| 11. |
- Brucker, S. Y., et al.
(författare)
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Living-Donor Uterus Transplantation: Pre-, Intra-, and Postoperative Parameters Relevant to Surgical Success, Pregnancy, and Obstetrics with Live Births
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- Uterus transplantation (UTx) can provide a route to motherhood for women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS), a congenital disorder characterized by uterovaginal aplasia, but with functional ovaries. Based on our four successful living-donor transplantations and two resulting births, this analysis presents parameters relevant to standardizing recipient/donor selection, UTx surgery, and postoperative treatment, and their implementation in routine settings. We descriptively analyzed prospectively collected observational data from our four uterus recipients, all with MRKHS, their living donors, and the two newborns born to two recipients, including 1-year postnatal follow-ups. Analysis included only living-donor/recipient pairs with completed donor/recipient surgery. Two recipients, both requiring ovarian restimulation under immunosuppression after missed pregnancy loss in one case and no pregnancy in the other, each delivered a healthy boy by cesarean section. We conclude that parameters crucial to successful transplantation, pregnancy, and childbirth include careful selection of donor/recipient pairs, donor organ quality, meticulous surgical technique, a multidisciplinary team approach, and comprehensive follow-up. Surgery duration and blood vessel selection await further optimization, as do the choice and duration of immunosuppression, which are crucial to timing the first embryo transfer. Data need to be collected in an international registry due to the low prevalence of MRKHS.
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| 12. |
- Brännström, Mats, 1958, et al.
(författare)
-
Evolution of surgical steps in robotics-assisted donor surgery for uterus transplantation: results of the eight cases in the Swedish trial.
- 2020
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Ingår i: Fertility and sterility. - : Elsevier BV. - 1556-5653 .- 0015-0282. ; 114:5, s. 1097-1107
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Tidskriftsartikel (refereegranskat)abstract
- To perform a stepwise development of the surgical method for robotics-assisted laparoscopy in donor hysterectomy for uterus transplantation (UTx), a unique treatment for absolute uterine-factor infertility.Prospective observational study.University hospital.Eight donors, aged 38-62 years, underwent surgery for retrieval of the uterus and vasculature.Robotics-assisted laparoscopy was performed in donors for 6-7 h with video recording. Conversion to laparotomy was performed for last parts of retrieval surgery.Description, evaluation, and timing of 12 specific surgical steps, as well as surgical outcomes and complications.There was a progression during the course of eight surgeries. In the initial two cases, seven and six items were completed with robotics compared with all 12 items in the last three procedures. The passive surgical time decreased from ∼20% in the first four cases to ∼8% in the last three procedures. The estimated median (range) blood loss, total surgical time, and length of hospital stay were, respectively, 125 mL (100-600), 11.25 h (10-13), and 5.5 days (5-6). Two reversible complications occurred: One patient acquired pressure alopecia, and one developed pyelonephritis.The study demonstrates a clear evolution of a strategy toward fully robotic donor surgery in UTx. This is likely to become the main approach in donor surgery of live UTx donors.NCT02987023.
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| 13. |
- Brännström, Mats, 1958, et al.
(författare)
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Fixation of the uterine graft after uterus transplantation
- 2020
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Ingår i: Uterus Transplantation. Brännström M. (red.). - Cham : Springer. - 9783319941622 ; , s. 147-149
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- At uterus transplantation into the recipient, surgical fixation of the uterus is important and performed after anastomoses of the vasculature and the vagina which has been done in order to minimize warm ischemia and secure optimal location of the uterus with its vessels. At the stage of fixation, the uterine graft is reperfused. The fixation of the uterus is recommended onto several ligamentous structures in order to prevent prolapse of the organ in the pregnant and non-pregnant state. © Springer Nature Switzerland AG 2020.
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| 14. |
- Brännström, Mats, 1958, et al.
(författare)
-
Medical work-up of the live donor
- 2020
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Ingår i: Uterus Transplantation. Brännström M. (red.). - Cham : Springer. - 9783319941622 ; , s. 83-87
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The accumulated experience in live donor uterus transplantation is that the qualities of the uterus and the vasculature of the graft are critical factor for successful outcome of the transplantation procedure. Thus, the medical screening procedure to exclude possible cases with suboptimal donor organs is important for high success rate, in terms of transplantations that result in live births. This chapter reviews the current knowledge about several factors that have to be taken into account in screening for inclusion/exclusion of potential live donors. These factors include age, lifestyle factors, obstetric history, laboratory tests, cardiovascular examination, gynaecological examination and imaging modalities. © Springer Nature Switzerland AG 2020.
