Graft failure - uterus transplantation

Ready to upload
Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
3/5 of the cases described here
Time to detection: 
6-14 days
Alerting signals, symptoms, evidence of occurrence: 
Of the first 5 cases of Living Donor Uterus Transplantation performed in the US, the first 3 failed. A graft hysterectomy was required on postoperative day 14 for the first patient, day 12 for the second patient, and day 6 for the third patient. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses (explant pathology in recipients 1and 3: necrotic hemorrhagic damage suggestive of outflow problems; recipient 2: ischemic necrosis). The remaining two recipients have functioning grafts with regular menstrual cycles 6 and 3 months post-transplant.
Demonstration of imputability or root cause: 
Postoperative complication (direct result of the operation)
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest references: 
G. Testa, E. C. Koon, L. Johannesson, et al. Living Donor Uterus Transplantation: A Single Center’s Observations and Lessons Learned from Early Setbacks to Technical Success. Am J Transplant. 2017 Apr 22
TO ADD: Organs-> Composite tissues grafts -> Uterus - ok
Expert comments for publication: 
The first 5 cases of Living Donor Uterus Transplantation performed in the US and the lessons learned are described in this paper. New clinical trials in order to accumulate data to further optimize the procedure in relation to safety and efficiency are needed. In this regard, the creation of a global registry to follow donors, recipients and children born after uterus transplantation is central.