Meeting Report: First State-of-the-Art Meeting on Uterus Transplantation

摘要

Uterus transplantation (UTx) is a young, albeit rapidly growing field in medicine in which multidisciplinary efforts of transplantation surgery, gynecology, and assisted reproduction technologies are synergized. The first clinical transplantation trial was launched in 2012 in Sweden following extensive preparatory work in small and large animals.1,2 The first baby born to a recipient of a live donor uterus transplant in Sweden had been the third attempt, preceded by a live donor procedure in Saudi Arabia (2000) and a deceased donor procedure in Turkey (2011). Attempts in Saudi Arabia and Turkey had failed due to surgical complications or have not resulted into the birth of a healthy baby.3,4 The mother of this first baby born after a uterus transplant suffered from absolute uterine infertility due to Mayer-Rokitansky-Kuester-Hauser (MRKH) syndrome. She was 35 year old and had received a living donor (unrelated) uterus transplant (LDUTx) from a 61-year-old donor in Gothenburg. A first attempt of an embryo transfer had been successful and the embryo had been cryopreserved at the 8-cell stage. This transplant had been part of a series of 9 living donor transplants in Sweden and initiated activities at several centers around the world to set up clinical UTx studies with variations regarding major surgical techniques and donor selection.5 Additional key events have been the first healthy baby born to a recipient of a nondirected living donor in the United States6 and the first baby born to a recipient of a deceased donor uterus transplant (DDUTx) in Sao Paulo, Brazil.7 INTERNATIONAL SOCIETY OF UTERUS TRANSPLANTATION (ISUTX) ISUTx (www.isutx.org) has been founded in Gothenburg, Sweden (2016), with participants from centers worldwide with an interest in clinical and experimental UTx. The ISUTx is truly multidisciplinary with members representing gynecology, reproductive medicine, transplantation surgery, nephrology, maternal-fetal medicine, psychology, and medical ethics. The society aims to exchange data efficiently, to foster clinical and experimental research, to facilitate the communication between all disciplines advancing the field, and to maintain an international registry to assure quality and safety. UTx is recognized in most countries as a vascularized allotransplant comparable to solid organ transplants or other vascularized transplant such as face and hand transplants. The society emphasizes on the importance of this determination as the allocation and jurisdiction for tissue transplants will not allow to utilize established organ allocation principles.8 During the last 2 years, most vascularized allotransplant procedures in Europe and the United States have been UTx. Notably, there is a large contribution of altruistic donors.9 Moreover, surveys have shown a broad acceptance of deceased uterus donation.10 Facing the rapidly evolving field, the American Society for Reproductive Medicine has recently published a position paper summarizing indications and guidelines.11 Relevant aspects of clinical and experimental research in addition to open questions have been summarized in a recent review.12 At the first international congress of ISUTx in Gothenburg in 2017, the society agreed on having biannual international congresses and in the alternating years state-of-the-art (SOTA) meetings providing centers around the world with updates of the rapidly advancing field, this to assure safe and effective treatments. The first SOTA meeting on UTx took place in Ghent, Belgium, on October 19–20, 2018, and was attended by some 120 participants. A clear majority of teams who are known to be involved in a program for UTx were present at this meeting (Figure 1). As of this meeting, approximately 20 clinical studies on UTx have been registered and 52 transplants have been performed worldwide, showing not only a broader acceptance but also an exponentially increasing rate of the procedure. To our knowledge, 13 healthy babies have been born i