Uterus transplantation

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Uterus transplant
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A uterine transplant is a surgical procedure whereby a healthy

implantation, effectively rendering the female infertile. This phenomenon is known as absolute uterine factor infertility
(AUFI). Uterine transplant is a potential treatment for this form of infertility.

History

Studies

In 1896, Emil Knauer, a 29-year-old Austrian working in one of Vienna's gynecological clinics, published the first study of ovarian autotransplantation documenting normal function in a rabbit. This led to the investigation of uterine transplantation in 1918.[1][2] In 1964 and 1966, Eraslan, Hamernik and Hardy, at the University of Mississippi Medical Center in Jackson, Mississippi, were the first to perform an animal (dog) autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus.[3] In 2010 Diaz-Garcia and co-workers, at Department of Obstetrics and Gynecology, University of Gothenburg in Sweden, demonstrated the world's first successful allogenic uterus transplantation, in a rat, with healthy offspring.[4]

As of 2023, more than 100 womb transplants have taken place, with around 50 babies having been born worldwide.[5][6]

Notable cases

Germany

Except perhaps in rare cases of

postsurgical infection and died from cardiac arrest just three months later.[8]

Saudi Arabia

The first modern day attempt at a uterine transplant occurred in 2000, in Saudi Arabia.

hemorrhaging following childbirth.[10] Because the patient ultimately needed for the uterus to be removed after just 99 days, due to necrosis, whether or not the case is considered successful is disputed, but the uterus did function for a time, with the patient experiencing two menstrual cycles.[9] Members of the medical community have expressed concerns over the ethics of the procedure.[11]

Turkey

The first incidence of a uterine transplant involving a deceased donor occurred in

fetal heartbeat, but this is a common complication and may not have been related to the transplant.[21] Following another pregnancy that was initiated with in vitro fertilisation and sustained for 28 weeks, the patient finally delivered a baby on June 4, 2020.[22]

Sweden

In

Gothenburg University led by Mats Brännström.[23][24][25]

In October 2014, it was announced that, for the first time, a healthy baby had been born to a uterine transplant recipient, at an undisclosed location in

corticosteroids. Three mild rejection episodes occurred, one during the pregnancy, but were all successfully suppressed with medication. Some other women were also reported to be pregnant at that time using transplanted uteri.[28]

United States

The first uterine transplant performed in the United States took place on 24 February 2016 at the Cleveland Clinic.[29] The team was led by Dr Andreas Tzakis. The transplant failed due to an undisclosed complication on 8 March, and the uterus was removed.[30] In April, they reported a yeast infection had spread to one of the arteries the surgeons had connected to provide blood flow to the transplanted uterus, which damaged the artery and caused blood clots to form.[31]

In November 2017, the first baby was born after a uterus transplantation in the US.[32] The birth occurred at Baylor University Medical Center in Dallas, Texas, by Drs Liza Johannesson and Giuliano Testa, after a uterus donation from a non-directed living donor.[33] The first baby born after a deceased donor uterus transplant in the US was at the Cleveland Clinic in June 2019.[34]

India

The first uterine transplant performed in India took place on 18 May 2017 at the Galaxy Care Hospital in Pune, Maharashtra. The 26-year-old patient had been born without a uterus, and received her mother's womb in the transplant.[35][36] India's first uterine transplant baby, weighing 1.45 kg, was delivered through a Caesarean section[37] at Galaxy Care Hospital in Pune on Thursday.[38] The surgery was performed by a team of doctors at Pune's Galaxy Care Hospital and led by the hospital's medical director, Shailesh Puntambekar.[39]

Brazil

The first uterine transplant performed in Brazil took place on 2016 at the Hospital das Clínicas da USP in São Paulo. The 32-year-old patient had

Mayer-Rokitansky-Küster-Hauser Syndrome, and therefore born without an uterus, and received a deceased donor's womb in the transplant.[35] Brazil's first uterine transplant baby was delivered through a Caesarean section[37] at Hospital das Clínicas da USP in December 2017. The surgery was performed by a team of doctors at Hospital das Clínicas da USP and led by Dani Ejzenberg, the head of the Human Reproductive Center at the hospital. Results of this procedure, the first to be performed in Latin America, were published in the medical journal The Lancet, in December 2018.[39]

United Kingdom

On August 23, 2023, doctors at the Churchill Hospital Oxford in the U.K. conducted the country's first uterus transplant. They removed the uterus from a 40-year-old woman and transplanted it to her 34-year-old sister, who had a rare condition that affected her ability to reproduce.[40] A team of experts performed the surgery for 17 hours in total.[41] Prof Richard Smith, a gynaecological surgeon who led the organ retrieval team, has spent 25 years researching womb transplantation, said that the surgery was a "massive success".[42]

