RAMB - Agosto 2016

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Silva and Carvalho
474 Rev Assoc M ed Bras 2016; 62(5):474-477
REVIEW ARTICLE
A meta-analysis on uterine transplantation: Redefining the limits of
reproductive surgery
Ana Flávia Garcia Silva1*, Luiz Fernando Pina Carvalho2
1BS – Medical Student, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
2PhD – Department of Gynecology and Obstetrics, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
Summary
Study conducted at Faculdade de
Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
Article received: 5/30/2015
Accepted for publication: 6/21/2015
*Correspondence:
Address: Rua Oscar Freire, 2121,
apto. 1107, Pinheiros
São Paulo, SP – Brazil
Postal code: 05409-011
In September 2014, the first baby grown in a transplanted uterus was born, which
represented an astonishing scientific progress that will mark the history of hu-
man reproduction. The recipient was a 32-year-old woman with Rokytanski syn-
drome who became pregnant after a successful embryo transfer and had an un-
eventful pregnancy, giving birth to a healthy newborn and marking the beginning
of a new era. Patients who do not have a uterus or have a dysfunctional uterus
now have the chance of dreaming with pregnancy and motherhood. Combining
principles of solid organ transplantation and techniques of human reproduc-
tion, uterus transplantation is the first ephemeral transplant performed in or-
der to promote reproductive potential of women and may be removed after suc-
cessful pregnancy. Worldwide, 11 uterine transplantations were performed in
patients. Of these, seven maintained their reproductive potential, with viable
transplanted uteri and regular menstrual cycles.
Keywords: reproduction, reproductive techniques, transplantation.
Introduction
In 2014, the first baby of a transplanted uterus was born,
surpassing another limit of reproductive surgery. This
was a scientific breakthrough that will be remembered in
the history of human reproduction and transform the
lives of many women who dream of being a mother. Med-
ically speaking, this would be impossible for patients who
were born without a uterus or had them surgically re-
moved. But now, there is hope.
Currently, patients without a uterus or those who
have dysfunctional uteri face great difficulties when they
wish to become pregnant. The options available include
adoption and surrogacy, which are subject to ethical, psy-
chological and legal dilemmas.
In this sense, uterine transplant appears as a revolution-
ary form of treatment for uterine infertility, which occurs
in patients who have severe intrauterine adhesions, those
presenting Müllerian anomalies, or who underwent prior
hysterectomy. For approximately 9.5 million women in the
United States, it is the only treatment option that would al-
low these patients to experience pregnancy and to give birth
to their children.1 In Brazil, where about 100,000 hysterec-
tomies are performed annually,2 the scenario is similar.
Uterus transplantation consists of a complex treat-
ment that combines principles of solid organ transplan-
tation and assisted reproduction techniques. Further-
more, conducted with the aim of promoting fertility and
thus improve the quality of life of the patient, and not
necessarily to extend it, this is the first ephemeral trans-
plantation, i.e., the transplanted organ may be removed
after the treatment’s objectives are achieved.3
D evelopment of uterus transplantation :
Describing the surgical technique
The donor’s surgery begins with a midline incision ex-
tending from the navel to the pubic symphysis. Then, the
uterus and vascular pedicles are dissected, that is, uter-
ine vessels and a segment of the internal iliac vessels bi-
laterally. For better fixation in the receiver’s pelvis, parts
of the round ligament, uterosacral ligament and the peri-
toneum are also removed. The lateral walls of the pelvis
are dissected, and the ureters are completely separated
from the cervix and the uterine vessels. The vagina is then
dissected 10-15 mm distal to the vaginal fornix. Finally,
the vessels are clamped and the blood supply is interrupt-
ed. Then, the uterus is removed and transported to the