First baby born in a transplanted uterus from deceased donor!

First baby born in a transplanted uterus from deceased donor!

9 December 2018 08:52 am

Hospital das Clinicas at the University of of São Paulo School of Medicine in Brazil reports that a baby has been born to a woman who received a uterus transplanted from a deceased donor.

This is considered to be the first time in history a baby is born in a transplanted uterus received from a deceased donor.

Upon conception the uterus nourishes a foetus until birth. Per remarks of medical journal ‘The Lancet’, at least a dozen children have been conceived to women with transplanted uteri in Sweden, the United States and Serbia, however only donated by a living relative. Ten previous attempts, according to 'NewScientists', in the United States, Czech Republic and Turkey, to achieve a live birth adopted by a uterus retrieved from a deceased individual had proven to be failure.

Dr. Dani Ejzenberg, and Obstetrician and Gynaecologist at the University of Sao Paulo and Hospital das Clinicas in Brazil, and Dr. Wellington Andraus, a Transplant Surgeon at the Sao Paulo University School of Medicine, wrote, “The results provide proof-concept for a new treatment option for absolute uterine factor infertility.” According to them, less than 5% of women worldwide have a form of a an absolute uterine factor infertility, in which an abnormality of the uterus that interferes with foetal development.

The first successful uterus transplantation was performed from a living donor in 2013 at the University of Gothenburg, Sweden.

The mother who received the transplanted uterus from a deceased donor was born without a uterus and was 32 years old at the time of the surgery in September, 2016. Per medical reports, her diagnosis was ‘Mayer-Rokitansky- Küster-Hauser syndrome, a genetic condition that occurs one in 4,500 women with symptoms in which the woman’s vagina and uterus are either absent or underdeveloped, albeit with normal appearance of the external genitals and the ovaries. Months before receiving a uterus transplant, the patient underwent in-vitro fertilization. This resulted in eight good-quality early-stage embryos, which were cryopreserved in the hopes of being used after a uterus transplant.

The donor was a 45-year old woman who died of a stroke, with a matching blood type, O-positive, and had no reported sexual disease. The deceased donor was deemed a good candidate because she had had three vaginal deliveries during her lifetime.

The procedure to transfer the uterus from donor to recipient lasted more than 10 hours. The surgery involved connecting the recipient's veins and arteries, ligaments and vaginal canals with the donated uterus. For eight days, the recipient remained in the hospital, where she received five immuno-suppression drugs, which control the body's natural instinct to fight off and reject a transplanted organ.

Five months after the transplant, the biology of the recipient showed no signs of rejecting the uterus, and for the first time in her life, she experienced menstruation. Ultrasound scans also indicated zero abnormalities.

After seven months of careful observation, doctors implanted a single fertilized egg, though in previous uterus transplants, doctors waited a full year to implant. The shorter timetable was intended to reduce patient expenses and risk, because the possibility of the body rejecting an organ can increase over time.

Pregnancy was confirmed 10 days later. Throughout the pregnancy, all the usual tests showed a normal foetus with no anomalies. Other than a kidney infection treated with antibiotics at 32 weeks, the mother had no issues during her pregnancy and continued her immuno-suppression regimen to prevent rejection of the implanted uterus.

A girl weighing nearly 6 pounds was born on December 15, 2017, at 35 weeks and three days -- a late pre-term birth.

The mother delivered via c-section, which included a removal of the transplanted uterus so she could stop using immuno-supressive drugs. The organ showed no evidence of rejection, only the usual changes that occur during pregnancy. Both mother and child were discharged from the hospital three days later.

At the age of 7 months and 20 days, the baby continued to breastfeed and weighed nearly 16 pounds.

The baby will celebrate her first birthday within two weeks. Mother and child have experienced no complications or abnormalities.

This birth is the first uterus transplant of any kind performed in Latin America and the first using a cadaver organ. Previous attempts at using a cadaver uterus have not resulted in a live birth.

Uniqueness to the pregnancy

Dr. Andrew Shennan, a professor of Obstetrics at Kings College London, told the ‘Science Media Centre’ that the pregnancy occurred "in spite of the uterus being without oxygen for 8 hours before transplant", a unique significance among other cases. The new study proves that it could remain functional after cold, oxygen-less storage at least four times as long as the average time after live donation.

He added that this case opens up the possibility of women donating their uterus following demise, as with many other organs, and rather than relying on live donors, a surrogate adoption, women who are infertile due to uterine factor infertility might soon have another option.

Sources: CNN, New Scientist

- MIAP