Live birth following a uterine transplantation explained in paper

By Julie Griffiths on 24 December 2018 Newborn The Lancet Caesarean Section

The first case of a livebirth following uterine transplantation from a deceased donor has taken place and those involved have written about it in The Lancet.

The authors said that the successful birth of a baby girl has established proof-of-concept for treating uterine infertility by transplantation from a deceased donor. It has, they added, opened an opportunity for a healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.

In 2016, a 32-year-old woman with congenital uterine absence underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of brain haemorrhage. 

The donor was 45 years old and had three previous vaginal deliveries. The recipient had one IVF cycle four months before transplant, which yielded eight cryopreserved blastocysts.

The recipient showed satisfactory post-operative recovery and was discharged after eight days in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until five months post-transplantation, at which time azathioprine replaced MMF. 

First menstruation occurred 37 days post-transplantation, and regularly (every 26 to 32 days) thereafter. 

Pregnancy occurred after the first single embryo transfer, seven months post-transplantation. 

No blood flow abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during the pregnancy. 

In December 2017, at 36 weeks’ gestation, a baby girl was delivered by CS. 

She weighed 2550g at birth, with Apgar scores of nine at one minute, 10 at 5 minutes, and 10 at 10 minutes. The article said that, along with the mother, the baby remained healthy and developing normally at seven months postpartum. 

The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.

Read the full paper here.