Uterus transplantation

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The uterine transplant is the surgical procedure whereby a healthy uterus is transplanted into an organism whose uterus is absent or diseased. As part of the normal mammalian sexual reproduction process, a diseased or absent uterus does not allow for normal embryonic implantation to occur, effectively rendering a female infertile. This phenomenon is known as Absolute uterine factor infertility (AUFI). The uterine transplant is currently being proposed as a potential treatment to this form of infertility.

History[edit]

In 1896, Emil Knauer published the first study of ovarian autotransplantation documenting normal function (in a rabbit) and that led to the investigation of uterine transplantation in 1918.[1][2] Eraslan, Hamernik and Hardy, in 1964 and 1966, 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 an co-workers demonstrated the worlds first succesful allogenic uterus transplantation in rat with healthy offspring.[4]

In humans[edit]

In 1931, Lili Elbe died from organ rejection three months after receiving one of the world's earliest uterine transplants.[5] With the availability of in vitro fertilization in 1978, uterine transplantation research was deferred (Confino et al. 1986).

In Saudi Arabia in 2000, a uterine transplant was performed by Dr. Wafa Fagee from a 46 year old hysterectomy patient into a 26 year old recipient[6] whose own uterus had hemorrhaged after childbirth. The transplanted uterus functioned for 99 days; however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful.[7] Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea; exploratory laparotomy confirmed uterine necrosis. The procedure has raised some moral and ethical concerns, which have been addressed in the literature.[8]

In Turkey 9th of August 2011 The world's first uterus transplant from a deceased donor was conducted by a team of doctors from Akdeniz University Hospital in southern Turkey.[9][10][11][12][13][14][15][16] A 21-year-old Turkish woman named Derya Sert, who was born without a uterus, was the first woman in history to have received a womb from a deceased donor. The operation, performed by Dr. Ömer Özkan, Dr. Munire Erman Akar and their team at Akdeniz University Hospital in Antalya, was the world's first uterus transplant surgery gaining long term function as evident by the fact that Ms. Sert has had 6 menstrual periods post-surgery and it is said that the uterus is fully functioning. However, the Turkish medical team who performed the delicate surgery is still cautious about declaring the operation a complete success. "The surgery was a success. But we will be successful when she has her baby", Ozkan said. "For now, we are happy that the tissue is living".[17] On 12 April 2013, Akdeniz University announced that Derya Sert was pregnant.[18][19][20] The statement made by the university hospital also added that Ms Sert would give birth by C-section to prevent any complications. On 14 May 2013, it was announced that Ms Sert terminated her pregnancy in its 8th week following a routine examination where doctors failed to detect a fetal heartbeat.[21]


In Sweden 2012 The first mother-to-daughter[22] womb transplant was done by Swedish doctors at Sahlgrenska University Hospital at Gothenburg University led by Prof. Mats Brännström[23][24][25] The Uterus transplantation trial encompasses a total of 9 recipients.

Procedure[edit]

Uterus transplantation starts with uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates and more recently humans.[26][27][28][29][30][31] It may need to be stored, e.g., for transportation to the location of the donor. Studies on cold-ischemia/reperfusion indicate an ischemic tolerance of >24 h.[27]

The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation[edit]

"The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" were developed at McGill University and published in Transplant International.[8] 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.[32] An update to "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" has since been published in Fertility and Sterility[33]

References[edit]

