Uterus Proposed as Transplant Candidate

By Michael Smith, Senior Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. January 02, 2007
Additional Infertility Coverage
NEW YORK, Jan. 2 -- The next step in assisted reproduction may be a uterus transplant, according to researchers here.

Although the prospect of a uterus transplant raises ethical issues, it is technically feasible by current transplant protocols and local organ donor networks, says Giuseppe Del Priore, M.D., of New York Downtown Hospital.
Dr. Del Priore and colleagues took part in an organ donor network retrieval team for more than six months and successfully retrieved the uterus in eight of nine cases, they reported in the January issue of Obstetrics & Gynecology.
"Our hope is to eventually restore reproductive function through transplantation of a human uterus," Dr. Del Priore and colleagues said, and creating techniques to retrieve the organ is a key first step.
For the study, about 1,800 eligible organ donors were identified and multi-organ procurement surgery took place in about 150, the researchers reported. There was specific consent from the families to retrieve the uterus in nine cases.
However, one donor did not have retrieval surgery because her clinical status deteriorated before a full retrieval team could be gathered, the researchers said.
The causes of death included stroke, cardiac arrest during electrophysiologic testing, and traumatic brain injury. All donors had previously given birth, with between one and three deliveries of healthy children, and were 30 to 45 years old.
The procedure added 10 to 30 minutes of operating time, Dr. Del Priore and colleagues reported, but by the fourth patient, the average time needed for the entire uterine dissection was down to about 15 minutes.
The organs appeared to remain viable, with no histologic changes when they were kept for 12 hours in cold conditions without a blood supply.
Before the development of current assisted reproductive therapy, the researchers noted, scientists had been studying reproductive organ transplant in animals with a view to transferring the techniques to humans.
Current reproductive therapy has helped many people. Dr. Del Priore and colleagues noted, but there is little that can be done for women without a functioning uterus.
Potential mothers who wish to receive a uterus would have to take the risk of short-term immunosuppression - one or two years for one successful pregnancy, Dr. Del Priore said.
On the other hand, the situation for the fetus appears to be relatively reassuring, the researchers said, because many women who have had other forms of transplants have had successful pregnancies.
"When controlled for other factors, pregnancy outcomes appear acceptable," the researchers said. "Fortunately, long-term safety data are available because generations have now become pregnant after organ transplants."
The procedure appears likely to have many takers, Dr. Del Priore said. He and colleagues have more than one hundred candidates in the preparation process.
http://www.medpagetoday.com/Endocrinology/Infertility/tb/4783