Ejzenberg D, et al. - Given the lack of even a single successful case of livebirth via deceased donor uterus has raised questions on the feasibility and viability of uterus transplantation from a deceased donor, researchers here present the first case worldwide of livebirth following uterine transplantation from a deceased donor in a patient with Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome. Findings established proof-of-concept for treating uterine infertility by transplantation from a deceased donor.

Methods

• The case of a 32-year-old woman with congenital uterine absence (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome) who had uterine transplantation from a donor who died of subarachnoid haemorrhage, was analyzed.
• The transplantation was performed in September, 2016 in Hospital das Clínicas, University of São Paulo, Brazil.
• The donor was 45 years old and had three previous vaginal deliveries.
• Four months before transplant, the one recipient had one in-vitro fertilisation cycle which yielded eight cryopreserved blastocysts.

Results

• Postoperative recovery was satisfactory and discharge was granted after 8 days' observation in hospital.
• Prednisolone and thymoglobulin-induced immunosuppression was continued via tacrolimus and mycophenalate mofetil (MMF), until 5 months post-transplantation, at which time azathioprine replaced MMF.
• At 37 days post-transplantation, first menstruation happened, which thereafter occurred regularly (every 26–32 days).
• Following the first single embryo transfer 7 months post-transplantation, the occurrence of pregnancy was reported.
• Doppler ultrasound of uterine arteries, fetal umbilical, or middle cerebral arteries revealed no blood flow velocity waveform abnormalities, nor any fetal growth impairments were observed during pregnancy.
• Post- transplantation or during gestation, no rejection episodes occurred.
• On Dec 15, 2017, the occurrence of Caesarean delivery was reported, near gestational week 36.
• The measured weight of the female baby was 2550 g at birth, she was appropriate for gestational age, and had Apgar scores of 9 at 1 min, 10 at 5 min, and 10 at 10 min, and along with the mother remains healthy and developing normally 7 months post partum.
• Uterus removal was carried out in the same surgical procedure as the livebirth and immunosuppressive therapy was suspended.