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| 15. |
- Brännström, Mats, 1958, et al.
(författare)
-
Novel approaches in uterus transplantation
- 2020
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Ingår i: Current Opinion in Organ Transplantation. - : Ovid Technologies (Wolters Kluwer Health). - 1087-2418 .- 1531-7013. ; 25:6, s. 584-593
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Tidskriftsartikel (refereegranskat)abstract
- Purpose of review Uterus transplantation (UTx) is the first existing infertility treatment for women with no uterus and for women with a present nonfunctional uterus, which is unable to carry a pregnancy. This type of transplantation is a novel addition within the field of vascularized composite allografts and is the first ephemeral kind of transplantation, with the graft intended for only a restricted number of years, until the desired numbers of children have been born and with subsequent graft removal. The proof-of-concept of UTx, as an infertility treatment for women with uterine factor infertility, came with the report of the first live birth after UTx, occurring in Sweden in 2014. This UTx live birth has been followed by around 30 births, taking place in four continents. Despite the initial clinical success, UTx should still be regarded as an experimental procedure, at a developmental phase. The clinical UTx activities at several centers around the globe take place within scientific clinical trials and aim to advance UTx further. This review describes certain developmental areas around UTx. These relate to surgery, donor selection, assisted reproduction, and inclusion of new recipient groups. Recent findings Successful UTx procedures, with live births, have been reported both after live and deceased donor transplantation. There exist developments in the areas of robotic surgery for live donor hysterectomy, of alternate vascular connections to the graft, modifications of inclusion criteria/investigations of donors, assisted reproduction in conjunction with UTx, as well as discussions concerning expanding the pool of eligible recipients. Uterus transplantation has repeatedly proven to be a feasible infertility treatment for women with absolute uterine factor infertility. Ongoing studies aim to increase safety and efficiency of the procedure as well as to better define suitable donors and recipients.
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| 16. |
- Brännström, Mats, 1958, et al.
(författare)
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Registry of the International Society of Uterus Transplantation: First Report
- 2023
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Ingår i: Transplantation. - : Ovid Technologies (Wolters Kluwer Health). - 0041-1337. ; 107:1, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- Background.Uterus transplantation (UTx) is a novel type of transplantation to treat infertility in women with an absent or nonfunctioning uterus. The International Society of Uterus Transplantation (ISUTx) has developed a registry to monitor worldwide UTx activities while serving as a repository for specific research questions. Methods.The web-based registry has separate data fields for donor, recipient, surgeries, immunosuppression, rejections, pregnancies with live birth(s), and transplant hysterectomies. Data are prospectively registered. Results.A total of 45 UTx procedures have been registered; the majority (78%) of those procedures were live donor (LD) transplants. Median age of the LDs, deceased donors, and recipients were 50 y (range 32-62), 38.5 y (19-57), and 29 y (22-38), respectively. The duration of LD surgery was approximately twice as long as the recipient surgery. Postoperative complications of any Clavien-Dindo grade were registered in 20% of LDs and 24% of recipients. Rejection episodes were more frequent (33%) early after transplantation (months 1-5) compared with later time points (months 6-10; 21%). Healthy neonates were delivered by 16 recipients, with 3 women giving birth twice. The total live birth rate per embryo transfer was 35.8%. Median length of pregnancy was 35 gestational weeks. Twelve uteri were removed without childbirth, with 9 transplant hysterectomies occurring during the initial 7 mo post-UTx. Conclusions.A mandatory registry is critical to determine quality and process improvement for any novel transplantation. This registry provides a detailed analysis of 45 UTx procedures performed worldwide with a thorough analysis of outcomes and complications.
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| 17. |
- Brännström, Mats, 1958, et al.
