Uterine transplant: current results.
Preparation of a multidisciplinary team in Argentina
Keywords:
Infertility, Transplantation, UterusAbstract
Absolute uterine factor infertility, due to absence or non-function of the uterus, is now treatable. The first attempt of human uterus transplantation was in year 2000, but it failed and a necrotic uterus had to be removed after 99 days. This pioneering case inspired several research groups around the globe to initiate animal-based studies to investigate uterus transplantation in relation to surgery, immunosuppression, rejection and pregnancy outcome. The first clinical trial of uterus transplantation was initiated in Sweden in 2013 and involved nine live donor procedures. The world´s first live birth was reported from that trial in September 2014 and this was followed by two more births within the trial in November 2014. Births after uterus transplantation has since then been reported from Sweden, USA and Brazil. The live birth in Brazil is the first and only birth from a deceased donor so far. All published cases of uterus transplantation and the live births will be review in detail.
In 2016 there was the first symposium on uterus transplantation in Latin-America under the auspice of ALMER. At the meeting, the Swedish team shared their experiences of human uterus transplantation. This was the starting point for a collaboration work between our team in Rosario and the Swedish team, with the aim to prepare for a scientific trial of uterus transplantation in Argentina. The important steps in this procedure will be reviewed.
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References
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2. Barzilai A, Paldi E, Gal D, Hampel N. Autotransplantation of the uterus and ovaries in dogs. Isr J Med Sci 9:49- 52, 1973.
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4. Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynecol Obste 76:245-251, 2002.
5. Racho El-Akouri R, Kurlberg G, Brännström M. Successful uterine transplantation in the mouse: pregnancy and post-natal development of offspring. Hum Reprod 18:2018-2023,
2003
6. Díaz-García C, Akhi SN, Wallin A, et al. First report on fertility after allogeneic uterus transplantation. Acta Obstet Gynecol Scand 89:1491-1494, 2010.
7. Díaz-García C, Johannesson L, Shao R, et al. Pregnancy after allogeneic uterus transplantation in the rat: perinatal outcome and growth trajectory. Fertil. Steril 102:1545-52, 2014.
8. Ramirez ER, Ramirez Nessetti DK, Nessetti MB, et al. Pregnancy and outcome of uterine allotransplantation and assisted reproduction in sheep J Minim Invasive Gynecol 18:238-45, 2011.
9. Mihara M, Kisu I, Hara H, et al. Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. Hum Reprod 27:2332-40, 2012.
10. Brännström M, Johannesson L, Dahm-Kähler P, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril 101:1228-36, 2014.
11. Díaz-García C, Johannesson L, Enskog A, et al. Uterine transplantation research: laboratory protocols for clinical application. Mol Hum Reprod 18:68-78, 2012.
12. McCulloch P, Altman DG, Campbell WB et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105-1112, 2009.
13. Oppelt P, Renner SP, Kellermann A, Brucker S, Hauser GA, Ludwig KS, et al. Clinical aspects of Mayer-Rokitansky-Kuester-Hauser syndrome: recommendations for clinical diagnosis and staging. Hum Reprod 21:792-7, 2006.
14. Johannesson L, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Diaz-Garcia C, Olausson M, Brännström M, Uterus transplantation trial, 1-year outcome. Fertil Steril 103:199-204, 2015.
15. 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 108:346-356, 2017.
16. Chmel R, Novackova M, Janousek L, et al. 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. 3;855-864, 2019.
17. Brucker SY, 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.
18. Testa G, Koon EC, Johannesson L, et al. Living donor uterus transplantation: a single center’s observations and lessons learned from early setbacks to technical success. Am J Transplant 17:2901-2910, 2017.
19. Puntambekar S, Telang M, Kulkarni P, et al. Laparoscopic-assisted uterus retrieval from live organ donors of uterine transplant; our experience of two patients. J Minim Invasive Gynecol 25:622-631, 2018.
20. Puntambekar, S., S. Puntambekar, M. Telang, et al. Novel anastomotic technique for uterine transplant using utero-ovarian veins for venous drainage and internal iliac arteries for perfusion in two laparoscopically harvested uteri. J Minim Invasive Gynecol 4:628-635, 2019.
21. Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet 14:607-616, 2015.
22. 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 106:261-266, 2016.
23. Mölne J, Broecker V, Ekberg J, et al. Monitoring of human uterus transplantation with cervical biopsies: a provisional scoring system for rejection. Am J Transplant 17:1628-1636, 2017.
24. Testa G, McKenna GJ, Gunby RT Jr, et al. First live birth after uterus transplantation in the United States. Am J Transplant 18:1270-1274, 2018.
25. Ozkan O, Akar ME, Ozkan O, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril 99:470-6, 2013.
26. Erman Akar M, Ozkan O, Aydinuraz B, et al. Clinical pregnancy after uterus transplantation. Fertil Steril 100:1358-1363, 2013.
27. Flyckt RL, Farrell RM, Perni UC, et al. Deceased donor uterine transplantation: innovation and adaption. Obstet Gynecol 128:837-42, 2016.
28. 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 392:2697-2704, 2019.
29. Favre-Inhofer A, Carbonnel M, Revaux A, et al. Critical steps for initiating an animal uterine transplantation model in sheep: experience from a case series. Int J Surg 60:245-251, 2018.
30. Saso S, Petts G, Thum MY, et al. Achieving uterine auto-transplantation in a sheep model using iliac vessel anastomosis; a short-term viability study. Acta Obstet Gynecol Scand 94:245-252, 2015.
