Livebirth after uterus transplantation

Mats Brännström, Liza Johannesson, Hans Bokström, Niclas Kvarnström, Johan Mölne, Pernilla Dahm-Kähler, Anders Enskog, Milan Milenkovic, Jana Ekberg, Cesar Diaz-Garcia, Markus Gäbel, Ash Hanafy, Henrik Hagberg, Michael Olausson, Lars Nilsson

Research output: Contribution to journalArticleResearchpeer-review

260 Citations (Scopus)

Abstract

BACKGROUND: Uterus transplantation is the first available treatment for absolute uterine infertility, which is caused by absence of the uterus or the presence of a non-functional uterus. Eleven human uterus transplantation attempts have been done worldwide but no livebirth has yet been reported.

METHODS: In 2013, a 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) underwent transplantation of the uterus in Sahlgrenska University Hospital, Gothenburg, Sweden. The uterus was donated from a living, 61-year-old, two-parous woman. In-vitro fertilisation treatment of the recipient and her partner had been done before transplantation, from which 11 embryos were cryopreserved.

FINDINGS: The recipient and the donor had essentially uneventful postoperative recoveries. The recipient's first menstruation occurred 43 days after transplantation and she continued to menstruate at regular intervals of between 26 and 36 days (median 32 days). 1 year after transplantation, the recipient underwent her first single embryo transfer, which resulted in pregnancy. She was then given triple immunosuppression (tacrolimus, azathioprine, and corticosteroids), which was continued throughout pregnancy. She had three episodes of mild rejection, one of which occurred during pregnancy. These episodes were all reversed by corticosteroid treatment. Fetal growth parameters and blood flows of the uterine arteries and umbilical cord were normal throughout pregnancy. The patient was admitted with pre-eclampsia at 31 full weeks and 5 days, and 16 h later a caesarean section was done because of abnormal cardiotocography. A male baby with a normal birthweight for gestational age (1775 g) and with APGAR scores 9, 9, 10 was born.

INTERPRETATION: We describe the first livebirth after uterus transplantation. This report is a proof-of-concept for uterus transplantation as a treatment for uterine factor infertility. Furthermore, the results show the feasibility of live uterus donation, even from a postmenopausal donor.

FUNDING: Jane and Dan Olsson Foundation for Science.

Original languageEnglish
Pages (from-to)607-616
Number of pages10
JournalThe Lancet
Volume385
Issue number9968
DOIs
Publication statusPublished - 14 Feb 2015
Externally publishedYes

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Uterus
Transplantation
Pregnancy
Infertility
Adrenal Cortex Hormones
Single Embryo Transfer
Tissue Donors
Cardiotocography
Uterine Artery
Menstruation
Umbilical Cord
Azathioprine
Tacrolimus
Fertilization in Vitro
Therapeutics
Fetal Development
Pre-Eclampsia
Fetal Blood
Sweden
Cesarean Section

Cite this

Brännström, M., Johannesson, L., Bokström, H., Kvarnström, N., Mölne, J., Dahm-Kähler, P., ... Nilsson, L. (2015). Livebirth after uterus transplantation. The Lancet, 385(9968), 607-616. https://doi.org/10.1016/S0140-6736(14)61728-1
Brännström, Mats ; Johannesson, Liza ; Bokström, Hans ; Kvarnström, Niclas ; Mölne, Johan ; Dahm-Kähler, Pernilla ; Enskog, Anders ; Milenkovic, Milan ; Ekberg, Jana ; Diaz-Garcia, Cesar ; Gäbel, Markus ; Hanafy, Ash ; Hagberg, Henrik ; Olausson, Michael ; Nilsson, Lars. / Livebirth after uterus transplantation. In: The Lancet. 2015 ; Vol. 385, No. 9968. pp. 607-616.
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Brännström, M, Johannesson, L, Bokström, H, Kvarnström, N, Mölne, J, Dahm-Kähler, P, Enskog, A, Milenkovic, M, Ekberg, J, Diaz-Garcia, C, Gäbel, M, Hanafy, A, Hagberg, H, Olausson, M & Nilsson, L 2015, 'Livebirth after uterus transplantation' The Lancet, vol. 385, no. 9968, pp. 607-616. https://doi.org/10.1016/S0140-6736(14)61728-1

Livebirth after uterus transplantation. / Brännström, Mats; Johannesson, Liza; Bokström, Hans; Kvarnström, Niclas; Mölne, Johan; Dahm-Kähler, Pernilla; Enskog, Anders; Milenkovic, Milan; Ekberg, Jana; Diaz-Garcia, Cesar; Gäbel, Markus; Hanafy, Ash; Hagberg, Henrik; Olausson, Michael; Nilsson, Lars.

In: The Lancet, Vol. 385, No. 9968, 14.02.2015, p. 607-616.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Johannesson, Liza

AU - Bokström, Hans

AU - Kvarnström, Niclas

AU - Mölne, Johan

AU - Dahm-Kähler, Pernilla

AU - Enskog, Anders

AU - Milenkovic, Milan

AU - Ekberg, Jana

AU - Diaz-Garcia, Cesar

AU - Gäbel, Markus

AU - Hanafy, Ash

AU - Hagberg, Henrik

AU - Olausson, Michael

AU - Nilsson, Lars

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N2 - BACKGROUND: Uterus transplantation is the first available treatment for absolute uterine infertility, which is caused by absence of the uterus or the presence of a non-functional uterus. Eleven human uterus transplantation attempts have been done worldwide but no livebirth has yet been reported.METHODS: In 2013, a 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) underwent transplantation of the uterus in Sahlgrenska University Hospital, Gothenburg, Sweden. The uterus was donated from a living, 61-year-old, two-parous woman. In-vitro fertilisation treatment of the recipient and her partner had been done before transplantation, from which 11 embryos were cryopreserved.FINDINGS: The recipient and the donor had essentially uneventful postoperative recoveries. The recipient's first menstruation occurred 43 days after transplantation and she continued to menstruate at regular intervals of between 26 and 36 days (median 32 days). 1 year after transplantation, the recipient underwent her first single embryo transfer, which resulted in pregnancy. She was then given triple immunosuppression (tacrolimus, azathioprine, and corticosteroids), which was continued throughout pregnancy. She had three episodes of mild rejection, one of which occurred during pregnancy. These episodes were all reversed by corticosteroid treatment. Fetal growth parameters and blood flows of the uterine arteries and umbilical cord were normal throughout pregnancy. The patient was admitted with pre-eclampsia at 31 full weeks and 5 days, and 16 h later a caesarean section was done because of abnormal cardiotocography. A male baby with a normal birthweight for gestational age (1775 g) and with APGAR scores 9, 9, 10 was born.INTERPRETATION: We describe the first livebirth after uterus transplantation. This report is a proof-of-concept for uterus transplantation as a treatment for uterine factor infertility. Furthermore, the results show the feasibility of live uterus donation, even from a postmenopausal donor.FUNDING: Jane and Dan Olsson Foundation for Science.

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Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P et al. Livebirth after uterus transplantation. The Lancet. 2015 Feb 14;385(9968):607-616. https://doi.org/10.1016/S0140-6736(14)61728-1