transplantation in order to perform a systematic review and comparison with living donor rates.

Obstetrics and Gynecology Cannizzaro Hospital 95126 Catania Italy

Obstetrics and Gynecology Cannizzaro Hospital Kore University of Enna 95126 Catania Italy

Obstetrics and Gynecology Giovanni Paolo 2 Hospital 97100 Ragusa Italy

Obstetrics and Gynecology Umberto 1 Hospital Kore University of Enna 94100 Enna Italy

Vascular Surgery and Organ Transplant Unit Department of General Surgery and Medical Surgical Specialties University Hospital of Catania 95124 Catania Italy

Zobrazit více v PubMed

Malasevskaia I., Al-Awadhi A.A. A New Approach for Treatment of Woman with Absolute Uterine Factor Infertility: A Traditional Review of Safety and Efficacy Outcomes in the First 65 Recipients of Uterus Transplantation. Cureus. 2021;13:e12772. doi: 10.7759/cureus.12772. PubMed DOI PMC

Jones B.P., Ranaei-Zamani N., Vali S., Williams N., Saso S., Thum M.Y., Al-Memar M., Dixon N., Rose G., Testa G., et al. Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation. Obstet. Gynaecol. 2021;23:138–147. doi: 10.1111/tog.12729. PubMed DOI PMC

Brännström M., Racowsky C., Carbonnel M., Wu J., Gargiulo A., Adashi E.Y., Ayoubi J.M. Uterus transplantation: From research, through human trials and into the future. Hum. Reprod. Update. 2023;29:521–544. doi: 10.1093/humupd/dmad012. PubMed DOI PMC

Fageeh W., Raffa H., Jabbad H., Marzouki A. Transplantation of the human uterus. Int. J. Gynaecol. Obstet. 2002;76:245–251. doi: 10.1016/S0020-7292(01)00597-5. PubMed DOI

Brännström M., Johannesson L., Bokström H., Kvarnström N., Mölne J., Dahm-Kähler P., Enskog A., Milenkovic M., Ekberg J., Diaz-Garcia C., et al. Livebirth after uterus transplantation. Lancet. 2015;385:607–616. doi: 10.1016/S0140-6736(14)61728-1. PubMed DOI

Ejzenberg D., Andraus W., Baratelli Carelli Mendes L.R., Ducatti L., Song A., Tanigawa R., Rocha-Santos V., Macedo Arantes R., Soares J.M., Jr., Serafini P.C., et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet. 2019;392:2697–2704. doi: 10.1016/S0140-6736(18)31766-5. PubMed DOI

Hammond-Browning N., Yao S.L. Deceased Donation Uterus Transplantation: A Review. Transplantology. 2021;2:140–148. doi: 10.3390/transplantology2020014. DOI

Brännström M., Tullius S.G., Brucker S., Dahm-Kähler P., Flyckt R., Kisu I., Andraus W., Wei L., Carmona F., Ayoubi J.M., et al. Registry of the International Society of Uterus Transplantation: First Report. Transplantation. 2023;107:10–17. doi: 10.1097/TP.0000000000004286. PubMed DOI

Ozkan O., Akar M.E., Erdogan O., Ozkan O., Hadimioglu N. Uterus transplantation from a deceased donor. Fertil. Steril. 2013;100:e41. doi: 10.1016/j.fertnstert.2013.06.041. PubMed DOI

Ozkan O., Ozkan O., Dogan N.U. The Ozkan Technique in Current Use in Uterus Transplantation: From the First Ever Successful Attempt to Clinical Reality. J. Clin. Med. 2023;12:2812. doi: 10.3390/jcm12082812. PubMed DOI PMC

Ozkan O., Ozkan O., Dogan N.U., Bahceci M., Mendilcioglu I., Boynukalin K., Ongun H., Kantarci A.M., Yaprak M., Cengiz M., et al. Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant. Ann. Surg. 2022;275:825–832. doi: 10.1097/SLA.0000000000005346. PubMed DOI

Ongun H., Celik K., Arayici S., Dogan N.U., Mendilcioglu I., Ozkan O., Ozkan O. Miracles of science: Birth after uterus transplantation. J. Obstet. Gynaecol. Res. 2024;50:5–14. doi: 10.1111/jog.15825. PubMed DOI

Flyckt R., Kotlyar A., Arian S., Eghtesad B., Falcone T., Tzakis A. Deceased donor uterine transplantation. Fertil. Steril. 2017;107:e13. doi: 10.1016/j.fertnstert.2016.12.009. PubMed DOI

