Cleveland Clinics performs first Uterine Transplant from deceased donor in U.S.

The surgeons at Cleveland clinic performed first uterine transplant in U.S. this week.

Earlier in November 2015, Cleveland clinic announced a clinical trial that involved performing 10 uterine transplants in women with Uterine Factor Infertility (UFI).

About 1 in 4,500 women in the United States is born without a uterus - a condition known as Mayer-Rokitansky-Küster-Hauser syndrome, according to the NIH.

UFI is an irreversible condition affecting 3-5% of pregnancies worldwide. "Women who are coping with UFI have few existing options," Tommaso Falcone, chairman of the Department of Obstetrics-Gynecology at Cleveland Clinic, said when the clinical trial was announced. "Although adoption and surrogacy provide opportunities for parenthood, both pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons."

The first two International attempts on Uterine Transplant were unsuccessful due to organ rejection. Finally a team of Doctors in Sweden were able to treat the mild organ rejection. The University of  Gothenburg team  led by Dr. Mats Brännström   achieved its first birth in September 2014. To date, the Swedish group has performed nine uterus transplants, achieving five pregnancies and four live births.

In the Brännström case report, the woman who became pregnant following uterus transplantation took tacrolimus and azathioprine to prevent organ rejection both before and during her pregnancy.

Uterine Transplant is a complex process involving multiple steps. Each Candidate selected for the transplant undergo a extensive medical evaluation and psychological counseling, and her candidature has to be approved unanimously by the team of experts in the field.

According to the team at Baylor hospital, Dallas:

 

 

The selection criteria for the recipient are :

· Women with uterine infertility
· Ages 20-35, with working ovaries
· Body mass index of less than 30
· Cancer-free for at least five years
· No history of diabetes
· Non-smoker

The criteria to be a donor are:

  Ages 65 and younger
· At least one full-term delivery
· Body mass index of less than 30
· Cancer-free for at least five years
· Test negative for HIV, herpes and hepatitis B and C

According to the Cleveland clinic, once a woman is selected for the transplant she has to follow the following protocols:

• Her ovaries are stimulated to produce multiple eggs, starting the in vitro fertilization (IVF) process.
• Her eggs are retrieved, fertilized with sperms in a laboratory, and 6-8 embryos are frozen.
• Lifebanc, an organ procurement agency, begins the search for a donor between 18-40 years of age.
• The donor’s next-of-kin signs an informed consent for uterus donation.
• The donor uterus is removed along with the uterine arteries and   transplanted within six to eight hours into the patient’s pelvis.
• Over 12 months, the transplanted uterus fully heals.
• Women who receive the uterus transplants will not be able to become pregnant without ARTs, because the transplanted uterus will not be connected to their fallopian tubes, where normal fertilization takes place.
• One year after transplant, the frozen embryos are then thawed and implanted, one at a time, into the patient until she becomes pregnant.
• During her pregnancy, she takes immunosuppressant drugs.
• She is monitored by a high-risk obstetrics team throughout pregnancy and delivery.
• She has a monthly cervical biopsy to check for organ rejection.
• The baby is delivered by cesarean section.
• After one to two babies, she has a hysterectomy to remove the transplanted uterus.
• Her anti-rejection drugs are stopped after hysterectomy to reduce long-term exposure to transplant medications.

Andreas Tzakis, MD, the transplant surgeon at the Cleveland clinic says “It is critical that the risks for uterus transplant, which is not lifesaving, are no greater than the risks for other transplants. Like transplants of the face and extremities, uterus transplant is considered life-enhancing rather than lifesaving.”

He further adds “Unlike any other transplants, they are ‘ephemeral,” he says. “They are not intended to last for the duration of the recipient’s life, but will be maintained for only as long as is necessary to produce one or two children.”

References:

http://www.livescience.com/52799-uterus-transplants-cleveland-clinic.html

http://www.dallasnews.com/lifestyles/health-and-fitness/health/20160129-baylor-dallas-to-become-one-of-first-u.s.-hospitals-to-offer-uterine-transplants.ece

http://www.reuters.com/article/us-ohio-transplant-idUSKCN0VZ0O7