Uterus Transplant Feasible with 70 Percent Success Rate and Live Births, Amid Frequent Adverse Events: JAMA

The study, published in JAMA, revealed that uterus transplantation proved feasible and led to at least one live birth following a successful allograft.

"In this study of 20 participants, 70% of uterus allografts were successful, and all recipients with successful transplants achieved at least one live birth. However, adverse events were prevalent, with medical and surgical risks impacting recipients and donors," the researchers reported.

Uterus transplantation, a relatively new procedure in the field of reproductive medicine, involves surgically placing a healthy uterus from a donor into a recipient who lacks a functional uterus. The procedure has been gaining attention for its potential to enable women with AUFI to experience pregnancy and childbirth. The recent success of several high-profile cases has brought renewed hope to many individuals struggling with this condition.

Against the above background, Giuliano Testa, Baylor University Medical Center, Dallas, Texas, and colleagues aimed to determine whether a uterus transplant is safe and feasible and results in births of healthy infants.

A case series involving 20 participants with uterine-factor infertility and at least one functioning ovary was conducted at a major US tertiary care center between September 14, 2016, and August 23, 2019. These participants underwent uterus transplantation with grafts from 18 living donors and two deceased donors.

The transplants were surgically positioned in the orthotopic location with vascular connections to the external iliac vessels. Participants were given immunosuppressive therapy until the transplanted uterus was either removed following one or two live births or due to graft failure. The primary outcomes measured were the survival of the uterus graft and the occurrence of subsequent live births.

The following were the key findings of the study:

• Of 20 participants (median age, 30 years; 2 Asian, 1 Black, and 16 White), 70% had a successful uterus allograft; all 14 recipients gave birth to at least one live-born infant. Eleven of 20 recipients had at least one complication.
• Maternal or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (14%), cervical insufficiency (14%), and preterm labor (14%).
• Among the 16 live-born infants, there were no congenital malformations.
• Four of 18 living donors had grade 3 complications.

The findings showed that uterus transplantation is technically feasible and resulted in a high rate of live births following successful graft survival. However, adverse events were frequent, with both medical and surgical risks impacting recipients and donors.

"To date, no congenital abnormalities or developmental delays have been reported in the children born from these procedures," the researchers concluded.

Reference:

Testa G, McKenna GJ, Wall A, et al. Uterus Transplant in Women With Absolute Uterine-Factor Infertility. JAMA. Published online August 15, 2024. doi:10.1001/jama.2024.11679