Liza Johannesson1, Niclas Kvarnström2, Johan Mölne3, Pernilla Dahm-Kähler1, Anders Enskog4, Cesar Diaz-Garcia5, Michael Olausson2, Mats Brännström6. 1. Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden. 2. Department of Transplantation, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden. 3. Department of Clinical Pathology and Genetics, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden. 4. Department of Anesthesiology and Intensive Care, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden. 5. Department of Gynecology and Obstetrics, La Fe University Hospital, University of Valencia, Valencia, Spain. 6. Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Stockholm IVF, Stockholm, Sweden. Electronic address: mats.brannstrom@obgyn.gu.se.
Abstract
OBJECTIVE: To report the 12-month outcome of seven patients with viable uteri after uterus transplantation (UTx). DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): Seven patients with absolute uterine infertility and viable uteri for 12 months after live-donor UTx. INTERVENTION(S): Predetermined immunosuppression was with tacrolimus and mychophenolate mofetil (MMF) during 6 months, whereupon MMF should be withdrawn. Frequent ultrasound examinations were performed to assess uterine appearance and uterine artery blood flow. Cervical biopsies (for histological detection of rejection) were obtained at preset time points, with temporary adjustments of immunosuppression if there were signs of rejection. Menstruations were systematically recorded. MAIN OUTCOME MEASURE(S): Menstruation, uterine artery blood flow, histology of cervical biopsies, and blood levels of tacrolimus. RESULT(S): All patients showed regular menses after 1-2 months. Uterine artery blood flow was unchanged, with a median pulsatility index of 1.9 (range, 0.5-5.4). Blood levels of tacrolimus were approximately 10, 9, and 8 (μg/L) during months 2, 9, and 12, respectively. Four recipients showed mild inflammation in biopsies after MMF withdrawal and were treated with corticosteroids and azathioprine during the remainder of the 12 months. Subclinical rejection episodes were detected on ectocervical biopsies in five recipients. Histology showed apoptotic bodies and occasional spongiosis in the squamous epithelium. Moderate infiltration of lymphocytes and neutrophils was seen in the epithelial/stromal interface. All rejection episodes were successfully treated for 2 weeks with corticosteroids or dose increments of tacrolimus. CONCLUSION(S): We demonstrate long-term uterine viability after UTx, with continued menstruation and unaltered uterine artery blood flow. Subclinical rejection episodes were effectively reversed by temporary increase of immunosuppression. CLINICAL TRIAL REGISTRATION NUMBER: NCT01844362.
OBJECTIVE: To report the 12-month outcome of seven patients with viable uteri after uterus transplantation (UTx). DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): Seven patients with absolute uterine infertility and viable uteri for 12 months after live-donorUTx. INTERVENTION(S): Predetermined immunosuppression was with tacrolimus and mychophenolate mofetil (MMF) during 6 months, whereupon MMF should be withdrawn. Frequent ultrasound examinations were performed to assess uterine appearance and uterine artery blood flow. Cervical biopsies (for histological detection of rejection) were obtained at preset time points, with temporary adjustments of immunosuppression if there were signs of rejection. Menstruations were systematically recorded. MAIN OUTCOME MEASURE(S): Menstruation, uterine artery blood flow, histology of cervical biopsies, and blood levels of tacrolimus. RESULT(S): All patients showed regular menses after 1-2 months. Uterine artery blood flow was unchanged, with a median pulsatility index of 1.9 (range, 0.5-5.4). Blood levels of tacrolimus were approximately 10, 9, and 8 (μg/L) during months 2, 9, and 12, respectively. Four recipients showed mild inflammation in biopsies after MMF withdrawal and were treated with corticosteroids and azathioprine during the remainder of the 12 months. Subclinical rejection episodes were detected on ectocervical biopsies in five recipients. Histology showed apoptotic bodies and occasional spongiosis in the squamous epithelium. Moderate infiltration of lymphocytes and neutrophils was seen in the epithelial/stromal interface. All rejection episodes were successfully treated for 2 weeks with corticosteroids or dose increments of tacrolimus. CONCLUSION(S): We demonstrate long-term uterine viability after UTx, with continued menstruation and unaltered uterine artery blood flow. Subclinical rejection episodes were effectively reversed by temporary increase of immunosuppression. CLINICAL TRIAL REGISTRATION NUMBER: NCT01844362.
Authors: Michael Feichtinger; Eytan R Barnea; Atunga Nyachieo; Mats Brännström; S Samuel Kim Journal: J Assist Reprod Genet Date: 2017-11-11 Impact factor: 3.412
Authors: Maximilian Kueckelhaus; Sebastian Fischer; Midas Seyda; Ericka M Bueno; Mario A Aycart; Muayyad Alhefzi; Abdallah ElKhal; Bohdan Pomahac; Stefan G Tullius Journal: Transpl Int Date: 2015-09-14 Impact factor: 3.782