US five-year follow-up study shows uterus transplants safe

Uterus transplants in the USA have been shown to be safe for recipients and donors, with a high percentage of successful pregnancies resulting from them.

In a cohort study published in JAMA Surgery, the success of organ graft, birth rates and pregnancy complications were measured in 33 uterus transplant recipients who underwent transplants between 2016 and 2021 in the USA. Three-quarters of transplants successfully grafted, and in this group, 19 out of 23 women had a successful birth following IVF treatment.

'Based on the experience of the first five years of uterus transplantation in the USA, this procedure should be considered a clinical reality in the USA and presented as an option for the many women with infertility due to a uterine factor [who are] interested in parenthood,' said Dr Liza Johannesson lead author of this study, medical director of uterine transplant at the Annette C and Harold C Simmons Transplant Institute at Baylor University Medical Centre in Dallas, Texas.

Most transplant recipients in this study were born without a uterus, a congenital condition called Mayer-Rokitansky-Küster-Hauser syndrome, which affects 1 in 4500 women. Uterus donations for the transplants came from a mix of living and deceased donors; no difference was found in the success rate from either source.

IVF treatment is required for pregnancy following uterine transplant as the fallopian tubes are not transplanted. 83 percent of successful transplant recipients had at least one live-born child after embryo transfer. The live birth rate in this cohort was 36 percent of total embryo transfers, which is comparable to that in the general population in the UK. However, preterm delivery was more common in this cohort than with standard IVF treatment and occurred for 63 percent of the births.

Another recent study of nine uterine transplant recipients from a research group at the University of Gothenburg, Sweden, had similar success rates with IVF treatment following uterine transplant (see BioNews 1147).

Risks remain with this type of transplant. Immunosuppressive medications were consistently taken by transplant recipients before and following the transplant, which increased their susceptibility to infection. Following a live birth, a hysterectomy to remove the transplanted uterus was carried out, either at the same time as a caesarean section or later.

Although promising, more data is needed to fully understand the safety of uterine transplants. 'The small sample size, lack of medical profile of the recipients, lack of racial diversity in the cohort, and potential bias toward highly motivated patients should temper absolute comments about the safety of the procedure', warned Dr Rachel Forbes from Vanderbilt University Medical Centre, Nashville, Tennessee, in an editorial published alongside the study.