Twelve Live Births After Uterus Transplantation in the Dallas UtErus Transplant Study.

Obstet Gynecol

Annette C. and Harold C. Simmons Transplant Institute, the Fertility Center of Dallas, the Department of Obstetrics and Gynecology, and the Department of Neonatology, Baylor University Medical Center, and the Fetal Care Center, Dallas, Texas; and the Department of Obstetrics and Gynecology, PRISMA Health-University of South Carolina School of Medicine, Columbia, South Carolina.

Published: February 2021

AI Article Synopsis

  • The study focused on the pregnancy outcomes of 20 women who underwent uterus transplantation at Baylor University Medical Center from 2016 to 2019, emphasizing live birth rates and maternal complications.
  • Six graft failures occurred during the transplants, while 11 out of 14 successful transplants resulted in at least one live birth, leading to a 55% overall live-birth rate per attempted transplant and 79% for successful ones.
  • Maternal complications were noted, including elevated creatinine, gestational diabetes, and hypertension, with a median gestational age at delivery of about 37 weeks, and all neonates had Apgar scores of 8 or higher, indicating good health at birth.

Article Abstract

Objective: To describe aggregated pregnancy outcomes after uterus transplantation from a single, experienced center.

Methods: This prospective study reports on live births among 20 women who received a uterus transplant from 2016 to 2019 at Baylor University Medical Center at Dallas. These live births occurred between November 2017 and September 2020. The main measures were live birth, maternal complications, and fetal and newborn outcomes.

Results: There were six graft failures (four surgical complications and two with poor perfusion postoperatively). Of the 14 technically successful transplants, at least one live birth occurred in 11 patients. Thus far, the live birth rate per attempted transplant is 55%, and the live-birth rate per technically successful transplant is 79%. Ten uteri were from nondirected living donors and one uterus was from a deceased donor. In vitro fertilization was performed to achieve pregnancy. Ten recipients delivered one neonate, and one recipient delivered two neonates. One organ rejection episode was detected during pregnancy and was resolved with steroids. The median birth weight was 2,890 g (range 1,770-3,140 g [median 68th percentile]). Maternal weight gain was higher than Institute of Medicine recommendations. Maternal medical complications were observed in five recipients (elevated creatinine level, gestational diabetes, gestational hypertension [n=2], and preeclampsia). In five recipients, maternal medical or obstetric complications led to an unplanned preterm delivery (elevated creatinine level, preeclampsia; preterm labor [n=3]). The median gestational age at delivery was 36 6/7 weeks (range 30 6/7-38 weeks). All neonates were liveborn, with Apgar scores of 8 or higher at 5 minutes.

Conclusion: Over the first 3 years, our program experienced a live-birth rate per attempted transplant of 55% and a live-birth rate per technically successful transplant of 79%. In our experience, uterus transplantation resulted in a third-trimester live birth in all cases in which pregnancies reached 20 weeks of gestation. Maternal medical and obstetric complications can occur; however, these were manageable by applying principles of generally accepted obstetric practice.

Clinical Trial Registration: ClinicalTrials.gov, NCT02656550.

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Source
http://dx.doi.org/10.1097/AOG.0000000000004244DOI Listing

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