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Cadaveric Uterus Transplant Outcomes: Cleveland Experience

C. Quintini1, G. D’Amico1, B. Eghtesad1, E. Richards1, C. Kwon1, K. Hashimoto1, S. Ricci1, R. Flyckt2, C. Ferrando1, A. Simioni1, L. Del Angel Diaz1, C. Miller1, T. Falcone1, A. Tzakis3

1Cleveland Clinic, Cleveland, OH, 2University Hospitals, Cleveland, OH, 3Cleveland Clinic Florida, Weston, FL

Meeting: 2020 American Transplant Congress

Abstract number: 505

Keywords: Cadaveric organs, Morbidity, Outcome, Pregnancy

Session Information

Session Name: Vascularized Composite Allograft

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 3:15pm-3:27pm

Location: Virtual

*Purpose: Uterus transplantation (UTx) is a novel treatment modality for women with absolute uterine factor infertility. The majority of uterine transplants performed in the world are from living donation. We report here our experience with 7 uterine transplants performed with cadaveric donors.

*Methods: Key recipient inclusion criteria for this IRB approved study were: a diagnosis of uterine factor infertility, a BMI < 30 kg/m2, ages 18 to 45 and embryos produced between the ages 21 to 39. Key donor criteria were: a healthy uterus and acceptable serologies. Donor hospital located within a radius of 250 miles of our transplant center and a history of previous term pregnancies were prioritized.

*Results: A total of 7 UTx from brain dead donors have been performed since 2016. Indication was Mayer-Rokitansky-Küster-Hauser syndrome in all cases. The median operative time was 7 hrs 46 min (6:49-8:52) and median cold ischemia time was 5 hrs 29 min (4:14-5:48). The median hospital stay was 7(6-14) days. One of the transplants resulted in the delivery of a healthy baby, a second patient is pregnant (second trimester) and one is scheduled for embryo transfer. Two recipients are 4 months after transplant with a viable graft. Two of these six patients experienced bouts of severe rejection successfully treated without graft loss. Interestingly, one rejected graft hosted the full term pregnancy. All patients are alive, 2 grafts were lost (Table 1- complications).

*Conclusions: Our results suggest that deceased donor uterus transplantation is an effective strategy for the treatment of uterine factor infertility avoiding the potential morbidity and mortality related to living donor surgeries.

Table 1: UTx complications
UTx Complications
1
  • Hysterectomy (Mycotic Pseudoaneurism)
2
  • Rejection before pregnancy (Grade 3) and early during pregnancy (Grade 2)
  • Placenta previa and accrete
  • Transient creatinine elevation (1.4 mg/dl)
3
  • Graft requiring venous outflow Y graft reconstruction
  • Reoperation for hematoma
  • DVT/PE
  • Hemorrhagic ovarian cyst (POM2)
4
  • Biopsy related endocervical hematoma
  • Post-transplant DM and elevated HbA1C
  • Transient CMV viremia
5
  • Hysterectomy POD6 (delayed vascular thrombosis)
6
  • Re-exploration on POD1 due to poor window US, tachycardia and pain
  • Severe rejection
7
  • Incisional hematoma

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To cite this abstract in AMA style:

Quintini C, D’Amico G, Eghtesad B, Richards E, Kwon C, Hashimoto K, Ricci S, Flyckt R, Ferrando C, Simioni A, Diaz LDelAngel, Miller C, Falcone T, Tzakis A. Cadaveric Uterus Transplant Outcomes: Cleveland Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/cadaveric-uterus-transplant-outcomes-cleveland-experience/. Accessed May 9, 2025.

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