31. Dahm-Kähler P, Wranning C, Lundmark C, et al. Transplantation of the uterus in the sheep: methodology and early reperfusion events. J Obstet Gynaecol Res 34:784-793, 2008.
32. Andraus W, Ejzenberg D, Santos RM, et al. Sheep model for uterine transplantation: the best option before starting a human program. Clinics (Sao Paulo) 72:178-182, 2017.
2. Barzilai A, Paldi E, Gal D, Hampel N. Autotransplantation of the uterus and ovaries in dogs. Isr J Med Sci 9:49- 52, 1973.
3. Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 312:366, 1978.
4. Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynecol Obste 76:245-251, 2002.
5. Racho El-Akouri R, Kurlberg G, Brännström M. Successful uterine transplantation in the mouse: pregnancy and post-natal development of offspring. Hum Reprod 18:2018-2023,
2003
6. Díaz-García C, Akhi SN, Wallin A, et al. First report on fertility after allogeneic uterus transplantation. Acta Obstet Gynecol Scand 89:1491-1494, 2010.
7. Díaz-García C, Johannesson L, Shao R, et al. Pregnancy after allogeneic uterus transplantation in the rat: perinatal outcome and growth trajectory. Fertil. Steril 102:1545-52, 2014.
8. Ramirez ER, Ramirez Nessetti DK, Nessetti MB, et al. Pregnancy and outcome of uterine allotransplantation and assisted reproduction in sheep J Minim Invasive Gynecol 18:238-45, 2011.
9. Mihara M, Kisu I, Hara H, et al. Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. Hum Reprod 27:2332-40, 2012.
10. Brännström M, Johannesson L, Dahm-Kähler P, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril 101:1228-36, 2014.
11. Díaz-García C, Johannesson L, Enskog A, et al. Uterine transplantation research: laboratory protocols for clinical application. Mol Hum Reprod 18:68-78, 2012.
12. McCulloch P, Altman DG, Campbell WB et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105-1112, 2009.
13. Oppelt P, Renner SP, Kellermann A, Brucker S, Hauser GA, Ludwig KS, et al. Clinical aspects of Mayer-Rokitansky-Kuester-Hauser syndrome: recommendations for clinical diagnosis and staging. Hum Reprod 21:792-7, 2006.
14. Johannesson L, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Diaz-Garcia C, Olausson M, Brännström M, Uterus transplantation trial, 1-year outcome. Fertil Steril 103:199-204, 2015.
15. 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 108:346-356, 2017.
16. Chmel R, Novackova M, Janousek L, et al. 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. 3;855-864, 2019.
17. Brucker SY, 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.
18. Testa G, Koon EC, Johannesson L, et al. Living donor uterus transplantation: a single center’s observations and lessons learned from early setbacks to technical success. Am J Transplant 17:2901-2910, 2017.
19. Puntambekar S, Telang M, Kulkarni P, et al. Laparoscopic-assisted uterus retrieval from live organ donors of uterine transplant; our experience of two patients. J Minim Invasive Gynecol 25:622-631, 2018.
20. Puntambekar, S., S. Puntambekar, M. Telang, et al. Novel anastomotic technique for uterine transplant using utero-ovarian veins for venous drainage and internal iliac arteries for perfusion in two laparoscopically harvested uteri. J Minim Invasive Gynecol 4:628-635, 2019.
21. Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet 14:607-616, 2015.
22. 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 106:261-266, 2016.
23. Mölne J, Broecker V, Ekberg J, et al. Monitoring of human uterus transplantation with cervical biopsies: a provisional scoring system for rejection. Am J Transplant 17:1628-1636, 2017.
24. Testa G, McKenna GJ, Gunby RT Jr, et al. First live birth after uterus transplantation in the United States. Am J Transplant 18:1270-1274, 2018.
25. Ozkan O, Akar ME, Ozkan O, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril 99:470-6, 2013.
26. Erman Akar M, Ozkan O, Aydinuraz B, et al. Clinical pregnancy after uterus transplantation. Fertil Steril 100:1358-1363, 2013.
27. Flyckt RL, Farrell RM, Perni UC, et al. Deceased donor uterine transplantation: innovation and adaption. Obstet Gynecol 128:837-42, 2016.
28. 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 392:2697-2704, 2019.
29. Favre-Inhofer A, Carbonnel M, Revaux A, et al. Critical steps for initiating an animal uterine transplantation model in sheep: experience from a case series. Int J Surg 60:245-251, 2018.
30. Saso S, Petts G, Thum MY, et al. Achieving uterine auto-transplantation in a sheep model using iliac vessel anastomosis; a short-term viability study. Acta Obstet Gynecol Scand 94:245-252, 2015.
31. Dahm-Kähler P, Wranning C, Lundmark C, et al. Transplantation of the uterus in the sheep: methodology and early reperfusion events. J Obstet Gynaecol Res 34:784-793, 2008.
32. Andraus W, Ejzenberg D, Santos RM, et al. Sheep model for uterine transplantation: the best option before starting a human program. Clinics (Sao Paulo) 72:178-182, 2017.
How to Cite
Dra. María Victoria Boccio, Dra. Leticia Solari, Mats Brännström MD, PhD, Niclas Kvarnström MD, PhD, Pernilla Dahm-Kähler MD, PhD and Dr. Gustavo Botti (2019) “Uterine transplant: current results. : Preparation of a multidisciplinary team in Argentina”, Revista Médica de Rosario, 85(2), pp. 081-087. Available at: http://revistamedicaderosario.org/index.php/rm/article/view/25 (Accessed: 23July2024).
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