Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2020, 164(1):115-120 | DOI: 10.5507/bp.2019.020

Uterine transplantation in an era of successful childbirths from living and deceased donor uteri: Current challenges

Roman Chmela, Zlatko Pastora, Jan Matechaa,c, Libor Janousekb, Marta Novackovaa, Jiri Fronekb
a Department of Obstetrics and Gynecology, 2 nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
b Transplantation Surgery Department, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
c Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

Background and Aims: Uterine transplantation (UTx) is an experimental sterility treatment method in women with absolute uterine factor infertility. This article describes the current trends and risks in UTx and provides an overview of our experience with this method, to date.

Methods: Based on our experience with the Czech UTx trial and the published results of other trials, we describe the possibilities and risks of this perspective method in the treatment of absolute uterine factor infertility (AUFI).

Results: Twelve healthy babies were born in 2014-2018 after more than 40 uterine transplantations. There is no general consensus whether it is more suitable to transplant uteri from living or deceased donors, and nulliparous or parous women (with proven obstetrical functionality). Most centers prefer to collect at least ten frozen embryos from in vitro fertilization (IVF) cycles before transplantation. The serious complication of a surgically successful uterine transplantation is posttransplant partial stenosis of the uterine-vaginal anastomosis that may be a technical problem for embryo transfer, outflow of menstrual blood, and sexual satisfaction due to the narrowed and shortened vagina. This paper concludes that, currently, procurement of the uterus and the transplant procedure are surgically feasible and that none of the transplanted uteri have been lost due to rejection but only because of graft thrombosis or infection.

Conclusion: Uterine transplantation, after optimization of surgical methods, selection of suitable donors, standardization of immunosuppressive therapy, adjustment of assisted reproductive technologies and obstetrical proceedings might be an effective therapeutic method for women with AUFI who wish to have their own biological child.

Keywords: uterus transplantation, absolute uterine factor infertility, deceased donor, living donor