Australia

On 15 December 2023, the first baby (male) was born in

embryo implantation. The donor was her mother, Michelle.[43]

Current status

The transplant is intended to be temporary – recipients will have to undergo a hysterectomy after one or two successful pregnancies. This is done to avoid the need to take immunosuppressive drugs for life with a consequent increased risk of infection.[44]

The procedure remains the last resort: it is a relatively new and somewhat experimental procedure, performed only by certain specialist surgeons in select centres, it is expensive and unlikely to be covered by insurance, and it involves risk of infection and organ rejection. Some ethics specialists consider the risks to a live donor too great, and some find the entire procedure ethically questionable, especially since the transplant is not a life-saving procedure.[45][46][47]

Description

Procedures

Uterine transplantation starts with the uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates and more recently humans.[48][49][50][51][52][53] The recovered uterus may need to be stored, for example for transportation to the location of the recipient. Studies on cold-ischemia reperfusion indicate an ischemic tolerance of more than 24 hours.[49]

The recipient has to look at potentially three major surgeries. First of all, there is the transplantation surgery. If a pregnancy is established and carried to viability a

immuno-suppressive therapy, eventually, after completion of childbearing, a hysterectomy needs to be done so that the immuno-suppressive therapy can be terminated.[citation needed
]

Ethics

Montreal criteria

Aside from considerations of costs, uterine transplantation involves complex

non-maleficence argues against it. In regard to the principles of beneficence and justice the procedure appears equivocal.[11] To address this dilemma the "Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" were developed at McGill University and published in Transplant International in 2012.[11] The Montreal Criteria are a set of criteria deemed to be required for the ethical execution of the uterine transplant in humans. These findings were presented at the International Federation of Gynecology and Obstetrics' 20th World Congress in Rome in October 2012.[54] In 2013 an update to "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" was published in Fertility and Sterility and has been proposed as the international standard for the ethical execution of the procedure.[55]

The criteria set conditions for the recipient, the donor, and the health care team, specifically:

  1. The recipient is a genetic female, with the ability to consent, with no medical contraindications to transplantation, has uterine disease that has failed other therapy, and has "a personal or legal contraindication" to other options (surrogacy, adoption). The recipient needs to be considered suitable for motherhood, deemed to be psychologically fit on evaluation, is likely to be compliant with treatment and the medical team, and understands the risks of the procedure. In 2021, a revision to the Montreal Criteria was published in Bioethics with an ethical framework for consideration of genetic XY individuals to be eligible for uterine transplants.[56]
  2. The donor is a female of reproductive age with no contraindication to the procedure who has concluded her childbearing or consented donating her uterus after her death. There is no coercion and the donor is responsible and capable of making informed decisions.
  3. The health care team belongs to an institution that meets Moore's third criterion[57] regarding institutional stability and has provided informed consent to both parties. There is no conflict of interests, and anonymity can be protected unless recipient or donor waive this right.

