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. 2023 Mar 1;107(3):729-736.
doi: 10.1097/TP.0000000000004437. Epub 2023 Feb 21.

Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Nicole K Wilson  1 , Philipp Schulz  2 , Anji Wall  2 , Megan Parrott  2 , Giuliano Testa  2 , Liza Johannesson  2   3 , Teena Sam  1
Affiliations

Immunosuppression in Uterus Transplantation: Experience From the Dallas Uterus Transplant Study

Nicole K Wilson et al. Transplantation. .

Abstract

Background: Uterus transplantation is a temporary transplant allowing women with absolute uterine factor infertility to experience pregnancy and childbirth. The degree of immunosuppression (IS) required to prevent rejection while minimizing toxicity to the recipient and fetus remains an area of investigation.

Methods: In this article, we describe immunosuppressive therapy, rejection episodes, infections, and adverse events in 14 uterus transplant recipients. Induction consisted of antithymocyte globulin and methylprednisolone. Ten recipients (71%) received no steroids postoperatively, and 4 (29%) had steroids tapered off at 42 d. All received oral tacrolimus, either immediate release (n = 2, 14%) or extended release (n = 12, 86%). Mycophenolate was used in 4 cases (29%), de novo azathioprine in 9 (64%), and de novo everolimus in 1 (7%).

Results: Sixteen clinically silent, treatment-responsive rejection episodes occurred in 10 recipients. Five recipients (36%) experienced acute kidney injury. In 3 recipients, IS was discontinued due to renal dysfunction. Eleven infection episodes were noted in 7 recipients. No babies had congenital abnormalities.

Conclusions: Our experience demonstrates that safe IS regimens can be used for uterus transplant recipients before and during pregnancy.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Testa G, McKenna GJ, Gunby RT Jr, et al. First live birth after uterus transplantation in the United States. Am J Transplant. 2018;18:1270–1274.
    1. Opitz JM. Vaginal atresia (von Mayer-Rokitansky-Küster or MRK anomaly) in hereditary renal adysplasia (HRA). Am J Med Genet. 1987;26:873–876.
    1. Herlin MK, Le VQ, Højland AT, et al. Whole-exome sequencing identifies a GREB1L variant in a three-generation family with Müllerian and renal agenesis: a novel candidate gene in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. A case report. Hum Reprod. 2019;34:1838–1846.
    1. Jacquinet A, Boujemla B, Fasquelle C, et al. GREB1L variants in familial and sporadic hereditary urogenital adysplasia and Mayer-Rokitansky-Kuster-Hauser syndrome. Clin Genet. 2020;98:126–137.
    1. Agarwal A, Johannesson L, Findeis SK, et al. Clinicopathological analysis of uterine allografts including proposed scoring of ischemia reperfusion injury and T-cell-mediated rejection—Dallas UtErus Transplant Study: a pilot study. Transplantation. 2022;106:167–177.

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