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Selecting living donors for uterus transplantation: lessons learned from two transplantations resulting in menstrual functionality and another attempt, aborted after organ retrieval

Journal article
Authors S. Y. Brucker
Mats Brännström
F. A. Taran
S. Nadalin
A. Konigsrainer
K. Rall
D. Scholler
M. Henes
H. Bosmuller
F. Fend
K. Nikolaou
M. Notohamiprodjo
P. Rosenberger
C. Grasshoff
E. Heim
B. Kramer
C. Reisenauer
M. Hoopmann
K. O. Kagan
P. Dahm-Kahler
Niclas Kvarnström
D. Wallwiener
Published in Archives of Gynecology and Obstetrics
Volume 297
Issue 3
Pages 675-684
ISSN 0932-0067
Publication year 2018
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 675-684
Language en
Links dx.doi.org/10.1007/s00404-017-4626-...
Keywords Human, Infertility, Transplantation, Uterus, Donor selection criteria, Vaginal agenesis, uterine transplantation, rat, trial, Obstetrics & Gynecology
Subject categories Obstetrics, Gynecology and Reproductive Medicine

Abstract

To contribute to establishing donor selection criteria based on our experience with two successful living-donor human uterus transplantations (UTx) and an aborted attempt. This interventional study included three patients with uterine agenesis, aged 23, 34, and 23 years, scheduled for UTx, and their uterus-donating mothers, aged 46, 61, and 46 years, respectively. Interventions included preoperative investigations, donor surgery, back-table preparation, and recipient surgery. Preoperative imaging, surgical data, histopathology, menstrual pattern, and uterine blood flow were the main outcome measures. In the first case (46-year-old mother/23-year-old daughter), donor/recipient surgery took 12.12/5.95 h. Regular spontaneous menstruations started 6-week post-transplantation, continuing at 24-28-day intervals throughout the 6-month observation period. Repeated follow-up cervical biopsies showed no signs of rejection. In the second case (61-year-old donor), surgery lasted 13.10 h; attempts to flush the retrieved uterus failed due to extreme resistance of the left uterine artery (UA) and inability to perfuse the right UA. Transplantation was aborted to avoid graft vessel thrombosis or insufficient blood flow during potential pregnancy. Histopathology revealed intimal fibrosis and initial sclerosis (right UA), extensive intimal fibrosis (parametric arterial segments), and subtotal arterial stenosis (myometrial vascular network). In the third case (46-year-old mother/23-year-old daughter), donor/recipient surgery took 9.05/4.52 h. Menstruations started 6-week post-transplantation. Repeated cervical biopsies showed no signs of rejection during the initial 12-week follow-up period. Meticulous preoperative evaluation of potential living uterus donors is essential. This may include selective contrast-enhanced UA angiograms and limitation of donor age, at least in donors with risk factors for atherosclerosis.

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