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Jones BP, Kasaven LS, Chan M, Vali S, Saso S, Bracewell-milnes T, Thum M, Nicopoullos J, Diaz-garcia C, Quiroga I, Yazbek J, Smith JR. Uterine Transplantation in 2021: Recent Developments and the Future. Clin Obstet Gynecol 2022; 65:4-14. [DOI: 10.1097/grf.0000000000000680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Jones BP, Kasaven L, Vali S, Saso S, Jalmbrant M, Bracewell-Milnes T, Thum MY, Quiroga I, Friend P, Diaz-Garcia C, Ghaem-Maghami S, Yazbek J, Lees C, Testa G, Johannesson L, Jones B, Smith JR. Uterine Transplantation: Review of Livebirths and Reproductive Implications. Transplantation 2021; 105:1695-707. [PMID: 33315758 DOI: 10.1097/TP.0000000000003578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Uterine transplantation (UTx) is a fertility restoring treatment for women with absolute uterine factor infertility. At a time when there is no question of the procedure's feasibility, and as the number of livebirths begins to increase exponentially, various important reproductive, fetal, and maternal medicine implications have emerged. Detailed outcomes from 17 livebirths following UTx are now available, which are reviewed herein, along with contextualized extrapolation from pregnancy outcomes in other solid organ transplants. Differences in recipient demographics and reproductive aspirations between UTx and other transplant recipients make extrapolating management strategies and outcomes in other solid organ transplants inappropriate. Whereas preterm delivery remains prominent, small for gestational age or hypertensive disorders do not appear to be as prevalent following UTx when compared to other solid organ transplants. Given the primary objective of undertaking UTx is to achieve a livebirth, publication of reproductive outcomes is essential at this early stage, to reflect on and optimize the management of future cases.
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Abstract
Uterus transplantation (UTx) offers women with absolute uterine factor infertility the option to gestate and birth their own biologically related child. The first birth following living donation UTx happened in 2014. The first birth following deceased donation happened in December 2017, with further successes since. Interest in deceased donation UTx is increasing. The authors established a database to track UTx clinical trials and outcomes. Utilising this database and existing literature, this article reviews the first reported cases of deceased donation UTx and outcomes, and drawing upon comparisons with living donor UTx, comments upon the future for this area of reproductive transplantation research. This is the first article to bring together the literature on deceased donation UTx procedures and outcomes.
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Jones BP, Rajamanoharan A, Williams NJ, Vali S, Saso S, Mantrali I, Jalmbrant M, Thum MY, Diaz-Garcia C, Ghaem-Maghami S, Wilkinson S, Quiroga I, Friend P, Yazbek J, Smith JR. Uterine Transplantation Using Living Donation: A Cross-sectional Study Assessing Perceptions, Acceptability, and Suitability. Transplant Direct 2021; 7:e673. [PMID: 34104711 DOI: 10.1097/TXD.0000000000001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. A uterine transplantation is a nonvital, quality-of-life–enhancing solid organ transplant. Given improvements in donor risk profile and the anticipated shortage of suitable deceased donors, nondirected donation could facilitate sustainability as uterine transplantation moves from research into the clinical realm. The aim of this article is to determine perceptions and identify motivations of potential nondirected living uterus donors and assess acceptability and suitability.
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Ricci S, Bennett C, Falcone T. Uterine Transplantation: Evolving Data, Success, and Clinical Importance. J Minim Invasive Gynecol 2021; 28:502-12. [PMID: 33348011 DOI: 10.1016/j.jmig.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
Abstract
Uterine transplantation is an evolving procedure to allow for childbearing in paitents with absolute uterine factor infertility. The objective of this study was to review the existing literature using a comprehensive PubMed literature search. A systematic medical subheadings search strategy was used with the terms "uterus transplant" and "uterine transplantation". Of the 75 full-text articles assessed for eligibility, 68 were included in the qualitative synthesis. Of these, 9 were included in the meta-analysis on living donor uterine transplant, 5 on deceased donor uterine transplant, and 6 case reports of single uterine transplants. In conclusion, uterus transplant is a nascent field undergoing a rapid rate of evolution as programs mature their data and increase the number of procedures performed. The most recent publications and advances are thus summarized in this article to capture the most up-to-date information.
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Jones BP, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Diaz-Garcia C, Friend P, Ghaem-Maghami S, Testa G, Johannesson L, Quiroga I, Yazbek J, Smith JR. Human uterine transplantation: a review of outcomes from the first 45 cases. BJOG 2019; 126:1310-1319. [PMID: 31410987 DOI: 10.1111/1471-0528.15863] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
Abstract
Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair. TWEETABLE ABSTRACT: Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.
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Affiliation(s)
- B P Jones
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - S Saso
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
| | - T Bracewell-Milnes
- Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - M-Y Thum
- Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - J Nicopoullos
- Imperial College London, London, UK.,Lister Fertility Clinic, The Lister Hospital, London, UK
| | - C Diaz-Garcia
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,IVI London, IVIRMA Global, London, UK
| | - P Friend
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - S Ghaem-Maghami
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
| | - G Testa
- Baylor University Medical Center, Dallas, TX, USA
| | | | - I Quiroga
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - J Yazbek
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
| | - J R Smith
- Hammersmith Hospital, Imperial College NHS Trust London, London, UK.,Imperial College London, London, UK
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