First birth from a deceased donor uterus in the United States: from severe graft rejection to successful cesarean delivery

American Journal of Obstetrics and Gynecology
Rebecca FlycktA G Tzakis

Abstract

Uterus transplantation is the only known potential treatment for absolute uterine factor infertility. It offers a unique setting for the investigation of immunologic adaptations of pregnancy in the context of the pharmacologic-induced tolerance of solid organ transplants, thus providing valuable insights into the early maternal-fetal interface. Until recently, all live births resulting from uterus transplantation involved living donors, with only 1 prior birth from a deceased donor. The Cleveland Clinic clinical trial of uterus transplantation opened in 2015. In 2017, a 35 year old woman with congenital absence of the uterus was matched to a 24 year old parous deceased brain-dead donor. Transplantation of the uterus was performed with vaginal anastomosis and vascular anastomoses bilaterally from internal iliac vessels of the donor to the external iliac vessels of the recipient. Induction and maintenance immunosuppression were achieved and subsequently modified in anticipation of pregnancy 6 months after transplant. Prior to planned embryo transfer, ectocervical biopsy revealed ulceration and a significant diffuse, plasma cell-rich mixed inflammatory cell infiltrate, with histology interpreted as grade 3 rejection suspicious for...Continue Reading

Citations

Aug 26, 2020·The Journal of Obstetrics and Gynaecology Research·Jakub KristekJiri Fronek
Jul 28, 2020·Journal of Clinical Medicine·Mats BrännströmNiclas Kvarnström
Jul 8, 2020·Journal of Clinical Medicine·Marie CarbonnelJean Marc Ayoubi
Nov 13, 2020·Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz·Uwe Walter
Sep 26, 2020·American Journal of Obstetrics and Gynecology·Lauren H Theilen, Cara C Heuser
Jan 9, 2021·Obstetrics and Gynecology·Liza JohannessonAnthony R Gregg
Dec 22, 2020·Journal of Minimally Invasive Gynecology·Stephanie RicciTommaso Falcone
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Jun 17, 2020·Transplantation·Giuliano Testa, Liza Johannesson
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Aug 28, 2021·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Roman ChmelRoman Chmel
Sep 18, 2021·Journal of Reconstructive Microsurgery·Joseph M EscandónOscar J Manrique
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Sep 29, 2021·Current Opinion in Organ Transplantation·Friederike Martin, Stefan G Tullius
Oct 21, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Felipe CastroAnabel Vanin

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