Successful birth after womb is transplanted from deceased donor

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A woman in Brazil who received a womb transplanted from a deceased donor has given birth to a baby girl in the first successful case of its kind, doctors reported. Reuters reports that the case involved connecting veins from the donor uterus with the recipient’s veins, as well as linking arteries, ligaments and vaginal canals. It comes after 10 previously known cases of uterus transplants from deceased donors – in the US, the Czech Republic and Turkey – failed to produce a live birth.

The girl born in the Brazilian case was delivered via caesarean section at 35 weeks and three days, and weighed 2,550 grams (nearly 6 lbs), the case study said. Dani Ejzenberg, a doctor at Brazil’s Sao Paulo University Hospital who led the research, said the transplant – carried out in September 2016 when the recipient was 32 – shows the technique is feasible and could offer women with uterine infertility access to a larger pool of potential donors.

The current norm for receiving a womb transplant is that the organ would come from a live family member willing to donate it. “The numbers of people willing and committed to donate organs upon their own deaths are far larger than those of live donors offering a much wider potential donor population,” Ejzenberg said. She added, however, that the outcomes and effects of womb donations from live and deceased donors have yet to be compared, and said the technique could still be refined and optimised.

The report says the first baby born after a live donor womb transplant was in Sweden in 2013. Scientists have so far reported a total of 39 procedures of this kind, resulting in 11 live births.

Experts estimate that infertility affects around 10% to 15% of couples of reproductive age worldwide. Of this group, around one in 500 women have uterine problems. Before uterus transplants became possible, the only options to have a child were adoption or surrogacy.

In the Brazilian case the recipient had been born without a uterus due to a condition known as Mayer-Rokitansky-Küster-Hauser syndrome. The donor was 45 and died of a stroke. Five months after the transplant, Eizenberg’s team wrote, the uterus showed no signs of rejections, ultrasound scans were normal, and the recipient was having regular menstruation. The woman’s previously fertilised and frozen eggs were transplanted after 7 months and 10 days later she was confirmed pregnant.

At seven months and 20 days, the baby girl was continuing to breastfeed and weighed 7.2kg.

Summary
Background: Uterus transplantation from live donors became a reality to treat infertility following a successful Swedish 2014 series, inspiring uterus transplantation centres and programmes worldwide. However, no case of livebirth via deceased donor uterus has, to our knowledge, been successfully achieved, raising doubts about its feasibility and viability, including whether the womb remains viable after prolonged ischaemia.
Methods: In September, 2016, a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) underwent uterine transplantation in Hospital das Clínicas, University of São Paulo, Brazil, from a donor who died of subarachnoid haemorrhage. The donor was 45 years old and had three previous vaginal deliveries. The recipient had one in-vitro fertilisation cycle 4 months before transplant, which yielded eight cryopreserved blastocysts.
Findings: The recipient showed satisfactory postoperative recovery and was discharged after 8 days’ observation in hospital. Immunosuppression was induced with prednisolone and thymoglobulin and continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF. First menstruation occurred 37 days post-transplantation, and regularly (every 26–32 days) thereafter. Pregnancy occurred after the first single embryo transfer 7 months post-transplantation. No blood flow velocity waveform abnormalities were detected by Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries, nor any fetal growth impairments during pregnancy. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred on Dec 15, 2017, near gestational week 36. The female baby weighed 2550 g at birth, appropriate for gestational age, with Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum. The uterus was removed in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.
Interpretation: We describe, to our knowledge, the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with MRKH syndrome. The results establish proof-of-concept for treating uterine infertility by transplantation from a deceased donor, opening a path to healthy pregnancy for all women with uterine factor infertility, without need of living donors or live donor surgery.

Authors
Dani Ejzenberg, Wellington Andraus, Luana Regina Baratelli Carelli Mendes, Liliana Ducatti, Alice Song, Ryan Tanigawa, Vinicius Rocha-Santos, Rubens Macedo Arantes, José Maria Soares Jr, Paulo Cesar Serafini, Luciana Bertocco de Paiva Haddad, Rossana Pulcinelli Francisco, Luiz Augusto Carneiro D’Albuquerque, Edmund Chada Baracat

 

British doctors say they are planning to replicate the procedure in the UK. According to a report in The Daily Telegraph, infertility affects one in seven people in Britain, and while some problems can be solved through IVF, most women with womb issues have no alternative but adoption or surrogacy.

Richard Smith, consultant gynaecologist at Queen Charlotte’s and Chelsea Hospital in London and clinical lead at Womb Transplant UK said that his team hoped to start similar procedures shortly.

Hundreds of women in Britain have already signed up to have womb transplants and doctors are now waiting for suitable tissue matches and donors to become available.
“The UK womb transplant research team is absolutely delighted with the news from Brazil,” said Smith “Womb transplant using organs from living donors and donors who have just died is a real option for some of the many women in the UK who don’t have a viable womb. We hope to replicate this in the not too distant future. Watch this space.”

The study was welcomed by British fertility experts, saying if offered new hope for a woman with womb problems to carry and give birth to their own child.

Dr Srdjan Saso, honorary clinical lecturer & senior registrar in obstetrics and gynaecology, at Imperial College London, and also part of the Womb Transplant team said the research was “extremely exciting.”

“Our hope, as we plan to kick-start the UK programme at the beginning of 2019, is for the deceased donor uterine transplant programme to grow alongside its ‘live donor’ counterpart, prove achievable and successful so that both women with willing donors in their families, and those not, can have a real option of carrying a healthy pregnancy.”

Professor Andrew Shennan, professor of obstetrics, King’s College London, added: “This opens the possibility of women donating their womb following death, as with many other organs. “This allows a further option for women with uterine problems preventing them having a baby to carry their own child, rather than relying on live donors, a surrogate or adoption.”

“This is particularly important, as all previous successful live births were from patients who received a uterine transplant from a live donor.”

Reuters report
The Lancet article summary
The Daily Telegraph report


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