RAMB - Agosto 2016

ilva

and

arvalho

476

ssoc

ras

2016; 62(5):474-477

ing donor. Three months after transplantation, the

transplanted uterus developed progressive necrosis, and

hysterectomy was performed.

The second case occurred

in 2011 in Turkey, in a patient with Rokytanski syndrome

who received the organ from a deceased donor. The trans-

planted uterus was viable and the patient underwent em-

bryo transfer 18 months after the operation, having pre-

sented two pregnancies spontaneously aborted before 6

weeks of gestational age (GA).

Initiated in 2012 in Sweden by the group of Dr.

Brannstrom, the clinical trial on uterus transplant was

responsible for the following nine cases in which nine pa-

tients, eight suffering from Rokytanski syndrome and

one with prior hysterectomy due to cervical cancer, re-

ceived transplants from living donors. Two patients un-

derwent hysterectomy during the first few months after

transplantation due to uterine artery thrombosis and se-

vere intrauterine infection, respectively. The remaining

seven patients started to have menstrual cycles about 2

to 3 months after transplantation, and maintained reg-

ular menstrual cycles during the first year. Transplants

remained viable and, to date, the seven patients have re-

productive potential (Table 1).

One of the cases in the clinical trial, a 35 year-old pa-

tient with Rokytanski syndrome that in 2013 received the

uterus of a donor aged 61, resulted in pregnancy and in

the first baby born after uterus transplantation and suc-

cessful embryo transfer. The transplanted uterus had only

one episode of mild rejection, reversed by corticosteroids.

Pregnancy had no complications, with a benign fetal eval-

uation and uneventful throughout pregnancy. The pa-

tient was admitted with preeclampsia at 31 weeks and 5

days, and cesarean delivery was performed. A newborn

with normal weight for gestational age and Apgar scores

9, 9, 10 was born in September 2014.

onclusion

After 15 years of research, the first baby resulting from a

transplanted uterus was born in 2014. Uterus transplan-

tation is a revolutionary new option for patients with

uterine infertility, most commonly caused by Rokytans-

ki syndrome, previous hysterectomy, or severe intrauter-

ine adhesions. It is the only treatment that enables the

experience of pregnancy for women with such conditions.

Since this is still an experimental procedure, the risks and

benefits, as well as medical and legal complexities should

be discussed regarding the three parties involved: the do-

nor, the recipient and the fetus. Possible complications

include rejection, infection and necrosis of transplanted

uterus, and need for hysterectomy may occur. These com-

plications can be especially critical if they occur during

pregnancy, and should be addressed in the preoperative

counseling.

Furthermore, since the surgery involves section of

pelvic nerves, it is unclear how the pregnancy will be ex-

perienced by the recipient, since many sensations of preg-

nancy and labor may be perceived differently.

Thus, the

case of the aforementioned patient will be valuable, al-

though a greater number of cases is necessary for better

understanding of the perinatal period.

The limited number of transplants performed does

not allow the conclusion that there are differences in re-

sults depending on donor modality: deceased or living,

family or non-family. As for the immunosuppressive ther-

TABLE 1

Data of 11 cases of uterus transplant performed.

Date

Country

Receiver’s

condition

Donor

modality

Complications

Results

2000

Saudi Arabia

(N=1)

Hysterectomy due to

postpartum

hemorrhage

Living donor

Progressive uterine necrosis Uterus viable for 99 days, during

which the patient had two menstrual

cycles

2011

Turkey (N=1)

Rokytanski syndrome Deceased

No complications

Two pregnancies with spontaneous

abortion before the sixth week of

gestation

2012-

-current

Sweden (N=9)

Rokytanski syndrome

(N=8)

Hysterectomy due to

cervical cancer (N=1)

Living donor

Uterine artery thrombosis

(N=1)

Severe uterine infarction

(N=1)

Episodes of mild rejection

successfully treated with

corticosteroids (N=4)

Seven cases: Uterus viable in the late

postoperative period, with

reproductive potential

*In September 2014, the first baby of

a transplanted uterus patient was

born