Wednesday, 19 December, 2018

Baby born to woman with uterus from deceased donor

Doctors hold a baby girl born to a mother who received a uterus from a deceased donor in Brazil. A novel transplantation procedure may help more infertile women become pregnant First baby born via uterus transplanted from dead donor
Celia Hoffman | 05 December, 2018, 19:53

Deceased donor uterus transplants have been attempted in the past few years, but none resulted in the birth of a healthy baby.

In a medical first, a mother who received a uterus transplant from a dead donor has given birth to a healthy baby.

"This is a very important birth for the whole uterus transplant community", said Dr. Liza Johannesson, a uterus transplant surgeon at Baylor who previously worked with the Swedish research team. Most obviously, doctors do not have to worry about the donor's heath.

Uterine factor infertility is infertility in women born without a uterus; loss of the organ due to hysterectomy, cancer or postpartum haemorrhage; or a congenital defect, such as the rare Mayer-Rokitankshy-Kuster-Hauser syndrome, which was the reason for the Brazilian woman's infertility. In the first, the uterus had to be removed from the recipient after an infection occurred; Flyckt said she couldn't say where things stood with the second case other than that the recipient was doing well.

Dr Dani Ejzenberg, from Hospital das Clínicas in Sao Paolo, said: "The first uterus transplants from live donors were a medical milestone, creating the possibility of childbirth for many infertile women with access to suitable donors and the needed medical facilities".

In a commentary published with the Lancet case study, two researchers suggest that as more successful uterus transplant surgeries are performed, it may be possible to expand the eligibility criteria. But donors are hard to find and the surgical procedure to remove the womb from a living person can be unsafe.

She added, however, that the outcomes and effects of womb donations from live and deceased donors have yet to be compared, and said the technique could still be refined and optimised. For future procedures he hopes to cut down on the time to transplant by removing the uterus before other organs, like the heart and kidneys.

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The woman's pregnancy was normal, and doctors performed a Caesarean section on December 15, 2017, after about 36 weeks (a full term is about 40 weeks).

The donor uterus was removed during delivery, Ejzenberg says, since the team's study involved only one birth per mother.

"We are authorized to do two more cases and we are focused on improving our protocol to be able to repeat this success story", Natalie Ehrmann Fusco, a spokesperson for the doctors on the project, told IFLScience.

The team carefully dissected the uterus from the donor before carrying out the 10-and-a-half-hour operation in September 2016 to insert the organ, which weighed 225g.

"The successful case in our service brings hope to other centers that believe in this type of transplant", Ejzenberg said in an email to TIME. They attached a stump of the donor's vagina to that of the recipient, as well as connecting blood vessels and ligaments.

Another unknown is how likely the body is to reject a transplanted uterus, and thus how much antirejection medication the recipient would need, O'Neill says. "While uterine surrogacy is legal in the us, this offers an option, albeit an extreme and expensive one, to women who want to carry their own baby".

In 2016, doctors at the Cleveland Clinic in OH transplanted a uterus from a deceased donor, but it failed after an infection developed.

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