Human Uterus Transplantation from Living and Deceased Donors: The Interim Results of the First 10 Cases of the Czech Trial
by
Jiri Fronek 1,2,3,*, Jakub Kristek 1,2, Jaroslav Chlupac 1,2, Libor Janousek 1,3 and Michael Olausson 4
1 Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
2 Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic
3 First Faculty of Medicine, Charles University, Katerinska 1660/32, 121 08 Prague, Czech Republic
4 Department of Transplantation Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Bla Straket 5, 413 45 Gothenburg, Sweden
* Author to whom correspondence should be addressed.
Abstract
Introduction: Uterus transplantation (UTx) is a rapidly evolving treatment of uterine-factor infertility. We report the results of the first 10 UTx procedures performed at our institution. Methods: The program started in April 2016 as a two-arm study comparing the efficacy of UTx from live donors (LD) and deceased donors (DD). Results: Between April 2016 and April 2018, we performed five DD UTx and five LD UTx. Two grafts had to be removed early due to thrombosis. One graft was removed due to chronic rejection and previous herpes simplex infection at month 7. Graft survival is 70% at one year. Recipient survival is 100% at two years. Live donor survival is 100% at three years. Three live-births have been achieved, two from a LD and one from a graft from a nulliparous DD. Vaginal anastomotic stenosis occurred in 63% (5/8) of grafts. Self-expanding stents have shown preliminary suitability for the treatment of vaginal stenosis. Three recipients developed severe acute rejection. Conclusion: The interim results of our study demonstrate mid-term viability in 70% of grafts. The LD UTx produced two live births and the DD UTx produced one live birth. Nulliparous donors should be considered for donation.
Introduction
Uterus transplantation (UTx) has evolved from a purely experimental to a single method of treatment for women affected with absolute uterine-factor infertility (AUFI) [1,2,3]. Albeit quite novel, the method soon demonstrated its feasibility [4,5] and has rapidly spread to multiple transplant centers over the world. Despite the procedure becoming more common, many aspects of it remain unclear due to its complexity and overall limited amount of experience. Many medical, technical, and ethical issues need to be clarified. For instance, due to the risk of morbidity along with ethical issues associated with the procurement of a graft from a living donor (LD) [6], it is vitally important to establish the potential of grafts procured from deceased donors (DD). Complications up to grade IVa according to the Clavien-Dindo classification [7], have been encountered in LDs and in recipients [3,8,9,10,11]. Although livebirths have been reported from DD grafts [2,12,13], the overwhelming majority of UTx has relied on grafts from LDs [1,14,15,16,17,18]. The aim of this report is to retrospectively present the interim results of our first 10 cases of UTx that represent the first half of the Czech UTx trial using both LDs and DDs.
