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UTERINE TRANSPLANTATION

First live birth following uterine transplantation from a deceased donor

Published 10 December 2018

Three years after a Swedish group announced live births following uterine transplantation from living donors, a group in Brazil has now reported the world's first live birth with a transplanted uterus retrieved from a deceased donor.

A Brazilian group from the University of Sao Paulo has announced the world's first birth following the transplantation of a uterus retrieved from a deceased donor. The case, confirmed in The Lancet, produced a healthy 2.5 kg girl delivered last December from a mother with congenital uterine absence (Rokitansky syndrome).(1)

The recipient, aged 32, underwent a 10-hour transplantation procedure in September 2016, with doctors harvesting the uterus from a 45-year-old donor who had had three previous vaginal deliveries. The donor is described in The Lancet report as having died from a subarachnoid haemorrhage, although no further details are provided about her health.

This latest development in uterine transplantation has been reached three years after Mats Brännström and colleagues at the Sahlgrenska University Hospital in Gothenburg, Sweden, announced their first deliveries, all from a living donors. As reported at the time in Focus on Reproduction, the Gothenburg group performed transplants in a total of nine women, in most cases with donations from the recipient's mother but also from other family members and close friends.(2) Since then a total of eight children have been born from the programme, two to one mother who achieved her pregnancies with the same donated uterus.

Uterine transplantations from deceased donors have apparently numbered at least ten to date, but doubts have been raised about their feasibility and viability. Until now, according to The Lancet, these procedures have either resulted in failure, or miscarriage - as occurred in a case in Turkey in 2011.

Writing in The Lancet, Dani Ejzenberg and colleagues from Hospital das Clinicas in Sao Paulo said that their results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor. They add that this opens up 'a path to healthy pregnancy for all women with uterine factor infertility' and without need of 'living donors or live donor surgery'. The uterus used in the reported case had been ischemic for around seven hours before it was implanted.

The recipient underwent one IVF cycle, which was performed four months before the transplantation, and yielded a total of eight cryopreserved blastocysts. Her first menstruation occurred 37 days after transplantation, and she continued to menstruate at regular intervals (26 to 32 days). Embryo transfer was carried out seven months after transplantation and resulted in a normal pregnancy. Her daughter was delivered by Caesarean section on 15 December 2017.

These details compare with 43 days to first menstruation and one year to first embryo transfer in the case of the Gothenburg recipient who gave birth to the first live uterine transplant baby.
Speaking to The Lancet in an online audio interview, Dr Ejzenberg said he and colleagues had learned much from Brännström's own experience, but said live uterine transplantations had limitations. 'There are limitations only using living donors when you don't have a close friend or relative that can donate their uterus,' said Ejzenberg. 'This way we can help many more women to obtain a pregnancy.'

1. Ejzenberg D, Andraus W, Regina Baratelli Carelli Mendes L, et al. Livebirth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet 2018.

2. Brännström M, Johanneson L, Bokström N, et al. Livebirth after uterus transplantation. Lancet 2015; 385: 607-616.