Ellen Phiddian
Cosmos science journalist
A US study of 20 people who received uterus transplants has found the process feasible, with 14 recipients going on to have live births.
Researchers said there were no abnormalities in the children born via transplanted uterus, but they highlight risks from surgery that affected both recipients and donors.
The study, which is published in the Journal of the American Medical Association, reports on a clinical trial run at the Baylor University Medical Center in Dallas, USA.
Since the first successful uterus transplant in 2011, there have been about 100 transplants worldwide, from both living and deceased donors.
Recipients are generally women with “absolute uterine infertility” – that is, problems with their uterus that make them unable to have a successful pregnancy.
In the USA, there have been 48 uterus transplants since they began in 2016, with 33 of the recipients going on to have live births.
In this trial, researchers enrolled 20 people, aged between 20-36 years old, all of whom had absolute uterine infertility but at least 1 working ovary.
Participants received uterus transplants from 18 living and 2 deceased donors between 2016 and 2019.
Of the 20 participants, 6 had graft failures within a fortnight and lost the transplanted organ.
“During the study period, the technical success of graft survival improved with time and experience,” write the researchers in their paper.
All 14 of the successful transplant recipients went on to become pregnant via IVF, and give birth via caesarean.
Two of the recipients gave birth twice, resulting in 16 total live births. Some of the recipients had miscarriages, mostly early in their pregnancy, as well as having full-term pregnancies.
None of the 16 babies had congenital abnormalities, and none show any notable developmental delays to date (the oldest child the researchers have followed up with is 6). One child was diagnosed with autism at age 2 after missing communication milestones, and the researchers note his younger sister shows no signs of developmental delays.
Transplanted uteruses are typically removed again after 1 or 2 successful pregnancies, and this is the case with these 14 recipients. At the moment, 13 have had hysterectomies, while 1 still has the transplanted uterus in place for a second pregnancy.
Some of the surgeries in the trial – transplant donation, transplant reception, caesarean section, and graft hysterectomy – had complications.
Four of the living uterus donors had grade 3 complications – that is, they required surgery to fix – but none of them had experienced any long-term illness when they were followed up roughly 4 years later.
None of the successful graft recipients had severe complications from their transplant surgery, and while graft loss is a grade 3 complication, none of the 6 unsuccessful recipients had experienced long-term effects when they were followed up.
The researchers also point out that all recipients needed immunosuppression treatment to accept the donated organs, and the “long-term impact of immunosuppression in these otherwise healthy women remains unknown”.
In their paper, the researchers conclude that uterus transplants are technically feasible, but the surgeries involved carry risks for donors and recipients.
“The live birth success rate in this study suggests that a successfully transplanted uterus is capable of functioning at least on par with a native, in situ uterus,” they write.
But they also point out that the “currently prohibitive cost of uterus transplant” makes it difficult to tell how generalisable their results are.
