Uterus Transplant in Women With Absolute Uterine-Factor Infertility

Question  Is uterus transplant safe and feasible, resulting in subsequent live births?

Findings  In this series of 20 participants, uterus allograft was successful in 70% of recipients and was associated with at least 1 live birth for all recipients with a successful allograft. Adverse events were common, with medical and surgical risks affecting recipients as well as donors.

Meaning  Uterus transplant was feasible and was associated with at least 1 subsequent live birth following a successful allograft.

Importance  Uterus transplant in women with absolute uterine-factor infertility offers the possibility of carrying their own pregnancy.

Objective  To determine whether uterus transplant is feasible and safe and results in births of healthy infants.

Design, Setting, and Participants  A case series including 20 participants with uterine-factor infertility and at least 1 functioning ovary who underwent uterus transplant in a large US tertiary care center between September 14, 2016, and August 23, 2019.

Intervention  The uterus transplant (from 18 living donors and 2 deceased donors) was surgically placed in an orthotopic position with vascular anastomoses to the external iliac vessels. Participants received immunosuppression until the transplanted uterus was removed following 1 or 2 live births or after graft failure.

Main Outcomes and Measures  Uterus graft survival and subsequent live births.

Results  Of 20 participants (median age, 30 years [range, 20-36]; 2 Asian, 1 Black, and 16 White), 14 (70%) had a successful uterus allograft; all 14 recipients gave birth to at least 1 live-born infant. Eleven of 20 recipients had at least 1 complication. Maternal and/or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (2 [14%]), cervical insufficiency (2 [14%]), and preterm labor (2 [14%]). Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications.

Conclusions and Relevance  Uterus transplant was technically feasible and was associated with a high live birth rate following successful graft survival. Adverse events were common, with medical and surgical risks affecting recipients as well as donors. Congenital abnormalities and developmental delays have not occurred to date in the live-born children.

Trial Registration  ClinicalTrials.gov Identifier: NCT02656550