Received: November 18, 2018; Accepted: April 25, 2019; Prepublished online: May 23, 2019; Published: March 26, 2020  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Chmel, R., Pastor, Z., Matecha, J., Janousek, L., Novackova, M., & Fronek, J. (2020). Uterine transplantation in an era of successful childbirths from living and deceased donor uteri: Current challenges. Biomedical papers, 164(1), 115-120. doi: 10.5507/bp.2019.020
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978;2(8085):366. Go to original source... Go to PubMed...
    2. Gauthier T, Bertin F, Fourcade L, Maubon A, Saint Marcoux F, Piver P, Marquet P, Pommepuy I, Plainard X, Couquet C, Cornuejols MJ, Essig M, Aubard Y. Uterine allotransplantation in ewes using an aortocava patch. Hum Reprod 2011;26(11):3028-36. Go to original source... Go to PubMed...
    3. Brännström M, Diaz-Garcia C, Hanafy A, Olausson M, Tzakis A. Uterus transplantation: animal research and human possibilities. Fertil Steril 2012;97(6):1269-76. Go to original source... Go to PubMed...
    4. Mihara M, Kisu I, Hara H, Iida T, Araki J, Shim T, Narushima M, Yamamoto T, Moriguchi H, Kato Y, Tonsho M, Banno K, Aoki D, Suganuma N, Kagawa N, Takehara Y, Kato O, Koshima I. et al. Uterus autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. Hum Reprod 2012;27(8):2332-40. Go to original source... Go to PubMed...
    5. Johannesson L, Enskog A, Mölne J, Diaz-Garcia C, Hanafy A, Dahm-Kähler P, Tekin A, Tryphonopoulos P, Morales P, Rivas K, Ruiz P, Tzakis A, Olausson M, Brännström M. Preclinical report on allogeneic uterus transplantation in non-human primates. Hum Reprod 2013;28(1):189-98. Go to original source... Go to PubMed...
    6. Brännström M, Johannesson L, Dahm-Kähler P, Enskog A, Mölne J, Kvarnström N, Diaz-Garcia C, Hanafy A, Lundmark C, Marcickiewicz J, Gäbel M, Groth K, Akouri R, Eklind S, Holgersson J, Tzakis A, Olausson M. First clinical uterus transplantation trial: a six-month report. Fertil Steril 2014;101(5):1228-36. Go to original source... Go to PubMed...
    7. Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Milenkovic M, Ekberg J, Diaz-Garcia C, Gäbel M, Hanafy A, Hagberg H, Olausson M, Nilsson L. Livebirth after uterus transplantation. Lancet 2015;385(9968):607-16. Go to original source... Go to PubMed...
    8. Lotz M. Uterus transplantation as radical reproduction: Taking the adoption alternative more seriously. Bioethics 2018;32(8):499-508. Go to original source... Go to PubMed...
    9. Rumpik D, Rumpikova T, Pohanka M, Ventruba P, Belaskova S. Gestational surrogacy in Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018 Sep 20. doi: 10.5507/bp.2018.040 [Epub ahead of print] Go to original source... Go to PubMed...
    10. Lefkowitz A, Edwards M, Balayla J. Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Fertil Steril 2013;100(4):924-6. Go to original source... Go to PubMed...
    11. Balayla J. Uterine transplants in the Canadian setting: a theoretical framework. J Obstet Gynaecol Can 2016;38(10):955-60. Go to original source... Go to PubMed...
    12. Olausson M, Johannesson L, Brattgard D, Diaz-Garcia C, Lundmark C, Groth K, Marcickiewizc J, Enskog A, Akouri R, Tzakis A, Rogiers X, Janson PO, Brännström M. Ethics of uterus transplantation with live donors. Fertil Steril 2014;102(1):40-3. Go to original source... Go to PubMed...
    13. Fageeh W, Rabba H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynaecol Obstet 2002;76(3):245-51. Go to original source... Go to PubMed...
    14. Ozkan O, Akar ME, Ozkan O, Erdogan O, Hadimioglu N, Yilmaz M, Gunseren F, Cincik M, Pestereli E, Kocak H, Mutlu D, Dinckan A, Gecici O, Bektas G, Suleymanlar G. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril 2013;99(2):470-6. Go to original source... Go to PubMed...
    15. Flyckt RL, Farrell RM, Perni UC, Tzakis AG, Falcone T. Deceased donor uterus transplantation. Innovation and adaptation. Obstet Gynecol 2016;128(4):837-42. Go to original source... Go to PubMed...
    16. Testa G, McKenna GJ, Gunby RT Jr, Anthony T, Koon EC, Warren AM, Putman JM, Zhang L, dePrisco G, Mitchell JM, Wallis K, Klintmalm GB, Olausson M, Johannesson L. First live birth after uterus transplantation in the United States. Am J Transplant 2018;18(5):1270-4. Go to original source... Go to PubMed...
    17. Brucker SY, Brännström M, Taran FA, Nadalin S, Königsrainer A, Rall K, Schöller D, Henes M, Bösmüller H, Fend F, Nikolaou K, Notohamiprodjo M, Rosenberger P, Grasshoff C, Heim E, Krämer B, Reisenauer C, Hoopmann M, Kagan KO, Dahm-Kähler P, Kvarnström N, Wallwiener D. Selecting living donors for uterus transplantation: lessons learned from two transplantations resulting in menstrual functionality and another attempt, aborted after organ retrieval. Arch Gynecol Obstet 2018;297(3):675-84. Go to original source... Go to PubMed...
    18. Wei L, Xue T, Tao KS, Zhang G, Zhao GY, Yu SQ, Cheng L, Yang ZX, Zheng MJ, Li F, Wang Q, Han Y, Shi YQ, Dong HL, Lu ZH, Wang Y, Yang H, Ma XD, Liu SJ, Liu HX, Xiong LZ, Chen BL. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril 2017;108(2):346-351.e1. Go to original source... Go to PubMed...
    19. Chmel R, Novackova M, Janousek L, Matecha J, Pastor Z, Maluskova J, Cekal M, Kristek J, Olausson M, Fronek J. Revaluation and lessons learned from the first nine cases of a Czech uterus transplantation trial: four deceased donor and five living donor uterus transplantations. Am J Transplant 2019;19(3):855-64. doi: 10.1111/ajt.15096 Go to original source... Go to PubMed...
