Living Donor Uterus Transplantation: A Single Center’s Observations and Lessons Learned from Early Setbacks to Technical Success

Uterus transplantation is a vascularized composite allograft transplantation. It allows women
who do not have a uterus to become pregnant and deliver a baby. In this paper we analyze the
first 5 cases of Living Donor Uterus Transplantation performed in the US. The first 3 recipients
lost their uterus grafts at day 14, 12 and 6 after transplant. Vascular complications, related to
both inflow and outflow problems, were identified as the primary reason for the graft losses.
Two recipients, 6 and 3 months post-transplant have functioning grafts with regular menstrual
cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis
of evaluation, surgical technique and follow-up of these five living donor uterus transplants. The
lessons learned were instrumental in allowing us to evolve from failure to technical and
functional success. We aim to share our conclusions and build on the knowledge in the evolving
field of uterus transplantation.