  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. ^ Nugent, D; Meirow, D; Brook, PF; Aubard, Y; Gosden, RG (1997). "Transplantation in reproductive medicine: Previous experience, present knowledge and future prospects". Human Reproduction Update 3 (3): 267–80. doi:10.1093/humupd/3.3.267. PMID 9322102. 
  3. ^ Eraslan, S; Hamernik, RJ; Hardy, JD (1966). "Replantation of uterus and ovaries in dogs, with successful pregnancy". Archives of surgery 92 (1): 9–12. doi:10.1001/archsurg.1966.01320190011002. PMID 5948103. 
  4. ^ Díaz-García, César; Akhi, Shamima N.; Wallin, Ann; Pellicer, Antonio; Brännström, Mats. "First report on fertility after allogeneic uterus transplantation". Acta Obstetricia et Gynecologica Scandinavica 89 (11): 1491–1494. doi:10.3109/00016349.2010.520688. 
  5. ^ "Nicole Kidman as the world's first reported woman with surgically corrected Harry Benjamin Syndrome". Shb-info.org. Retrieved 2012-11-20. 
  6. ^ Nair, Anjana; Stega, Jeanetta; Smith, J. Richard; Del Priore, Giuseppe (2008). "Uterus Transplant". Annals of the New York Academy of Sciences 1127: 83–91. doi:10.1196/annals.1434.003. PMID 18443334. 
  7. ^ Grady, Denise (March 7, 2002). "Medical First: A Transplant Of a Uterus". The New York Times. 
  8. ^ a b Lefkowitz, Ariel; Edwards, Marcel; Balayla, Jacques (2012). "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation". Transplant International 25 (4): 439–47. doi:10.1111/j.1432-2277.2012.01438.x. PMID 22356169. 
  9. ^ "Nurse hopes to have world's first baby from a transplant womb donated by her own MOTHER". The Daily Mail (London). 2011-10-18. 
  10. ^ "Turkish woman has world's first womb transplant". timesofmalta.com. Retrieved 2012-11-21. 
  11. ^ "Revolutionary ‘Womb Transplant’ performed in Turkey - World’s First". Allvoices.com. Retrieved 2012-11-21. 
  12. ^ "World’s first successful uterus transplant performed in Turkey — RT". Rt.com. Retrieved 2012-11-21. 
  13. ^ "World’s first womb transplant in Turkey promises hope for women". Alarabiya.net. 2011-10-01. Retrieved 2012-11-21. 
  14. ^ "HEALTH - Doctors hopeful for uterus transplant". Hurriyetdailynews.com. 2011-09-13. Retrieved 2012-11-21. 
  15. ^ "World's first uterus transplant performed in Turkey/TRT-English". Trt-world.com. 2012-02-27. Retrieved 2012-11-21. 
  16. ^ "Turkish surgeons perform world's first uterus transplant | Family & Health". World Bulletin. Retrieved 2012-11-21. 
  17. ^ "World's first successful uterus transplant performed in Turkey". Rt.com. Oct 2011. Retrieved 2012-11-20. 
  18. ^ "Womb transplant recipient Derya Sert pregnant". AAP. 2013-04-13. 
  19. ^ http://shine.yahoo.com/healthy-living/womb-transplant-patient-derya-sert-is-pregnant--confirms-doctor-210119461.html
  20. ^ http://www.hurriyetdailynews.com/worlds-first-uterus-transplant-patient-pregnant-say-doctors.aspx?pageID=238&nID=44790&NewsCatID=373
  21. ^ Derya Sert'in gebeliği sonlandırıldı. CNNTurk.com. (Turkish)
  22. ^ Brännström, Mats; Johannesson, Liza; Dahm-Kähler, Pernilla; Enskog, Anders; Mölne, Johan; Kvarnström, Niclas; Diaz-Garcia, Cesar; Hanafy, Ash; Lundmark, Cecilia; Marcickiewicz, Janusz; Gäbel, Markus; Groth, Klaus; Akouri, Randa; Eklind, Saskia; Holgersson, Jan; Tzakis, Andreas; Olausson, Michael. "First clinical uterus transplantation trial: a six-month report". Fertility and Sterility 101 (5): 1228–1236. doi:10.1016/j.fertnstert.2014.02.024. 
