The world’s first baby born by a uterus transplant from a deceased donor is healthy and nearing her first birthday, according to a new case study published Tuesday in
Uterus transplants have become more common in recent years, resulting in 11 live births around the world. But all of the other successful deliveries so far have been made possible by living donors — often women who opt to donate their uterus to a close friend or family member without one. The birth resulting from the case detailed in , which took place at Brazil’s Hospital das Clínicas last December, is both the first in the world to involve a uterus from a deceased woman, and the first from any uterus transplant in Latin America.
The baby’s birth suggests that more women who suffer from uterine infertility — including those who have undergone hysterectomies for reasons ranging from cancer to endometriosis — may be able to take advantage of the procedure moving forward, says paper co-author Dr. Dani Ejzenberg, who oversaw the case and is a medical faculty member in the division of obstetrics and gynecology at the University of São Paulo.
“The successful case in our service brings hope to other centers that believe in this type of transplant,” Ejzenberg said in an email to the reporter. “It is also a source of hope for those patients who [do not have a uterus] or who have lost it unexpectedly and do not have a family member or close friend to donate the uterus.”
The patient was a 32-year-old woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a rare genetic disorder that causes the vagina or uterus to either under-develop or not develop at all. The woman had ovaries and a vagina, but no uterus.
When a 45-year-old mother of three died in September 2016 from a stroke that caused a brain bleed, doctors identified her as a match for the MRKH patient. Shortly thereafter, surgeons performed a uterus transplant, connecting the donor organ to the recipient’s veins, arteries, ligaments and vaginal canals during a surgery that lasted more than 10 hours. After the transplant, the woman began a regimen of immunosuppressant medication to ensure she would not reject the donor organ.
The patient began menstruating about a month after surgery. And just seven months after the operation, doctors began in vitro fertilization, through which the woman’s own fertilized eggs — which had been harvested prior to the transplant surgery — were transferred to her new uterus. She became pregnant after just one embryo transfer.
“The pregnancy in the first attempt, with the transfer of only one embryo, surprised us, but we were confident of achieving gestation due to the quality of the staff of our human reproduction center that has worked for 15 years with good results,” Ejzenberg says.
Aside from a kidney infection that was treated with antibiotics, the woman had a healthy and normal pregnancy. Around 35 weeks, doctors performed a caesarean section and delivered a healthy baby girl, weighing nearly six pounds and measuring almost 18 inches long.
The donor uterus was removed during delivery, Ejzenberg says, since the team’s study involved only one birth per mother. Removal of the donor organ also allowed the woman to stop taking immunosuppressant medication. Though it’s never been done before, Ejzenberg says “theoretically, it may be possible” to someday use such discarded organs for secondary transplants.
Almost exactly a year after the baby’s historic birth, Ejzenberg says she is developing normally and her mother feels “fulfilled.” The demonstrated success of a procedure involving a deceased donor, he says, may spare live donors from undergoing risky procedures, and make transplants possible for far more women.
Those possibilities, paired with improved surgical practices, means uterus transplantation could someday become a standard procedure, Ejzenberg says.
“The increase in the number of centers performing this transplant, standardization of the surgical technique and immunosuppressive therapy can facilitate access to this new modality of treatment,” he says.
Jamie Ducharme at jamie.ducharme.