Elliott G Richards1, Ruth M Farrell1, Stephanie Ricci1, Uma Perni1, Cristiano Quintini2, Andreas Tzakis2, Tommaso Falcone3. 1. Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Desk A-81, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. 2. Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA. 3. Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Desk A-81, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. falcont@ccf.org.
Abstract
PURPOSE: To provide a comprehensive review of uterus transplantation in 2021, including a discussion of pregnancy outcomes of all reported births to date, the donor and recipient selection process, the organ procurement and transplant surgeries, reported complications, postoperative monitoring, preimplantation preparation, and ethical considerations. METHODS: Literature review and expert commentary. RESULTS: Reports of thirty-one live births following uterus transplantation have been published from both living and deceased donors. The proper selection of donors and recipients is a labor-intensive process that requires advanced planning. A multidisciplinary team is critical. Reported complications in the recipient include thrombosis, infection, vaginal stricture, antenatal complications, and graft failure. Graft rejection is a common occurrence but rarely leads to graft removal. While most embryo transfers are successful, recurrent implantation failures in uterus transplant patients have been reported. Rates of preterm delivery are high but appear to be declining; more data, including long-term outcome data, is needed. CONCLUSIONS: Uterus transplantation is an emerging therapy for absolute uterine factor infertility, a condition previously without direct treatment options. It is paramount that reproductive health care providers are familiar with the uterus transplantation process as more patients seek and receive this treatment.
PURPOSE: To provide a comprehensive review of uterus transplantation in 2021, including a discussion of pregnancy outcomes of all reported births to date, the donor and recipient selection process, the organ procurement and transplant surgeries, reported complications, postoperative monitoring, preimplantation preparation, and ethical considerations. METHODS: Literature review and expert commentary. RESULTS: Reports of thirty-one live births following uterus transplantation have been published from both living and deceased donors. The proper selection of donors and recipients is a labor-intensive process that requires advanced planning. A multidisciplinary team is critical. Reported complications in the recipient include thrombosis, infection, vaginal stricture, antenatal complications, and graft failure. Graft rejection is a common occurrence but rarely leads to graft removal. While most embryo transfers are successful, recurrent implantation failures in uterus transplant patients have been reported. Rates of preterm delivery are high but appear to be declining; more data, including long-term outcome data, is needed. CONCLUSIONS: Uterus transplantation is an emerging therapy for absolute uterine factor infertility, a condition previously without direct treatment options. It is paramount that reproductive health care providers are familiar with the uterus transplantation process as more patients seek and receive this treatment.
Authors: Antoine Tardieu; P Chazelas; P-A Faye; F Favreau; L Nadal-Desbarats; C Sallée; F Margueritte; C-Y Couquet; P Marquet; C Barin-Le Guellec; T Gauthier Journal: J Assist Reprod Genet Date: 2019-05-12 Impact factor: 3.412