Flyckt R., Falcone T., Quintini C., Perni U., Eghtesad B., Richards E.G., Farrell R.M., Hashimoto K., Miller C., Ricci S., et al. First birth from a deceased donor uterus in the United States: From severe graft rejection to successful cesarean delivery. Am. J. Obstet. Gynecol. 2020;223:143–151. doi: 10.1016/j.ajog.2020.03.001. PubMed DOI

Johannesson L., Richards E., Reddy V., Walter J., Olthoff K., Quintini C., Tzakis A., Latif N., Porrett P., O’Neill K., et al. The First 5 Years of Uterus Transplant in the US: A Report from the United States Uterus Transplant Consortium. JAMA Surg. 2022;157:790–797. doi: 10.1001/jamasurg.2022.2612. PubMed DOI PMC

Fronek J., Kristek J., Chlupac J., Janousek L., Olausson M. Human Uterus Transplantation from Living and Deceased Donors: The Interim Results of the First 10 Cases of the Czech Trial. J. Clin. Med. 2021;10:586. doi: 10.3390/jcm10040586. PubMed DOI PMC

Fronek J., Janousek L., Kristek J., Chlupac J., Pluta M., Novotny R., Maluskova J., Olausson M. Live Birth Following Uterine Transplantation from a Nulliparous Deceased Donor. Transplantation. 2021;105:1077–1081. doi: 10.1097/TP.0000000000003346. PubMed DOI

Pecorino B., Scibilia G., Borzì P., Vento M.E., Veroux P., Scollo P. Diminished ovarian reserve and ectopic ovaries in patients with Mayer-Rokitansky-Küster-Hauser syndrome candidates for Uterus Transplantation: Our experience. Clin. Exp. Obstet. Gynecol. 2021;48:907–912. doi: 10.31083/j.ceog4804143. DOI

Scollo P., Pecorino B., La Spina S., Veroux P., Giaquinta A., Scibilia G. Psychological and personality assessment in patients candidates for uterus transplantation from deceased donor: Preliminary results. Ital. J. Gynaecol. Obstet. 2020;32:287–292. doi: 10.36129/jog.32.04.08. DOI

Scollo P., Scibilia G., Vento M.E., Borzì P., Veroux P., Mereu L., Pecorino B. Live Birth from Cryopreserved Oocyte after Uterus Transplantation: A Case Report. Am. J. Case Rep. 2023;24:e940960. doi: 10.12659/AJCR.940960. PubMed DOI PMC

Chmel R., Pastor Z., Matecha J., Janousek L., Novackova M., Fronek J. Uterine transplantation in an era of successful childbirths from living and deceased donor uteri: Current challenges. Biomed. Pap. 2020;164:115–120. doi: 10.5507/bp.2019.020. PubMed DOI

Chmel R., Pastor Z., Novackova M., Matecha J., Cekal M., Fronek J. Clinical pregnancy after deceased donor uterus transplantation: Lessons learned and future perspectives. J. Obstet. Gynaecol. Res. 2019;45:1458–1465. doi: 10.1111/jog.13992. PubMed DOI

Chmel R., Novackova M., Janousek L., Matecha J., Pastor Z., Maluskova J., Cekal M., Kristek J., Olausson M., Fronek J. Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations. Am. J. Transplant. 2019;19:855–864. doi: 10.1111/ajt.15096. PubMed DOI

Testa G., Anthony T., McKenna G.J., Koon E.C., Wallis K., Klintmalm G.B., Reese J.C., Johannesson L. Deceased donor uterus retrieval: A novel technique and workflow. Am. J. Transplant. 2018;18:679–683. doi: 10.1111/ajt.14476. PubMed DOI

Taherkhani S. Differences between living and deceased donation in human uterus transplantation: A narrative review. Int. J. Reprod. Biomed. 2023;21:193–204. doi: 10.18502/ijrm.v21i3.13195. PubMed DOI PMC

Kisu I., Kato Y., Obara H., Matsubara K., Matoba Y., Banno K., Aoki D. Emerging problems in uterus transplantation. BJOG. 2018;125:1352–1356. doi: 10.1111/1471-0528.15230. PubMed DOI

Kisu I., Mihara M., Banno K., Umene K., Araki J., Hara H., Suganuma N., Aoki D. Risks for donors in uterus transplantation. Reprod. Sci. 2013;20:1406–1415. doi: 10.1177/1933719113493517. PubMed DOI

Warren A.M., McMinn K., Testa G., Wall A., Saracino G., Johannesson L. Motivations and Psychological Characteristics of Nondirected Uterus Donors from The Dallas UtErus Transplant Study. Prog. Transplant. 2021;31:385–391. doi: 10.1177/15269248211046027. PubMed DOI

