Birth of a Healthy Baby 9 Years After a Surgically Successful Deceased Donor Uterus Transplant

Omer Ozkan; Ozlenen Ozkan; Nasuh Utku Dogan; Mustafa Bahceci; Inane Mendilcioglu; Kubra Boynukalin; Hakan Ongun; Abdul Mecit Kantarci; Muhittin Yaprak; Melike Cengiz; Necmiye Hadimioglu; Yusuf Taner Kafadar; Kiymet Celik

Disclosures

Annals of Surgery. 2022;275(5):825-832. 

In This Article

Abstract and Introduction

Abstract

Objective: To describe surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, birth of a healthy infant, in a uterus transplantation from a deceased donor.

Background: Majority of uterus transplants have involved live donors, but several advantages make deceased donor transplantation a practicable option, principally by eliminating surgical risks to the live donor.

Methods: Uterus transplantation from a deceased donor was performed in September 2011 in Turkey. After 5 miscarriages, perfusion computed tomography revealed an obstructed blood-outflow. To overcome this blood flow obstruction, a saphenous vein graft was anastomosed between utero-ovarian and left ovarian vein with laparotomy. Follow-up computed tomography confirmed resolution of venous congestion and a decrease in uterine volume.

Results: Following vascular augmentation surgery, fetal cardiac activity were observed 28 days after the first embryo transfer attempt. Preterm premature rupture of the membranes was diagnosed at 19 weeks' gestation. Cesarean section was planned at 28 weeks' gestation due to intrauterine growth restriction and suspected preeclampsia. A healthy 760 g male baby was delivered. The baby was discharged from the neonatal intensive care unit 79 days after delivery in good condition weighing 2475 g.

Conclusions: Deceased donor uterus transplantation is a reasonable approach for treating uterine factor-related infertility. In case of recurrent miscarriages, regional vascular augmentation by arterial or venous supercharging may be required to overcome regional misperfused regions determined by imaging studies.

Introduction

Absolute uterine factor infertility affects 3% to 5% of all reproductive women, and no treatment for this condition has been available until recently.[1] Surrogacy and adoption are alternative methods for overcoming uterine-related infertility, although surrogacy is not legal in many countries, and adoption does not establish a genetic link between mother and child. After the successful uterus transplantation in Turkey on September 2011, studies in this field accelerated significantly, and successful transplantations and consequently live births were reported from different parts of the world.[2–4] Most uterus transplants involve live donors, although several advantages make deceased donor transplantation a reasonable option, mainly by eliminating surgical risks to the live donor. This report describes in detail the surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, the birth of a healthy infant, in this uterus transplantation from a deceased donor.

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