uterine transplant Flashcards
General information
Uterine transplantation (UTx) is a potential therapeutic intervention for women with absolute uterine factorinfertility (AUFI). AUFI is widely considered to affect 1 in 500 women of childbearing age,
First successfully transplant in Sweden in 2010. First deceased donor success Brazil 2017.
>90 UTx performed wordlwide
Around 40 live births.
80% living donors and 20% deceased donors.
Use cervical biopsies to assess if immune rejection
Mycophenylate not safe for pregnancy
Ethics
“The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation” was published in Fertility and Sterility and has been proposed as the international standard for the ethical execution of the procedure.
The criteria set conditions for the recipient, the donor, and the health care team, specifically:
The recipient is a genetic female, with the ability to consent, with no medical contraindications to transplantation, has uterine disease that has failed other therapy, and has “a personal or legal contraindication” to other options (surrogacy, adoption). The recipient needs to be considered suitable for motherhood, deemed to be psychologically fit on evaluation, is likely to be compliant with treatment and the medical team, and understands the risks of the procedure. In 2021, a revision to the Montreal Criteria was published in Bioethics with an ethical framework for consideration of genetic XY individuals to be eligible for uterine transplants.[56]
The donor is a female of reproductive age with no contraindication to the procedure who has concluded her childbearing or consented donating her uterus after her death. There is no coercion and the donor is responsible and capable of making informed decisions.
The health care team belongs to an institution that meets Moore’s third criterion[57] regarding institutional stability and has provided informed consent to both parties. There is no conflict of interests, and anonymity can be protected unless recipient or donor waive this right.
Trans-female patients
Under the Equality Act (2010), individuals who are proposing to undergo, currently undergoing, or have undergone aprocess of gender reassignment cannot be subjected to discrimination based on this characteristic alone.Subsequently, if UTx becomes a treatment option for all women (encompassing bothcis-women and trans women)with AUFI, based on EU and UK legislation it will, in the absence of the provision of compelling justification, beunlawful not to perform UTx in trans (or transgender) women. Despite a number of anatomical, psychosocial,physiological, fertility and obstetric considerations that require further research before UTx can be performed intransgender women, there is no overwhelming clinical argument against performing this procedure.28
Complication - live and deceased donor
Live Donor Issues;
17% complication rates
10% serious eg repeat laparotomy
fecal impaction, Buttock pain, Vaginal cuff dehiscence, Pyelonephritis, Recurrent UTIs,
Prolapse, Reduced sensations to void, Psychological, Incontinence, Ureteric injury, Vesicovaginal fistula in 2/3 - hemostatic agent was left in one and expelled
Deceased donor issues;
longer cold ischemic time which may increase chance of rejection and chronic graft dysfunction.
Can’t screen for infections
Complications for recipients
32% complication rate
GDM, T2DM, Anaemia, CMV discordance, Tremor/dizziness/headache, 20% chance of need for removal of transplant eg fungal infection, Vaginal stenosis, Haemorrhage,
Infection
If get through first 15days unlikely you’ll need it out