  23. ^ Brännström, Mats; Diaz-Garcia, Cesar; Hanafy, Ash; Olausson, Michael; Tzakis, Andreas. "Uterus transplantation: animal research and human possibilities". Fertility and Sterility 97 (6): 1269–1276. doi:10.1016/j.fertnstert.2012.04.001. 
  24. ^ Brännström, Mats; Johannesson, Liza; Dahm-Kähler, Pernilla; Enskog, Anders; Mölne, Johan; Kvarnström, Niclas; Diaz-Garcia, Cesar; Hanafy, Ash; Lundmark, Cecilia; Marcickiewicz, Janusz; Gäbel, Markus; Groth, Klaus; Akouri, Randa; Eklind, Saskia; Holgersson, Jan; Tzakis, Andreas; Olausson, Michael. "First clinical uterus transplantation trial: a six-month report". Fertility and Sterility 101 (5): 1228–1236. doi:10.1016/j.fertnstert.2014.02.024. 
  25. ^ Brannstrom, M.; Wranning, C. A.; Altchek, A. (7 November 2009). "Experimental uterus transplantation". Human Reproduction Update 16 (3): 329–345. doi:10.1093/humupd/dmp049. 
  26. ^ Johannesson, Liza; Diaz-Garcia, Cesar; Leonhardt, Henrik; Dahm-Kähler, Pernilla; Marcickiewicz, Janusz; Olausson, Michael; Brännström, Mats. "Vascular Pedicle Lengths After Hysterectomy". Obstetrics & Gynecology 119 (6): 1219–1225. doi:10.1097/AOG.0b013e318255006f. 
  27. ^ a b Brannstrom, M.; Wranning, C. A.; Altchek, A. (2009). "Experimental uterus transplantation". Human Reproduction Update 16 (3): 329–45. doi:10.1093/humupd/dmp049. PMID 19897849. 
  28. ^ Wranning, C. A.; Akhi, S. N.; Diaz-Garcia, C.; Brannstrom, M. (15 December 2010). "Pregnancy after syngeneic uterus transplantation and spontaneous mating in the rat". Human Reproduction 26 (3): 553–558. doi:10.1093/humrep/deq358. 
  29. ^ Enskog, A.; Johannesson, L.; Chai, D. C.; Dahm-Kahler, P.; Marcickiewicz, J.; Nyachieo, A.; Mwenda, J. M.; Brannstrom, M. (2 June 2010). "Uterus transplantation in the baboon: methodology and long-term function after auto-transplantation". Human Reproduction 25 (8): 1980–1987. doi:10.1093/humrep/deq109. 
  30. ^ Dahm-Kähler, Pernilla; Wranning, Caiza; Lundmark, Cecilia; Enskog, Anders; Mölne, Johan; Marcickiewicz, Janusz; El-Akouri, Randa Racho; McCracken, John et al. "Transplantation of the uterus in sheep: Methodology and early reperfusion events". Journal of Obstetrics and Gynaecology Research 34 (5): 784–793. doi:10.1111/j.1447-0756.2008.00854.x. 
  31. ^ Wranning, Caiza Almen; El-Akouri, Randa Racho; Lundmark, Cecilia; Dahm-Kahler, Pernilla; Molne, Johan; Enskog, Anders; Brannstrom, Mats. "Auto-transplantation of the uterus in the domestic pig (Sus scrofa): Surgical technique and early reperfusion events". Journal of Obstetrics and Gynaecology Research 32 (4): 358–367. doi:10.1111/j.1447-0756.2006.00426.x. 
  32. ^ A. Lefkowitz, M. Edwards, J. Balayla, O081 THE MONTREAL CRITERIA FOR THE ETHICAL FEASIBILITY OF UTERINE TRANSPLANTATION, International Journal of Gynecology & Obstetrics, Volume 119, Supplement 3, October 2012, Page S289, ISSN 0020-7292, http://dx.doi.org/10.1016/S0020-7292(12)60511-6
  33. ^ Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation.A Lefkowitz, M Edwards, J Balayla - Fertility and Sterility, 2013. doi:10.1016/j.fertnstert.2013.05.026

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