The first human uterus allograft from a cadaveric donor

Transplantation of a uterus into a woman with absolute uterine-related infertility could be a real solution. We transplanted the uterus of a brain-dead woman into a patient of 21 with Rokitansky-Kuster-Hauser syndrome. Transplantation consisted of revascularisation of the right and left hypogastric vessels, orthotopic positioning of the uterus, connection of the transplanted vaginal extension to the neovaginal (previously reconstructed with intestine) vault and fixation of all necessary supplementary ligaments to provide a stable structure. Immunosuppressive treatment was administered with antithymocyte globulin (in the induction period of first 10 days), tacrolimus, mycophenolate mofetil (changed to Azothioprine 1 year postoperatively) and prednisone. Follow-up included routine viability tests, blood samples, biopsies and psychological support. The postoperative course was uneventful. No surgical complication occurred. No clinical or histopathological signs of rejection were seen. Starting from the first month after transplantation, the patient had menstrual bleeding with almost every cycle. Embryo transfers resulted with positive pregnancy in 4 of 8 attempts confirmed with transvaginal ultrasound visualization of an intrauterine gestational sac with heartbeating (in 2 of pregnancies) without any live birth. The early structural and functional results are promising, and real success will be assessed in the future; but this allograft can already be regarded as successful in that our patient is the first to receive a uterus from a deceased donor. This is also the longest-lived transplanted uterus to date. The three-year outcome demonstrates the feasibility of this procedure.