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. 2024 Feb 11;5(2):223-227.
doi: 10.1016/j.xfre.2024.02.002. eCollection 2024 Jun.

Uterus transplantation: a rescue technique to save the viability and functionality of the graft after intra-operative outflow thrombosis

Giuseppe D'Amico  1 , Koji Hashimoto  1 , Luca Del Prete  2 , Elliott Richards  3 , Stephanie Ricci  3 , Rebecca Flyck  4 , Bijan Eghtesad  1 , Teresa Diago  1   5 , Tommaso Falcone  3 , Charles Miller  1 , Andreas Tzakis  1 , Cristiano Quintini  1   5
Affiliations

Uterus transplantation: a rescue technique to save the viability and functionality of the graft after intra-operative outflow thrombosis

Giuseppe D'Amico et al. F S Rep. .

Abstract

Objective: To study a surgical approach to venous vascular thrombosis after uterus transplantation (UTx). Uterus transplantation is the only treatment for uterine factor infertility when conventional therapies are not possible. One of the major limitations of UTx is the high incidence of vascular thrombosis, which in most series reaches approximately 20%.

Design: A case report.

Setting: Hospital.

Patients: We report here a technique used in a 30-year-old woman with congenital absence of the uterus who developed intraoperative thrombosis after a UTx from a brain-dead donor.

Intervention: The UTx was performed by revascularizing the graft through bilateral donor internal iliac vessels (artery and vein) anastomosed end-to-side to the external iliac vessels of the recipient. The superior uterine veins were not anastomosed and were left unreconstructed. An end-to-end graft to the recipient's vaginal anastomosis was performed. After uterus reperfusion, congestion of the organ was noted, and bilateral venous thrombosis of the internal iliac veins of the graft was found. A "Y-shaped" venous jump graft was used to restore venous outflow of the left superior uterine vein and the internal iliac vein of the graft after thrombectomy.

Main outcome measures: Viability and functionality of the uterus graft after intraoperative bilateral venous thrombosis.

Results: The postoperative course was uneventful, and this UTx resulted in the delivery of a healthy infant.

Conclusion: To our knowledge, this is the first successful rescue technique used to restore venous outflow and save the viability and functionality of a transplanted uterus. We demonstrated that a transplanted uterus from a deceased donor with a monolateral outflow could succeed in pregnancy and the delivery of a healthy infant.

Keywords: Infertility; clot; pressure; reconstruction; thrombosis.

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Conflict of interest statement

G.D.A. has nothing to disclose. K.H. has nothing to disclose. L.D.P. has nothing to disclose. E.R. has nothing to disclose. S.R. has nothing to disclose. R.F. has nothing to disclose. B.E. has nothing to disclose. T.D. has nothing to disclose. T.F. has nothing to disclose. C.M. has nothing to disclose. A.T. has nothing to disclose. C.Q. has nothing to disclose.

Figures

Figure 1
Figure 1
Intraoperative Doppler ultrasound of the uterus graft with (A) high arterial resistive index and (B) poor venous flow because of outflow obstruction. (C) Arterial resistive index normalized and (D) venous flow improved after left-side venous revascularization using a “Y-shaped” venous graft.
Figure 2
Figure 2
(A) Bilateral thrombosis (in purple) involving the inferior uterine vein and the internal iliac veins of the uterine graft. (B) A “Y-shaped” donor venous graft, including the common, internal, and external iliac veins, was used to re-establish the left-side graft outflow.
See this image and copyright information in PMC

References

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