See also

References

  1. ^ Knauer, Emil (1896). "Einige Versuche über Ovarientransplantation bei Kaninchen" [An attempt at ovary transplantation in rabbits]. Zentralblatt für Gynäkologie (in German). 20: 524–8.
  2. PMID 9322102
    .
  3. PMID 5948103
    .
  4. S2CID 1188699
    .
  5. PMID 37037300
    .
  6. ^ "Woman receives sister's womb in first UK transplant". BBC News. 2023-08-22. Retrieved 2023-08-27.
  7. ISBN 978-1-83867-044-3
    . Retrieved 2023-02-22.
  8. ^ "Lili Elbe". Biography. Retrieved 2019-02-25.
  9. ^ a b c Grady, Denise (March 7, 2002). "Medical First: A Transplant Of a Uterus". The New York Times.
  10. S2CID 5100080
    .
  11. ^
    S2CID 39516819
    .
  12. ^ "Turkish woman has world's first womb transplant". timesofmalta.com. 10 October 2011. Retrieved 2012-11-21.
  13. ^ "Revolutionary 'Womb Transplant' performed in Turkey - World's First". Allvoices.com. Retrieved 2012-11-21.
  14. ^ "World's first womb transplant in Turkey promises hope for women". Alarabiya.net. 2011-10-01. Retrieved 2012-11-21.
  15. ^ "HEALTH - Doctors hopeful for uterus transplant". Hurriyetdailynews.com. 2011-09-13. Retrieved 2012-11-21.
  16. ^ "World's first uterus transplant performed in Turkey/TRT-English". Trt-world.com. 2012-02-27. Retrieved 2012-11-21.
  17. ^ "Turkish surgeons perform world's first uterus transplant | Family & Health". World Bulletin. Retrieved 2012-11-21.
  18. ^ "Womb transplant recipient Derya Sert pregnant". AAP. 2013-04-13.
  19. ^ "Yahoo Health". 12 April 2013. Retrieved 5 October 2014.
  20. ^ "World's first woman with uterus transplant gets pregnant - HEALTH". 14 April 2013. Retrieved 5 October 2014.
  21. ^ Derya Sert'in gebeliği sonlandırıldı. CNNTurk.com. (in Turkish)
  22. ^ "Kadavradan rahim nakli yapılan Derya Sert anne oldu" [Derya Sert, receiver of a uterus transplant from a cadaver, has become a mother] (in Turkish). Anadolu Agency. 2020-06-26.
  23. ^
    PMID 24582522
    .
  24. PMID 22542990
    .
  25. PMID 19897849
    .
  26. ^ "Woman has healthy baby boy after womb transplant in Sweden". ABC News. 4 October 2014.
  27. S2CID 20244453
    .
  28. ^ "BBC News - Womb transplant couple 'had no doubt' of success". BBC News.
  29. ^ Zeltner, Brie (2016-03-07). "Cleveland Clinic introduces nation's first uterus transplant recipient". The Plain Dealer. Retrieved 2016-03-08.
  30. ^ Zeltner, Brie (2016-03-09). "Nation's first uterus transplant, performed at the Cleveland Clinic, fails". The Plain Dealer. Retrieved 2016-03-10.
  31. ^ Denise Grady (April 8, 2016). "Yeast Infection Led to Removal of Transplanted Uterus". The New York Times. Retrieved April 8, 2016.
  32. ^ Sifferlin, Alexandra (2017-12-01). "First U.S. Baby Born After a Uterus Transplant". Time. Retrieved 2019-03-29.
  33. ^ "The first baby in the U.S. born via uterus transplant is here". December 2017. Retrieved 9 January 2018.
  34. S2CID 212651317
  35. ^ a b Pinheiro, Lara (5 December 2018). "Caso do primeiro bebê nascido de transplante de útero com doadora falecida é publicado em revista". G1. Retrieved 13 July 2022.
  36. ^ "India's first uterine transplant to take place on 18 May: Baroda woman to receive womb from mother". Firstpost. 12 May 2017. Retrieved 12 May 2017.
  37. ^ a b "Miracle baby: the first uterine transplant baby born in India". Mom And Baby Care (Mom ABC). 2018-11-01. Retrieved 2018-11-05.
  38. ^ Arora, Medhavi. "Mom donates womb to daughter in India's first uterus transplant". CNN. Retrieved 2018-11-05.
  39. ^
    PMID 30527853
    . Retrieved 2022-07-13.
  40. ISSN 0971-751X
    . Retrieved 2023-09-28.
  41. ^ Desk, India TV News; News, India TV (2023-08-24). "Woman donates her womb to younger sister; Britain's first successful uterus transplant". www.indiatvnews.com. Retrieved 2023-09-28. {{cite web}}: |last2= has generic name (help)
  42. ^ "Woman receives sister's womb in first UK transplant". BBC News. 2023-08-22. Retrieved 2023-09-28.
  43. ABC News Online
    , 2023-12-19
  44. ^ Ossola, Alexandra (18 February 2014). "Everything You Need To Know About Uterus Transplants". Popular Science. Retrieved 10 October 2014.
  45. ^ "Medical first: Baby born to woman who got new womb". Journal Star. 2006-2014 Gatehouse Media, Inc. 4 October 2014. Retrieved 4 October 2014.
  46. ^ "BBC News". 4 October 2014. Retrieved 5 October 2014.
  47. ^ "The Daily Telegraph". Telegraph.co.uk. 3 October 2014. Archived from the original on 4 October 2014. Retrieved 5 October 2014.
  48. S2CID 9423625
    .
  49. ^
    PMID 19897849
    .
  50. PMID 21159686
    .
  51. PMID 20519250
    .
  52. S2CID 20055019
    .
  53. S2CID 8576480
    .
  54. S2CID 76584337
    .
  55. PMID 23768985
    .
  56. S2CID 231862917
    .
  57. PMID 10636340
    .

External links
Retrieved from "https://en.wikipedia.org/w/index.php?title=Uterus_transplantation&oldid=1217214607"