First Baby Born to Woman With Uterus Transplant From Deceased Donor
(CNN)For the first time, a baby has been built-in to a woman who received a uterus transplant from a deceased donor, according to Infirmary das Clínicas at the University of São Paulo School of Medicine in Brazil.
The uterus or womb, which is shaped like a topsy-turvy pear and sits within the pelvis, is a female reproductive organ that houses and nourishes the fetus until birth. At least a dozen children in Sweden, the United states of america and Serbia have been born to women with transplanted uteri donated by a living relative, noted the authors of the study, which was published Tuesday in the medical periodical The Lancet.
"The results provide proof-of-concept for a new handling choice for absolute uterine factor infertility," wrote co-authors Dr. Dani Ejzenberg, an ob/gyn at the University of Sao Paulo and Infirmary das Clínicas in Brazil, and Dr. Wellington Andraus, a transplant surgeon at the Sao Paulo University School of Medicine in the report. Less than v% of women worldwide accept some type of "absolute uterine factor infertility," in which an abnormality of the womb interferes with fetal evolution.
The Brazilian squad followed protocols established by Dr. Mats Brännström and his team at the University of Gothenburg in Sweden, where the first successful uterus transplant, that one from a living donor, was performed in 2013. That recipient female parent gave birth in 2014.
From transplant to nascency
The transplant recipient, who had been born without a uterus, was 32 years erstwhile at the time of the surgery in September 2016. (The patient's identity remains bearding, which is typical for published case studies.) Her diagnosis: Mayer-Rokitansky-Küster-Hauser syndrome, a genetic condition that affects 1 in 4,500 women and causes a patient's vagina and uterus to exist either absent or underdeveloped, although her external genitals appear normal and her ovaries still part and comprise eggs.
Months before receiving a uterus transplant, the patient underwent in-vitro fertilization. This resulted in eight skillful-quality early-stage embryos, which were cryopreserved in the hopes of being used afterwards a uterus transplant.
The donor, a 45-year-old woman who died of a stroke, was deemed a good candidate because she had had three vaginal deliveries during her life, she had no reported sexual disease and her blood type, O-positive, matched that of the recipient.
The procedure to transfer the uterus from donor to recipient lasted more than than x hours. The surgery involved connecting the recipient'due south veins and arteries, ligaments and vaginal canals with the donated uterus. For eight days, the recipient remained in the infirmary, where she received five immunosuppression drugs, which command the body's natural instinct to fight off and reject a transplanted organ.
V months after the transplant, the recipient showed no signs of rejecting the uterus, and for the beginning time in her life, she experienced menstruation. Ultrasound scans too showed no abnormalities.
After seven months of cautious watching and waiting, doctors implanted a unmarried fertilized egg, though in previous uterus transplants, doctors waited a full year to implant. The shorter timetable was intended to reduce patient expenses and take a chance, because the possibility of the body rejecting an organ can increase over time.
Pregnancy was confirmed x days later. Throughout the pregnancy, all the usual tests showed a normal fetus with no anomalies. Other than a kidney infection treated with antibiotics at 32 weeks, the mother had no bug during her pregnancy and continued her immunosuppression regimen to prevent rejection of the implanted womb.
A girl weighing nearly 6 pounds was born on December 15, 2017, at 35 weeks and three days -- a late pre-term nascency. Ejzenberg and Andraus said Brännström's group "recommended commitment between 34 and 36 weeks due to the risk of restriction of fetal growth due to immunosuppressive therapy."
The mother delivered via c-section, which included a removal of the transplanted uterus so she could stop using immunosupressive drugs, according to Ejzenberg and Andraus. The organ showed no evidence of rejection, only the usual changes that occur during pregnancy. Both female parent and child were discharged from the infirmary 3 days after.
At the historic period of 7 months and xx days when the instance study was written, the babe connected to breastfeed and weighed well-nigh 16 pounds.
The baby volition celebrate her offset birthday inside ii weeks, Ejzenberg and Andraus said. Mother and child take experienced no complications or abnormalities.
This nascence is the first uterus transplant of any kind performed in Latin America and the showtime using a cadaver organ. Previous attempts at using a cadaver uterus take not resulted in a live nascence.
Ejzenberg and Andraus said their team'due south success "brings hope to other centers that believe in this blazon of transplant and that have not been successful until [this] moment. Information technology is also a source of hope for patients who do not accept a family fellow member or close friend to donate the uterus."
Why this is unique
Dr. Andrew Shennan, a professor of obstetrics at Kings Higher London, told the Scientific discipline Media Centre that what is unique about this case is that the pregnancy occurred "in spite of the uterus (womb) existence without oxygen for 8 hours before transplant." In fact, the new study proves that it could remain functional after common cold, oxygen-less storage at least 4 times equally long equally the average fourth dimension later on alive donation: nearly eight hours, versus less than than two.
Shennan, who was not involved in either the transplant or the birth, added that this instance "opens the possibility of women donating their womb following decease, as with many other organs." And "rather than relying on live donors, a surrogate or adoption," women who are infertile due to uterine factor infertility might soon take another option.
Brännström wrote in an electronic mail that "56 uterine transplant procedures accept been performed worldwide," and although half have occurred in Europe (Sweden, Czech Democracy, Germany, and Serbia), they have also been washed in Asia, the Middle E and North America. He added that 53 of the transplants involved women born with no uterus.
These transplants have yielded "13 babies built-in worldwide" via uterus transplants, including the nascence documented in the new case written report, Brännström said. His own team conducted a series of transplants in multiple women resulting in several live births.
Though the success of uterus transplants has been proven, Brännström said, "it is important that information technology too works with a deceased donor, with longer ischemic fourth dimension and less fourth dimension to investigate the organ." Ischemic fourth dimension is the amount of time a donated organ remains chilled and without blood menstruum. The technique yet needs to be "replicated by several teams effectually the globe" for further validation, he said.
The American Gild for Reproductive Medicine recognizes uterus transplantation every bit a "successful medical treatment of absolute uterus factor infertility" yet cautions that the procedure is all the same "highly experimental" in nature. At the time they wrote the study, the authors recorded 10 cadaver uterus transplants attempted or underway in the U.s., Turkey and the Czech Republic.
Brännström, though, feels hopeful and believes that time to come transplants volition not only create new life, they volition "greatly increase the quality of life for parents and grandparents."
Source: https://www.cnn.com/2018/12/04/health/uterus-transplant-deceased-donor-study/index.html
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