Kvarnström N., Enskog A., Dahm-Kähler P., Brännström M. Live versus deceased donor in uterus transplantation. Fertil. Steril. 2019;112:24–27. doi: 10.1016/j.fertnstert.2019.05.029. PubMed DOI

Jones B.P., Rajamanoharan A., Williams N.J., Vali S., Saso S., Mantrali I., Jalmbrant M., Thum M.Y., Diaz-Garcia C., Ghaem-Maghami S., et al. Uterine Transplantation Using Living Donation: A Cross-sectional Study Assessing Perceptions, Acceptability, and Suitability. Transplant. Direct. 2021;7:e673. doi: 10.1097/TXD.0000000000001124. PubMed DOI PMC

Matoba Y., Kisu I., Banno K., Aoki D. Operative and Clinical Outcomes of Minimally Invasive Living-Donor Surgery on Uterus Transplantation: A Literature Review. J. Clin. Med. 2021;10:349. doi: 10.3390/jcm10020349. PubMed DOI PMC

Flyckt R.L., Farrell R.M., Perni U.C., Tzakis A.G., Falcone T. Deceased Donor Uterine Transplantation: Innovation and Adaptation. Obstet. Gynecol. 2016;128:837–842. doi: 10.1097/AOG.0000000000001617. PubMed DOI

Ozkan O., Akar M.E., Ozkan O., Erdogan O., Hadimioglu N., Yilmaz M., Gunseren F., Cincik M., Pestereli E., Kocak H., et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil. Steril. 2013;99:470–476. doi: 10.1016/j.fertnstert.2012.09.035. PubMed DOI

Brucker S.Y., Brännström M., Taran F.A., Nadalin S., Königsrainer A., Rall K., Schöller D., Henes M., Bösmüller H., Fend F., 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. 2018;297:675–684. doi: 10.1007/s00404-017-4626-z. PubMed DOI

Falcone T., Farrell R.M., Flyckt R. The future of human uterine transplantation: Can minimally invasive techniques provide a uterus suitable for transplant? Fertil. Steril. 2017;108:243–244. doi: 10.1016/j.fertnstert.2017.06.021. PubMed DOI

Brännström M., Enskog A., Kvarnström N., Ayoubi J.M., Dahm-Kähler P. Global results of human uterus transplantation and strategies for pre-transplantation screening of donors. Fertil. Steril. 2019;112:3–10. doi: 10.1016/j.fertnstert.2019.05.030. PubMed DOI

Wei L., Xue T., Tao K.S., Zhang G., Zhao G.Y., Yu S.Q., Cheng L., Yang Z.X., Zheng M.J., Li F., 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. doi: 10.1016/j.fertnstert.2017.05.039. PubMed DOI

Lavoué V., Vigneau C., Duros S., Boudjema K., Levêque J., Piver P., Aubard Y., Gauthier T. Which Donor for Uterus Transplants: Brain-Dead Donor or Living Donor? A Systematic Review. Transplantation. 2017;101:267–273. doi: 10.1097/TP.0000000000001481. PubMed DOI

Richards E.G., Flyckt R., Tzakis A., Falcone T. Uterus transplantation: Organ procurement in a deceased donor model. Fertil. Steril. 2018;110:183. doi: 10.1016/j.fertnstert.2018.04.014. PubMed DOI

Froněk J., Janousek L., Chmel R. Deceased donor uterus retrieval—The first Czech experience. Rozhl. Chir. 2016;95:312–316. PubMed

Rehmer J.M., Ferrando C.A., Flyckt R., Falcone T. Techniques for successful vaginal anastomosis in the uterine transplantation patient. Fertil. Steril. 2021;115:802–803. doi: 10.1016/j.fertnstert.2020.05.017. PubMed DOI

Johannesson L., Humphries L.A., Porrett P.M., Testa G., Anderson S., Walter J.R., Rush M., Ferrando C.A., O’Neill K., Richards E.G. Classification and treatment of vaginal strictures at the donor-recipient anastomosis after uterus transplant. Fertil. Steril. 2024 doi: 10.1016/j.fertnstert.2024.04.019. in press . PubMed DOI

Kisu I., Banno K. Uterus Transplantation: From a Deceased Donor or Living Donor? J. Clin. Med. 2022;11:4840. doi: 10.3390/jcm11164840. PubMed DOI PMC

Brännström M., Belfort M.A., Ayoubi J.M. Uterus transplantation worldwide: Clinical activities and outcomes. Curr. Opin. Organ Transplant. 2021;26:616–626. doi: 10.1097/MOT.0000000000000936. PubMed DOI