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. 2022 Sep 1;157(9):790-797.
doi: 10.1001/jamasurg.2022.2612.

The First 5 Years of Uterus Transplant in the US: A Report From the United States Uterus Transplant Consortium

Liza Johannesson  1   2 , Elliott Richards  3 , Vikrant Reddy  1 , Jessica Walter  4 , Kim Olthoff  5 , Cristiano Quintini  6 , Andreas Tzakis  6 , Nawar Latif  7 , Paige Porrett  8 , Kathleen O'Neill  9 , Giuliano Testa  1
Affiliations

The First 5 Years of Uterus Transplant in the US: A Report From the United States Uterus Transplant Consortium

Liza Johannesson et al. JAMA Surg. .

Abstract

Importance: Uterus transplant is a viable surgical treatment for women affected by absolute uterine-factor infertility, which affects 1 in 500 women.

Objective: To review transplant and birth outcomes of uterus transplant recipients in the US since the first case in 2016.

Design, setting, and participants: In this cohort study, 5 years of uterus transplant outcome data were collected from the 3 centers performing uterus transplants in the US: Baylor University Medical Center, Dallas, Texas; Cleveland Clinic, Cleveland, Ohio; and University of Pennsylvania, Philadelphia. A total of 33 women with absolute uterine-factor infertility who underwent uterus transplant between February 2016 and September 2021 were included.

Main outcomes and measures: Graft survival, live birth, and neonatal outcome.

Results: Of the 33 included uterus transplant recipients, 2 (6%) were Asian, 1 (3%) was Black, 1 (3%) was South Asian, and 29 (88%) were White; the mean (SD) age was 31 (4.7) years; and the mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 24 (3.6). Most uterus transplant recipients (31 of 33 [94%]) had a congenitally absent uterus (Mayer-Rokitansky-Küster-Hauser syndrome), and 21 of 33 (64%) received organs from living donors. Mean (range) follow-up was 36 (1-67) months. There was no donor or recipient mortality. One-year graft survival was 74% (23 of 31 recipients). Through October 2021, 19 of 33 recipients (58%) had delivered 21 live-born children. Among recipients with a viable graft at 1 year, the proportion with a live-born child was 83% (19 of 23). 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 (median [range], 58th [6th-98th] percentile). No congenital malformations were detected.

Conclusions and relevance: Uterus transplant is a surgical therapy that enables women with uterine-factor infertility to successfully gestate and deliver children. Aggregate data from US centers demonstrate safety for the recipient, living donor, and child. These data may be used to counsel women with uterine-factor infertility on treatment options.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Porrett has received grants from Lung Biotechnology and the National Institute of Allergy and Infectious Diseases outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Annual Volume of Uterus Transplant in the US Between February 2016 and September 2021
Living donor (LD) and deceased donor (DD) transplants are displayed separately.
Figure 2.
Figure 2.. Uterus Transplants per Year in the US (2016-2021) and Uterine Graft Survival
A, Probability of uterine graft survival from living donors (LDs) and deceased donors (DDs). B, Proportion of viable uterine grafts at 1 year. Numbers indicate the number of transplants per year. The trend line indicates the mean percentage of technical success for all recipients.
Figure 3.
Figure 3.. Timing of Events After Uterus Transplant
Living donor (LD) and deceased donor (DD) transplants are displayed separately.
Figure 4.
Figure 4.. Gestational Age at Delivery by Year of Delivery
Differences in gestational age and year of delivery were not statistically significant (P = .40). Each dot represents a live birth.
See this image and copyright information in PMC

Comment in

References

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