Uterus transplant enables women with uterine-factor infertility to have children: JAMA

USA: Uterus transplant is an effective infertility treatment for women with uterine-factor infertility (UFI) and enables successful gestation and delivery of children. Also, it is safe for the recipient, living donor, and child, states an article published in JAMA Surgery.

Uterus transplant is a new and rapidly evolving surgical therapy that enables women with absolute uterine-factor infertility (AUFI) to successfully gestate and deliver children, which was previously considered untreatable. AUFI affects about 3-5% of the population. It is a form of infertility whereby conception and/or maintenance of pregnancy is impossible, due to either an abnormality of the uterus or a complete lack of uterus. Uterus transplant uniquely restores reproductive ability and enables gestation and childbirth. Increased data regarding outcomes following uterus transplant are essential to counsel individuals with AUFI to evaluate all available pathways to parenthood.

Liza J, Baylor University Medical Center, Texas, and colleagues conducted a study to review transplant and birth outcomes of uterus transplant recipients.

Researchers collected 5 years of uterus transplant outcome data from the 3 centers performing uterus transplants in the US. A total of 33 women (mean (SD) age  31 (4.7) years) with absolute uterine-factor infertility who underwent uterus transplants were included in the study. Most uterus transplant recipients had a congenitally absent uterus [94%], and (64%) received organs from living donors. The main Outcomes were set as Graft survival, live birth, and neonatal outcome.

Key findings of the study:

• There was no donor or recipient mortality.

• One-year graft survival rate was 74% .

• 58% recipients had delivered 21 live-born children.

• Among recipients with a viable graft at 1 year, the proportion with a live-born child was 83%.

• The median (range) gestational age at birth of neonates was 36 weeks 6 days (30 weeks, 1 day to 38 weeks), and the median (range) birth weight was 2860 (1310-3940) g.

• No congenital malformations were detected.

The authors conclude that uterus transplant is safe for mother and child; success is reproducible and is achieved with both deceased donor ( DD) and living donor( LD), and the success rate is comparable with the most effective infertility treatments. It should be considered a clinical reality and presented as an option for individuals with UFI interested in parenthood. Present data serve as a guide for health care professionals concerned about patients affected by AUFI, institutions seeking to expand treatment options for such patients, and patients interested in going for uterus transplants.

The aggregate data of the present study demonstrating the safety for the recipient, living donor, and child will be instrumental to establish best practices for the development and growth of uterus transplants worldwide, the authors wrote

Reference:

Johannesson L, Richards E, Reddy V, et al. The First 5 Years of Uterus Transplant in the US: A Report From the United States Uterus Transplant Consortium. JAMA Surg. Published online July 06, 2022. doi:10.1001/jamasurg.2022.2612