Annette C. and Harold C. Simmons Transplant Institute, the Fertility Center of Dallas, the Department of Obstetrics and Gynecology, and the Department of Neonatology, Baylor University Medical Center, and the Fetal Care Center, Dallas, Texas; and the Department of Obstetrics and Gynecology, PRISMA Health-University of South Carolina School of Medicine, Columbia, South Carolina.
Obstet Gynecol. 2021 Feb 1;137(2):241-249. doi: 10.1097/AOG.0000000000004244.
To describe aggregated pregnancy outcomes after uterus transplantation from a single, experienced center.
This prospective study reports on live births among 20 women who received a uterus transplant from 2016 to 2019 at Baylor University Medical Center at Dallas. These live births occurred between November 2017 and September 2020. The main measures were live birth, maternal complications, and fetal and newborn outcomes.
There were six graft failures (four surgical complications and two with poor perfusion postoperatively). Of the 14 technically successful transplants, at least one live birth occurred in 11 patients. Thus far, the live birth rate per attempted transplant is 55%, and the live-birth rate per technically successful transplant is 79%. Ten uteri were from nondirected living donors and one uterus was from a deceased donor. In vitro fertilization was performed to achieve pregnancy. Ten recipients delivered one neonate, and one recipient delivered two neonates. One organ rejection episode was detected during pregnancy and was resolved with steroids. The median birth weight was 2,890 g (range 1,770-3,140 g [median 68th percentile]). Maternal weight gain was higher than Institute of Medicine recommendations. Maternal medical complications were observed in five recipients (elevated creatinine level, gestational diabetes, gestational hypertension [n=2], and preeclampsia). In five recipients, maternal medical or obstetric complications led to an unplanned preterm delivery (elevated creatinine level, preeclampsia; preterm labor [n=3]). The median gestational age at delivery was 36 6/7 weeks (range 30 6/7-38 weeks). All neonates were liveborn, with Apgar scores of 8 or higher at 5 minutes.
Over the first 3 years, our program experienced a live-birth rate per attempted transplant of 55% and a live-birth rate per technically successful transplant of 79%. In our experience, uterus transplantation resulted in a third-trimester live birth in all cases in which pregnancies reached 20 weeks of gestation. Maternal medical and obstetric complications can occur; however, these were manageable by applying principles of generally accepted obstetric practice.
ClinicalTrials.gov, NCT02656550.
描述单中心子宫移植后的综合妊娠结局。
本前瞻性研究报告了 2016 年至 2019 年期间在达拉斯贝勒大学医学中心接受子宫移植的 20 名女性的活产情况。这些活产发生在 2017 年 11 月至 2020 年 9 月之间。主要指标为活产、产妇并发症、胎儿和新生儿结局。
有 6 例移植失败（4 例手术并发症，2 例术后灌注不良）。在 14 例技术成功的移植中，11 例至少有 1 例活产。迄今为止，每例尝试移植的活产率为 55%，每例技术成功移植的活产率为 79%。10 个子宫来自非定向活体供者，1 个子宫来自已故供者。为实现妊娠进行了体外受精。10 名受者分娩 1 名新生儿，1 名受者分娩 2 名新生儿。在妊娠期间发现 1 例器官排斥反应，用类固醇解决。中位出生体重为 2890g（范围 1770-3140g[中位数 68 百分位]）。产妇体重增加高于医学研究所的建议。5 名受者出现母体医学并发症（肌酐水平升高、妊娠期糖尿病、妊娠期高血压[2 例]和子痫前期）。在 5 名受者中，母体医学或产科并发症导致计划外早产（肌酐水平升高、子痫前期；早产[3 例]）。中位分娩孕周为 36 6/7 周（范围 30 6/7-38 周）。所有新生儿均为活产，5 分钟时 Apgar 评分为 8 分或更高。
在最初的 3 年中，我们的项目每尝试移植的活产率为 55%，每技术成功移植的活产率为 79%。根据我们的经验，在妊娠达到 20 周的所有情况下，子宫移植都能实现孕晚期活产。可能发生母体医学和产科并发症；然而，通过应用公认的产科实践原则，这些并发症是可以管理的。
ClinicalTrials.gov，NCT02656550。
