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Uterus transplantation for fertility preservation in patients with gynecologic cancer
  1. Pernilla Dahm-Kähler1,
  2. Niclas Kvarnström2,
  3. Emilia Alfonzo Rodriguez1,
  4. Ulrika Skogsberg Dahlgren2 and
  5. Mats Brännström1
  1. 1 Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg, Sweden
  2. 2 Department of Transplantation, Sahlgrenska Academy, Goteborg, Sweden
  1. Correspondence to Dr Pernilla Dahm-Kähler, Department of Obstetrics and Gynecology, Sahlgrenska Academy, 413 45 Gothenburg, Sweden; pernilla.dahm-kahler{at}vgregion.se

Abstract

Cervical and endometrial cancer may impact women interested in future fertility in approximately 5–25% of cases. The recommended treatment for patients with early stage disease is hysterectomy and/or radiation leading to infertility. This is referred to as absolute uterine factor infertility. Such infertility was considered untreatable until 2014, when the first child was born after uterus transplantation. Thereafter, multiple births have been reported, mainly from women with Mayer-Rokitansky-Küster-Hauser syndrome, with congenital uterine absence, although also from a patient with iatrogenic uterine factor infertility caused by radical hysterectomy secondary to an early stage cervical cancer 7 years before uterus transplantation. A live birth after uterus transplantation may be considered promising for many who may not otherwise have this option.

Uterus transplantation is a complex process including careful patient selection in both recipients and donors, in vitro fertilization, and complex surgery in the organ procurement procedure including harvesting the vessel pedicles with the thin-walled veins. Thereafter, the transplantation surgery with anastomosis to ensure optimal blood inflow and outflow of the transplanted organ. Knowledge regarding immunosuppression and pregnancy is essential. Lastly there is the hysterectomy component as the uterus must be removed. Multidisciplinary teams working closely are essential to achieve successful uterus transplantation and, ultimately, delivery of a healthy child. Both the living and deceased donor concept may be considered and we address both the advantages and disadvantages. This review summarizes the animal research thus far published on uterus transplantation, the suggested recipient selections including former gynecologic cancer patients, the living and deceased donor uterus transplantation concepts with reported results, and updated fertility outcomes.

  • gynecologic surgical procedures
  • surgical procedures
  • operative
  • hysterectomy
  • cervical cancer
  • uterine cancer

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Footnotes

  • Twitter @pdahmkahler

  • Contributors PD-K: conception and design, writing and reviewing the article. MB: writing the article and contribution to the concept and design, and reviewing the article. NK: writing and reviewing the article. EAR: writing and reviewing the article. USD: writing and reviewing the article.

  • Funding This study was funded by Cancerfonden (CAN2017/594).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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