*Purpose: Uterus transplantation (UTx) is the most commonly performed vascular composite allograft and is rapidly becoming an accepted treatment for absolute uterine-factor infertility (AUFI). There is little known of how ABO/HLA -donor/recipient compatibility affects UTx transplant outcome. This study aimed to assess the importance of ABO/HLA-donor/recipient compatibility in relation to rejection, graft survival and live birth rate.

*Methods: We included 16 recipients that underwent UTx at Baylor University Medical Center (2016-2021) from deceased (n=1) or living (n=15) donors. No donor/recipient pairs were biologically related. HLA high resolution typing in recipients and donors was performed by next generation sequencing. Patients received thymoglobulin and methylprednisolone at transplantation and tacrolimus and Azathioprine for maintenance therapy. Protocol cervical biopsies were performed monthly in non-pregnant patients and once/trimester in pregnant patients. The recipients were followed for a median of 36 months (range 1-60 months).

*Results: All donor/recipient pairs were ABO compatible. No recipients had pre-formed donor specific antibodies (DSA). Most cases (n=12/16) were ≥ 4/6 HLA mismatched to the recipients (Mean 4.25/6 A-B-DR mismatches, range 1-6). 38% (6/16) of the recipients experienced at least 1 acute rejection episode. One-year graft, patient survival, and live birth rate was 81%, 100%, and 56%, respectively. There was no association between HLA matching and outcomes.

*Conclusions: Uterus transplant has shown to be an efficacious treatment for absolute uterine infertility. In our study we observed no relation between HLA matching and transplant outcomes in rejection rate, graft survival, or live birth rate.

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