Uterus transplantation trial 1 year outcome

Capsule:
Nine women with uterine factor infertility underwent live-donor uterus transplantation. The seven cases with viable uteri after 12 months are presented, with special reference to menstruation, blood flow, rejection, and immunosuppression.

Authors:
Liza Johannesson, M.D., Ph.D., Niclas Kvarnström, M.D., Johan Mölne, M.D., Ph.D., Pernilla Dahm-Kähler, M.D., Ph.D., Anders Enskog, M.D., Ph.D., Cesar Diaz-Garcia, M.D., Michael Olausson, M.D., Ph.D., Mats Brännström, M.D., Ph.D.

Volume 103, Issue 1, Pages 199-204

Abstract:

Objective:
To report the 12-month outcome of seven patients with viable uteri after uterus transplantation (UTx).

Design:
Prospective observational study.

Setting:
University hospital.

Patient(s):
Seven patients with absolute uterine infertility and viable uteri for 12 months after live-donor UTx.

Intervention(s):
Predetermined immunosuppression was with tacrolimus and mychophenolate mofetil (MMF) during 6 months, whereupon MMF should be withdrawn. Frequent ultrasound examinations were performed to assess uterine appearance and uterine artery blood flow. Cervical biopsies (for histological detection of rejection) were obtained at preset time points, with temporary adjustments of immunosuppression if there were signs of rejection. Menstruations were systematically recorded.

Main Outcome Measure(s):
Menstruation, uterine artery blood flow, histology of cervical biopsies, and blood levels of tacrolimus.

Result(s):
All patients showed regular menses after 1–2 months. Uterine artery blood flow was unchanged, with a median pulsatility index of 1.9 (range, 0.5–5.4). Blood levels of tacrolimus were approximately 10, 9, and 8 (μg/L) during months 2, 9, and 12, respectively. Four recipients showed mild inflammation in biopsies after MMF withdrawal and were treated with corticosteroids and azathioprine during the remainder of the 12 months. Subclinical rejection episodes were detected on ectocervical biopsies in five recipients. Histology showed apoptotic bodies and occasional spongiosis in the squamous epithelium. Moderate infiltration of lymphocytes and neutrophils was seen in the epithelial/stromal interface. All rejection episodes were successfully treated for 2 weeks with corticosteroids or dose increments of tacrolimus.

Conclusion(s):
We demonstrate long-term uterine viability after UTx, with continued menstruation and unaltered uterine artery blood flow. Subclinical rejection episodes were effectively reversed by temporary increase of immunosuppression.

Clinical Trial Registration Number:
NCT01844362.

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