Authors: Lisa A Coscia; Serban Constantinescu; John M Davison; Michael J Moritz; Vincent T Armenti Journal: Best Pract Res Clin Obstet Gynaecol Date: 2014-08-07 Impact factor: 5.237
Authors: Liza Johannesson; Giuliano Testa; J Michael Putman; Gregory J McKenna; E Colin Koon; Jackie R York; Johanna Bayer; Lilly Zhang; Zachary S Rubeo; Robert T Gunby; Anthony R Gregg Journal: Obstet Gynecol Date: 2021-02-01 Impact factor: 7.661
Authors: Daniel Urcuyo; Matthew F Blum; Qiang Liu; Ahmed Nassar; Laura D Buccini; Teresa Diago Uso; Emilio D Poggio; William M Baldwin Iii; David A Goldfarb; Cristiano Quintini Journal: Int J Artif Organs Date: 2017-05-24 Impact factor: 1.595
Authors: B Beran; K Arnolds; M Shockley; K Rivas; M Medina; P F Escobar; A Tzakis; T Falcone; M L Sprague; S Zimberg Journal: Hum Reprod Date: 2017-09-01 Impact factor: 6.918
Authors: Rebecca Flyckt; Tommaso Falcone; Cristiano Quintini; Uma Perni; Bijan Eghtesad; Elliott G Richards; Ruth M Farrell; Koji Hashimoto; Charles Miller; Stephanie Ricci; Cecile A Ferrando; Giuseppe D'Amico; Shana Maikhor; Debra Priebe; Andres Chiesa-Vottero; Amy Heerema-McKenney; Steven Mawhorter; Myra K Feldman; Andreas Tzakis Journal: Am J Obstet Gynecol Date: 2020-03-07 Impact factor: 8.661
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 Date: 2014-10-06 Impact factor: 79.321
Authors: Mats Brännström; Hans Bokström; Pernilla Dahm-Kähler; Cesar Diaz-Garcia; Jana Ekberg; Anders Enskog; Henrik Hagberg; Liza Johannesson; Niclas Kvarnström; Johan Mölne; Michael Olausson; Jan I Olofsson; Kenny Rodriguez-Wallberg Journal: Fertil Steril Date: 2016-04-25 Impact factor: 7.329
Authors: E Coleman; A E Radix; W P Bouman; G R Brown; A L C de Vries; M B Deutsch; R Ettner; L Fraser; M Goodman; J Green; A B Hancock; T W Johnson; D H Karasic; G A Knudson; S F Leibowitz; H F L Meyer-Bahlburg; S J Monstrey; J Motmans; L Nahata; T O Nieder; S L Reisner; C Richards; L S Schechter; V Tangpricha; A C Tishelman; M A A Van Trotsenburg; S Winter; K Ducheny; N J Adams; T M Adrián; L R Allen; D Azul; H Bagga; K Başar; D S Bathory; J J Belinky; D R Berg; J U Berli; R O Bluebond-Langner; M-B Bouman; M L Bowers; P J Brassard; J Byrne; L Capitán; C J Cargill; J M Carswell; S C Chang; G Chelvakumar; T Corneil; K B Dalke; G De Cuypere; E de Vries; M Den Heijer; A H Devor; C Dhejne; A D'Marco; E K Edmiston; L Edwards-Leeper; R Ehrbar; D Ehrensaft; J Eisfeld; E Elaut; L Erickson-Schroth; J L Feldman; A D Fisher; M M Garcia; L Gijs; S E Green; B P Hall; T L D Hardy; M S Irwig; L A Jacobs; A C Janssen; K Johnson; D T Klink; B P C Kreukels; L E Kuper; E J Kvach; M A Malouf; R Massey; T Mazur; C McLachlan; S D Morrison; S W Mosser; P M Neira; U Nygren; J M Oates; J Obedin-Maliver; G Pagkalos; J Patton; N Phanuphak; K Rachlin; T Reed; G N Rider; J Ristori; S Robbins-Cherry; S A Roberts; K A Rodriguez-Wallberg; S M Rosenthal; K Sabir; J D Safer; A I Scheim; L J Seal; T J Sehoole; K Spencer; C St Amand; T D Steensma; J F Strang; G B Taylor; K Tilleman; G G T'Sjoen; L N Vala; N M Van Mello; J F Veale; J A Vencill; B Vincent; L M Wesp; M A West; J Arcelus Journal: Int J Transgend Health Date: 2022-09-06
Authors: Jean Marc Ayoubi; Marie Carbonnel; Niclas Kvarnström; Aurelie Revaux; Marine Poulain; Sarah Vanlieferinghen; Yves Coatantiec; Mathilde Le Marchand; Morgan Tourne; Paul Pirtea; Renaud Snanoudj; Morgan Le Guen; Pernilla Dahm-Kähler; Catherine Racowsky; Mats Brännström Journal: Front Surg Date: 2022-06-28
Authors: Emily H Frisch; Tommaso Falcone; Rebecca L Flyckt; Andreas G Tzakis; Eric Kodish; Elliott G Richards Journal: J Clin Med Date: 2022-08-03 Impact factor: 4.964