First live birth following a uterine transplant from a deceased donor

A Brazilian woman becomes the first person to successfully give birth to a healthy baby after receiving a uterine transplant from a deceased donor. This comes after a history of previous 10 unsuccessful attempts at live birth after deceased donor transplants in the United States, the Czech Republic, and Turkey.

This is a milestone in the history of uterine transplants as it opens the path forward for achieving successful pregnancies without the need of live donor and donor surgery. The details of the case were published by the Lancet on December 4, 2018, accompanied by an editorial.

Dr. Dani Ejzenberg, PhD, the lead author and researcher from the Department of Obstetrics and Gynecology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, said in a press release by Lancet, "The use of deceased donors could greatly broaden access to this treatment, and our results provide proof-of-concept for a new option for women with uterine infertility."

Ejzenberg and colleagues report that the 32-year old woman was born without a uterus because of congenital uterine agenesis, also called as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, which affects 1 in 4500 women.

The woman received uterus in September 2016 after 10.5-hour surgery from a 45-year old multiparous woman who died of subarachnoid hemorrhage. After the transplant, the woman was discharged on the 8th postoperative day with immunosuppression achieved and maintained with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF) when at five months post-transplant, azathioprine replaced MMF.

The woman got her first period 37 days after transplant and after that continued to have regular cycles every 26–32 days.  Pregnancy occurred following single embryo-transfer after seven months from cryopreserved blastocyst from a successful in-vitro fertilization four months before the transplant surgery.

The pregnancy progressed uneventfully and was monitored by ultrasound and Doppler flow velocity waveforms of uterine arteries, fetal umbilical, or middle cerebral arteries.

A healthy, female baby weighing 2550 g was delivered by elective cesarean section at 36 weeks on December 15, 2017. At the time of writing the article, the baby is healthy and developing normally.

The uterus was also removed at the time of cesarean section, and immunosuppressive therapy stopped.

Cesar Diaz-Garcia, MD, Nuffield Department of Women's and Reproductive Health, University of Oxford, UK, and Antonio Pellicer, MD, PhD, Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain, writes in an accompanying editorial, "In a context in which the scarcity of human data is still the norm, [the report] reveals a breakthrough in the field of uterus transplantation."

The first uterine transplant from a living donor took place in Sweden in 2013, followed by first live-birth after transplant in 2015. Since then, 11 more births have taken place worldwide, albeit all from live donor transplant.

However, uteri from living donors are limited because the person has to a relative of the recipient, thereby, limiting the option for women with uterine factor infertility. If uterine transplant after dead donor becomes successful, uteri will not be in short supply as people are more willing to donate organs after death than when they are alive.

The authors agree that many potential issues need to be addressed before deceased donor transplant becomes a norm. These include standardization of operative procedures, immunosuppressive therapy before and during pregnancy, criteria for rejection if it happens, and long-term outcome of the baby delivered after transplant.

Abstract 

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