Doctors from the University of Sao Paulo in Brazil have delivered the first baby born to a woman who received a uterus transplant from a deceased donor, according to a case report published in The Lancet Tuesday.
How the procedure works
Doctors in recent years have made advances in uterine transplant and in vitro fertilization (IVF). In 2017, Baylor University Medical Center became the first hospital in the United States to deliver a baby to a woman who'd received a uterus transplant from a living donor. Globally, there have been 11 live births using a transplanted uterus from living donors, according to Reuters.
Before receiving a uterus transplant, recipients must take hormone treatments that cause their ovaries to release multiple eggs. Those eggs are harvested, fertilized, and frozen to be implanted via IVF after the transplant. Doctors attempt IVF after the woman has recovered from the transplant surgery and begun menstruating.
The pregnancies are considered inherently high risk, and the babies are delivered via caesarian section to avoid straining the uterus.
The transplant is also intended to be temporary. At a later date—possibly after a successful pregnancy—the uterus is removed so the patient can stop taking powerful anti-rejection drugs.
However, the sparsity of willing living donors has pushed researchers to also explore whether a successful birth could be achieved from a deceased donor. Ten other uteruses have been transplanted from deceased donors, according to Reuters. However until, now, none have been able to produce a live birth.
Details on the birth
In the case report, the doctors noted that they removed a uterus from a 45-year-old woman who had died from a stroke and then transplanted the uterus into a 32-year-old woman. The woman was born without a uterus due to a rare condition called Mayer-Rokitansky-Küster-Hauser syndrome.
According to the case report, the donor uterus was ischemic—meaning it was off any blood supply—for nearly eight hours, which is almost twice the amount of time uteruses from living donors have been ischemic.
Seven months after the transplant, doctors placed an embryo fertilized externally with the patient's husband's sperm into the patient's womb via IVF. The pregnancy was normal, and after about 36 weeks, doctors performed a C-section, delivering the baby pre-term on Dec. 15, 2017. Full term is 40 weeks.
In the paper, which was written about seven months after the birth, the doctors said both the mother and the baby girl were healthy.
'A landmark birth'
Experts hope that uterus transplants could help women without uteruses or with damaged uteruses become pregnant, and this case suggests that the donor base could expand significantly, according to Dani Ejzenberg, lead researcher on the report.
"The use of deceased donors could greatly broaden access to this treatment," Ejzenberg said. "The numbers of people willing and committed to donate organs upon their … deaths are far larger than those of live donors, offering a much wider potential donor population." Ejzenberg added that the outcomes of births via uteruses from live donors and those from deceased donors has not been compared, and the technique could still be refined.
Cesar Diaz, who co-authored an accompanying editorial, said uterus transplants could also help experts gain more knowledge about pregnancies and answer some lingering questions. "There are still lots of things we don't understand about pregnancies, like how embryos implant," he said. "These transplants will help us understand implantation and every stage of pregnancy."
Liza Johannesson, a uterus transplant surgeon at Baylor University Medical Center, said the birth is "a very important birth for the whole uterus transplant community. It's a landmark birth."
Similarly, Rebecca Flyckt, a reproductive endocrinologist at the Cleveland Clinic, called the case "really an exciting moment," and said it shows "that a deceased donor is really a good model" (Joseph, STAT News, 12/4; Kelland, Reuters, 12/4; Cheng, AP/Sacramento Bee, 12/4).
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