Deans Rebecca, Gerstl Brigitte, Shand Antonia W, Lyons Sarah, Budden Aaron, Barrett Helen L, Luxton Grant, Fernando Mangalee, Yong Kenneth, Keung Karen, Arulpragasam Kaushalya, Pleass Henry, Wan King Man, Kehag Eva, Pittman Jana-Emily, Lotz Mianna, Fenn Maria, Nesbitt-Hawes Erin, Byun Lily, Tang Katrina, Brannstrom Mats, Abbott Jason
Royal Hospital for Women, Sydney, NSW.
The University of New South Wales, Sydney, NSW.
Med J Aust. 2025 Oct 20;223(8):404-409. doi: 10.5694/mja2.52682. Epub 2025 May 23.
To report the first live birth following uterus transplantation in Australia.
Case report.
SETTING, PARTICIPANT: The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.
Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.
The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.
The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.
Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.
报告澳大利亚首例子宫移植后的活产情况。
病例报告。
地点、参与者：悉尼威尔士亲王医院、皇家妇女医院和韦斯特米德医院子宫移植研究项目的首位参与者。
子宫移植后的临床过程；后续妊娠直至分娩的过程。
2023年1月10日子宫移植后的免疫抑制方案与低免疫风险肾移植所用方案相似。包括诱导治疗（第0天和第4天使用巴利昔单抗，第0天和第1天使用甲泼尼龙），随后用口服他克莫司、泼尼松龙和霉酚酸酯（MMF）进行维持治疗。泼尼松龙剂量在12周内稳步递减至低维持剂量（从每日25毫克降至5毫克）；第9周时MMF被硫唑嘌呤替代，整个孕期持续使用他克莫司。没有排斥反应的迹象。在移植后101天（15周）的自然排卵周期中移植了一枚冷冻的1级囊胚；成功启动了临床妊娠。该女性在20周时患上妊娠期糖尿病，接受胰岛素治疗。在37周时通过计划剖宫产分娩出一名健康男婴；他体重2990克，1分钟时阿氏评分7分，5分钟时9分。产后出血（估计2500毫升）导致产后输血补铁。该女性及其婴儿在出生后5天出院。婴儿进行母乳喂养，但该女性经历了反复的乳腺炎发作，通过口服抗生素以及两次住院期间的静脉抗生素治疗得以控制。出生8周后她开始给婴儿断奶。该女性及其婴儿均未出现严重并发症。
澳大利亚首例子宫移植后的活产表明，该手术可作为子宫因素不孕女性的辅助生殖技术在此应用。
澳大利亚和新西兰临床试验注册中心，ACTRN12622000917730。