    20. Brännström M. Current status and future direction of uterus transplantation. Curr Opin Organ Transplant 2018;23(5):592-7. doi: 10.1097/MOT.0000000000000568 Go to original source... Go to PubMed...
    21. Catsanos R, Rogers W, Lotz M. The ethics of uterus transplantation. Bioethics 2013;27(2):65-73. Go to original source... Go to PubMed...
    22. Arora KS, Blake V. Uterus transplantation: ethical and regulatory challenges. J Med Ethics 2014;40(6):396-400. Go to original source... Go to PubMed...
    23. Williams N. Should deceased donation be morally preferred in uterine transplantation trials? Bioethics 2016;30(6):415-24. Go to original source... Go to PubMed...
    24. Bruno B, Arora KS. Uterus transplantation: the ethics of using deceased versus living donors. Am J Bioeth 2018;18(7):6-15. Go to original source... Go to PubMed...
    25. Williams NJ. Deceased donation in uterus transplantation trials: novelty, consent, and surrogate decision making. Am J Bioeth 2018;18(7):18-20. Go to original source... Go to PubMed...
    26. Shapiro ME, Ward FR. Uterus transplantation: a step too far. Am J Bioeth 2018;18(7):36-7. Go to original source... Go to PubMed...
    27. Chmel R, Novackova M, Pastor Z, Fronek J. The interest of women with Mayer-Rokitansky-Küster-Hauser syndrome and laparoscopic Vecchietti neovagina in uterus transplantation. J Pediatr Adolesc Gynecol 2018;31(5):480-4. Go to original source... Go to PubMed...
    28. Erman Akar M, Ozekinci M, Alper O, Demir D, Cevikol C, Meric Bilekdemir A, Daloglu A, Ongut G, Senol Y, Ozdem S, Uzun G, Luleci G, Suleymanlar G. Assessment of women who applied for the uterine transplant project as potential candidates for uterus transplantation. J Obstet Gynecol Res 2015;41(1):12-16. Go to original source... Go to PubMed...
    29. Kisu I, Banno K, Soeda E, Kurihara Y, Okushima M, Yamaguchi A, Nakagawa E, Umene K, Aoki D. Survey of attitudes toward uterus transplantation among Japanese women of reproductive age: A cross-sectional study. PloS One 2016;11(5):e0156179. Go to original source... Go to PubMed...
    30. Huet S, Tardieu A, Filloux M, Essig M, Pichon N, Therme JF, Piver P, Aubard Y, Ayoubi JM, Garbin O, Collinet P, Agostini A, Lavoue V, Piccardo A, Gauthier T. Uterus transplantation in France: for which patients? Eur J Obstet Gynecol Reprod Biol 2016;205:7-10. Go to original source... Go to PubMed...
    31. Johannesson L, Wallis K, Koon EC, McKenna GJ, Anthony T, Leffingwell S, Klintmalm GB, Gunby RT, Testa G. Living uterus donation and transplantation: experience of interest and screening in a single center in the United States. Am J Obstet Gynecol 2018;218(3):331.e1-7. Go to original source... Go to PubMed...
    32. Taneja A, Das S, Hussain SA, Madadin M, Lobo SW, Fatima H, Menezes RG. Uterine transplant: a risk to life or a chance to life? Sci Eng Ethics 2018;25(2):635-42. doi: 10.1007/s11948-018-0018-4 Go to original source... Go to PubMed...
    33. Golan A, Ron-El R, Herman A, Soffer Y, Wainraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv 1989;44(6):430-40. Go to original source... Go to PubMed...
    34. Testa G, Koon EC, Johannesson L, McKenna GJ, Anthony T, Klintmalm GB, Gunby RT, Warren AM, Putman JM, dePrisco G, Mitchell JM, Wallis K, Olausson M. Living donor uterus transplantation: A single center´s observations and lessons learned from early setbacks to technical success. Am J Transplant 2017;17(11):2901-10. Go to original source... Go to PubMed...
    35. Johannesson L, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Diaz-Garcia C, Olausson M, Brännström M. Uterus transplantation trial: 1-year outcome. Fertil Steril 2015;103(1):199-204. Go to original source... Go to PubMed...
    36. Mölne J, Broecker V, Ekberg J, Nillson O, Dahm-Kähler P, Brännström M. Monitoring of human uterus transplantation with cervical biopsies: a provisional scoring system for rejection. Am J Transplant 2017;17(6):1628-36. Go to original source... Go to PubMed...
    37. Brännström M, Wranning CA, Altcheck A. Experimental uterus transplantation. Human Reprod Update 2010;16(3):329-45. Go to original source... Go to PubMed...
    38. McKay D, Josephson MA. Pregnancy in recipients of solid organs - effects on mother and child. N Engl J Med 2006;354(12):1281-93. Go to original source... Go to PubMed...
    39. Thakar R. Is the uterus a sexual organ? Sexual function following hysterectomy. Sex Med Rev 2015;3(4):264-78. Go to original source... Go to PubMed...
    40. Lentine KL, Schnitzler MA, Xiao H, Axelrod D, Davis CL, McCabe M, Brennan DC, Leander S, Garg AX, Waterman AD. Depression diagnosis after living kidney donation: Linking U.S. Registry data and administrative claims. Transplantation 2012;94(1):77-83. Go to original source... Go to PubMed...
    41. Testa G and Johannesson L. The ethical challenges of uterus transplantation. Curr Opin Organ Transplant 2017;22(6):593-7. Go to original source... Go to PubMed...
    42. Lavoue V, Vigneau C, Duros S, Boudjema K, Leveque J, Piver P, Aubard Y, Gauthier T. Which donor for uterine transplants: Brain-dead donor or living donor? A systematic review. Transplantation 2017;101(2):267-73. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content