*Purpose: Uterus transplantation allows women who do not have a uterus or have a nonfunctioning uterus to become pregnant and deliver a baby. We analyze the first 14 cases of uterus transplantation with focus on recipient complications, follow-up and outcome.

*Methods: Over a 2-year period we have performed 14 uterus transplantations in our institution using grafts from both deceased (n=2) and living donors (n=12). The recipients were followed regularly with gynecological examination, cervical biopsies and sonograms. The main outcome measurements were hospital stay, postoperative complications, and success rate.

*Results: Five recipients had their uterine grafts removed within the first two weeks after surgery. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for three of the graft losses and organ-related factors for two. Four out of the seven recipients with ongoing grafts have experienced vaginal strictures at the vagina-vagina anastomosis necessitating surgical interventions. Four recipients were treated for rejection (grade 1, 2 and borderline) with steroid recycling with complete resolution. One of the treated women with borderline rejection delivered a healthy baby. All other borderline episodes resolved without treatment. One recipient developed cervical intraepithelial neoplasia 1 (CIN 1), but no action was required. Four of the recipients had a total of 11 embryo transfers resulting in four pregnancies. One recipient had a decreased kidney function during pregnancy which led to a decrease in her immunosuppression levels up until delivery and hysterectomy.

*Conclusions: Uterine transplantation is a promising treatment of uterine factor infertility that affects 1-5% of women. The lessons learned from our initial 14 recipients have been instrumental to our success, and we aim to share our conclusions and build on knowledge in the field of uterus transplantation.

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