(författare)
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Reproductive, obstetric, and long-term health outcome after uterus transplantation: results of the first clinical trial
- 2022
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 118:3, s. 576-585
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate reproductive, obstetric, and long-term health of the first completed study of uterus transplantation (UTx). Design: Prospective. Setting: University hospital. Patient(s): Nine live donor UTx procedures were conducted and seven were successful. Donors, recipients, and children born were observed. Intervention(s): In vitro fertilization was performed with embryo transfer (ET) of day 2 or day 5 embryos in natural cycles. Pregnancies and growth trajectory of the children born were observed. Health-related quality of life, psychosocial outcome, and medical health of donors and recipients were evaluated by questionnaires. Main Outcome Measure(s): The results of in vitro fertilization, pregnancies, growth of children, and long-term health of patients were reported. Result(s): Six women delivered nine infants, with three women giving birth twice (cumulative birth rates of 86% and 67% in surgically successful and performed transplants, respectively). The overall clinical pregnancy rate (CPR) and live birth rate (LBR) per ET were 32.6% and 19.6%, respectively. For day 2 embryos, the CPR and LBR per ET were 12.5% and 8.6%, respectively. For day 5 embryos, the CPR and LBR per ET were 81.8% and 45.4%, respectively. Fetal growth and blood flow were normal in all pregnancies. Time of delivery (median in full pregnancy weeks + days [ranges]) by cesarean section and weight deviations was 35 + 3 (31 + 6 to 38 + 0) and -1% (-13% to 23%), respectively. Three women developed preeclampsia and four neonates acquired respiratory distress syndrome. All children were healthy and followed a normal growth trajectory. Measures of long-term health in both donors and recipients were noted to be favorable. When UTx resulted in a birth, scores for anxiety, depression, and relationship satisfaction were reassuring for both the donors and recipients. Conclusion(s): The results of this first complete UTx trial show that this is an effective infertility treatment, resulting in births of healthy children and associated with only minor psychological and medical long-term effects for donors and recipients. Clinical Trial Registration Number: NCT02987023.
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| 18. |
- Brännström, Mats, 1958, et al.
(författare)
-
Surgical technique of live donor in uterus transplantation
- 2020
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Ingår i: Uterus Transplantation. Brännström M. (red.). - Cham : Springer. - 9783319941622 ; , s. 111-117
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- One major part of surgery in uterus transplantation is surgery of the live donor. Early attempts have shown that this is the most challenging part of live donor uterus transplantation and the duration of donor surgery is around two times that of recipient surgery. Traditionally, live donor surgery was by laparotomy, but during the last few years minimal invasive surgery has gradually entered on the scene for donor surgery. Minimal invasive surgery has been both by traditional laparoscopy and by robotic-assisted laparoscopy. This chapter will review the technique of live donor surgery in uterus transplantation in detail. Complications that so far have been reported in donors will be discussed. There will be a continuous development in live donor surgery for uterus transplantation. These modifications will have positive impacts on surgical duration, tissue trauma, hospital stay, postoperative pain, time to return to common daily activities, and on rates of complications. © Springer Nature Switzerland AG 2020.
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| 19. |
- Brännström, Mats, 1958, et al.
(författare)
-
Uterus transplantation as an infertility treatment
- 2023
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Ingår i: Human Reproductive and Prenatal Genetics. - 9780323913805 ; , s. 657-678
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Bokkapitel (refereegranskat)abstract
- Uterus transplantation (UTx) has during the past two decades evolved as the first treatment for absolute uterine factor infertility (AUFI). Our team started a step-by-step animal research project to understand if UTx was a feasible option and to optimize the procedure before possible introduction in the human. Research was initiated in rodents and was then further developed in animal models of larger domestic species and primates. In 2012, our team in Sweden launched the first clinical UTx trial and with the announcement of the world's first live birth after UTx in 2014. After that, several UTx trials were started and with results gradually evolving. In the present chapter, we will outline possible patient groups for UTx, surgery of UTx, clinical outcomes of trials and assisted reproduction in UTx patients.
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| 20. |
- Brännström, Mats, 1958, et al.
(författare)
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UTERUS TRANSPLANTATION: In Transition from Experimental to Clinical Procedure
- 2023
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Ingår i: Textbook of Assisted Reproductive Techniques: Volume 2: Clinical Perspectives, Sixth Edition. - 9781000933505 ; , s. 746-755
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Uterus transplantation (UTx) during the last decades has developed as a novel infertility treatment for absolute uterine factor infertility (AUFI) caused by absence of a functional uterus. After systematic animal research [1] over a decade, and involving rodents, domestic species, and non-human primates, the first clinical UTx trial was launched in 2013 [2]. This was a live donor (LD) UTx trial and one out of nine participating women gave birth to the world’s first UTx baby in September 2014 [3]. Since then, more than 10 clinical UTx trials have been initiated, with a mix between LD UTx and deceased donor (DD) UTx. Based on data from all registered ongoing trials and our personal experience, we describe plausible patient groups for UTx and cover different techniques of surgery and assisted reproduction in conjunction with UTx.
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