Livebirth after uterus transplantation.

Abstract

BACKGROUND:

Uterus transplantation is the first available treatment for absolute uterine infertility, which is caused by absence of the uterus or the presence of a non-functional uterus. Eleven human uterus transplantation attempts have been done worldwide but no livebirth has yet been reported.

METHODS:

In 2013, a 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) underwent transplantation of the uterus in Sahlgrenska University Hospital, Gothenburg, Sweden. The uterus was donated from a living, 61-year-old, two-parous woman. In-vitro fertilisation treatment of the recipient and her partner had been done before transplantation, from which 11 embryos were cryopreserved.

FINDINGS:

The recipient and the donor had essentially uneventful postoperative recoveries. The recipient's first menstruation occurred 43 days after transplantation and she continued to menstruate at regular intervals of between 26 and 36 days (median 32 days). 1 year after transplantation, the recipient underwent her first single embryo transfer, which resulted in pregnancy. She was then given triple immunosuppression (tacrolimus, azathioprine, and corticosteroids), which was continued throughout pregnancy. She had three episodes of mild rejection, one of which occurred during pregnancy. These episodes were all reversed by corticosteroid treatment. Fetal growth parameters and blood flows of the uterine arteries and umbilical cord were normal throughout pregnancy. The patient was admitted with pre-eclampsia at 31 full weeks and 5 days, and 16 h later a caesarean section was done because of abnormal cardiotocography. A male baby with a normal birthweight for gestational age (1775 g) and with APGAR scores 9, 9, 10 was born.

INTERPRETATION:

We describe the first livebirth after uterus transplantation. This report is a proof-of-concept for uterus transplantation as a treatment for uterine factor infertility. Furthermore, the results show the feasibility of live uterus donation, even from a postmenopausal donor.

FUNDING:

Jane and Dan Olsson Foundation for Science.

• Authors: Mats Brännström, Liza Johannesson, Hans Bokström, Niclas Kvarnström, Johan Mölne, Pernilla Dahm-Kähler, Anders Enskog, Milan Milenkovic, Jana Ekberg, Cesar Diaz-Garcia, Markus Gäbel, Ash Hanafy, Henrik Hagberg, Michael Olausson, Lars Nilsson
• Journal: Lancet (London, England) (Lancet) Vol. 385 Issue 9968 Pg. 607-616 (Feb 14 2015) ISSN: 1474-547X [Electronic] England
• PMID: 25301505 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Immunosuppressive Agents
• Azathioprine
• Tacrolimus

Topics

• 46, XX Disorders of Sex Development (surgery)
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Apgar Score
• Azathioprine (therapeutic use)
• Cesarean Section
• Congenital Abnormalities (surgery)
• Embryo Transfer (methods)
• Female
• Fertilization in Vitro (methods)
• Graft Rejection (drug therapy, prevention & control)
• Gynecologic Surgical Procedures (methods)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infant, Newborn
• Infant, Premature
• Live Birth
• Living Donors
• Male
• Mullerian Ducts (abnormalities, surgery)
• Pre-Eclampsia
• Pregnancy
• Sweden
• Tacrolimus (therapeutic use)
• Uterus (transplantation)