Florin-Andrei Taran1, Dorit Schöller2, Katharina Rall2, Silvio Nadalin3, Alfred Königsrainer3, Melanie Henes2, Hans Bösmüller4, Falko Fend4, Konstantin Nikolaou5, Mike Notohamiprodjo5, Christian Grasshoff6, Eckhard Heim6, Stephan Zipfel7, Norbert Schäffeler7, Tamam Bakchoul8, Nils Heyne9, Martina Guthoff9, Bernhard Krämer2, Christl Reisenauer2, Markus Hoopmann2, Karl-Oliver Kagan2, Mats Brännström10, Diethelm Wallwiener2, Sara Y Brucker2. 1. Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany. Electronic address: florin-andrei.taran@med.uni-tuebingen.de. 2. Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany. 3. Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany. 4. Department of Pathology, University of Tübingen, Tübingen, Germany. 5. Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany. 6. Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany. 7. Department of Psychosomatic Medicine, University of Tübingen, Tübingen, Germany. 8. Center for Transfusion Medicine, University of Tübingen, Tübingen, Germany. 9. Department of Endocrinology and Diabetology, Angiology, Nephrology, and Clinical Chemistry, University of Tübingen, Tübingen, Germany. 10. Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Stockholm IVF, Stockholm, Sweden.
Abstract
OBJECTIVE: To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program. DESIGN: Part of an observational program. SETTING: University hospital. PATIENT(S): Patients with absolute uterine factor infertility (AUFI). INTERVENTION(S): Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation. MAIN OUTCOME MEASURE(S): Age, cause of AUFI, exclusion reasons, and preoperative workup. RESULT(S): A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19-41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22-35) years, and mean donor age was 51.3 (37-62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications. CONCLUSION(S): The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success.
OBJECTIVE: To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program. DESIGN: Part of an observational program. SETTING: University hospital. PATIENT(S): Patients with absolute uterine factor infertility (AUFI). INTERVENTION(S): Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation. MAIN OUTCOME MEASURE(S): Age, cause of AUFI, exclusion reasons, and preoperative workup. RESULT(S): A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19-41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22-35) years, and mean donor age was 51.3 (37-62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications. CONCLUSION(S): The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success.
Authors: H E Peters; L J M Juffermans; C B Lambalk; J J M L Dekker; T Fernhout; F A Groenman; C J M de Groot; A W J Hoksbergen; J A F Huirne; R A de Leeuw; N M van Mello; J H Nederhoed; R Schats; M O Verhoeven; W J K Hehenkamp Journal: Hum Reprod Open Date: 2020-02-28