General Practice 2022

Transplant of útero: what é, like é made and possibleí possible risks

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Transplant of útero: what é, like é made and possibleí possible risks
Transplant of útero: what é, like é made and possibleí possible risks

The uterus transplant, or uterine transplant, is a type of experimental treatment, which consists of removing the uterus of a living or brain-dead donor, to implant it in a woman who wants to become pregnant but who does not have uterus or who does not have a he althy uterus, being unable to maintain a pregnancy, for example.

In addition, uterus transplantation has been studied for transsexuals, but it is not yet known whether even with the transplanted uterus, they could become pregnant due to anatomical, physiological, fertility and obstetric differences.

Uterine transplantation is a complex procedure, which can bring risks to both the donor and the recipient, such as bleeding during surgery or postoperative pain, in addition to rejection of the transplanted uterus.Despite this, around 50 uterus transplants have been performed worldwide, 16 of which resulted in successful pregnancy.

When is indicated

Uterine transplantation may be indicated by the doctor for women of reproductive age, from 20 to 40 years old, in cases such as:

  • Malformations of the uterus that cannot be corrected by surgery;
  • Infertility due to lack of uterus, due to being born without a uterus;
  • Having undergone surgery to remove the uterus due to diseases such as fibroids, cervical cancer or chronic pelvic pain, for example;
  • Presence of uterus that does not function properly, preventing pregnancy.

Furthermore, for a uterus transplant, women must have a he althy weight, not smoke, and must not have other diseases such as diabetes, HIV infection or hepatitis B or C, for example.

Uterine transplantation in men

Uterine transplantation in men has been studied to allow pregnancy and birth of babies, specifically in transsexuals.

However, this type of treatment has some anatomical and physiological limitations such as the shape of the male pelvis, which is narrower and has a smaller opening than the female pelvis, fixation of the uterus in the abdominal cavity, use of specific hormonal drugs before to transfer the embryo to the uterus and to maintain the pregnancy.

Furthermore, it is necessary to use immunosuppressive drugs to avoid rejection of the uterus, which can lead to complications such as infections, for example, and the most effective dose in the uterus transplant is not yet known.

Uterine transplantation in transsexuals still needs further studies before it can be performed, and is not yet recommended for transsexual women.

How is a uterus transplant performed

Uterine transplant surgery has some steps that include:

  1. Initial assessment of the he alth status of the recipient of the uterus, which allows checking if she has any disease or complications that could harm the transplant;
  2. Ovulation induction, with the use of hormones, which stimulate the production of follicles by the ovaries. Understand better how ovulation induction is done and which hormones are used;
  3. In vitro fertilization and freezing of embryos, to be implanted in the future after uterus transplantation;
  4. Surgery to remove the non-functioning uterus of the woman who will receive the uterus donation, keeping the ovaries and fallopian tubes, also called fallopian tubes;
  5. Surgery to remove the he althy uterus from the livingdonor, which can be taken from a family member with the same blood type or be donated by another compatible woman, or can be done with the donation of the uterus of a brain-dead woman;
  6. Transplantation of he althy uterus from donor to recipient, without connection to the ovaries. However, muscles, cartilage, tendons, arteries, veins and other blood vessels are connected to allow the new uterus to function;
  7. Use of immunosuppressive drugs by the woman who received the transplant to avoid rejection of the new uterus.

The uterus transplant is temporary, that is, the uterus remains only long enough for 1 or 2 pregnancies. After this period, the uterus is removed through a surgery called a hysterectomy. See how a hysterectomy is performed and what recovery is like.

The transplanted uterus is removed to prevent the recipient from having to take immunosuppressants for prolonged periods, avoiding complications and side effects of this type of treatment.

How the uterus is donated

Uterine donation can be made by a living or brain-dead donor, however, due to the difficulty in obtaining the uterus from deceased donors, uterus transplantation from a living donor is more common.

To donate the uterus, some procedures and criteria are evaluated as:

  • Not having diseases that prevent donation, such as high blood pressure, diabetes or high cholesterol, for example;
  • He alth of the uterus through tests that identify infertility, size and thickness of the uterus, presence of polyps, fibroids, endometriosis, HPV, adhesions or infections, in addition to the he alth of the blood vessels and arteries that nourish the uterus;
  • Proved fertility, donor candidates cannot be menopausal;
  • Not having had any surgery on the uterus previously;
  • Blood type compatible with the woman who will receive the uterus;
  • Immune system compatibility of the donor and recipient;

After all evaluation of the selected donor, surgery is performed to remove the uterus and cervix, and it is important that the donor remains in the ICU for several days to allow pain control and medical follow-up to prevent infections.

Is it possible to get pregnant naturally after transplantation?

A woman can get pregnant through in vitro fertilization, because natural pregnancy is impossible since the ovaries are not connected to the uterus. The recommendation is that, after the uterus transplant, you should wait at least 12 months to perform in vitro fertilization, as it allows you to know if the uterus is not rejected by the body.

Doctors do not attach the new uterus to the ovaries because it would be very difficult to make sure that there are no scars that would make it difficult for the egg to travel through the fallopian tubes to the uterus, which could make pregnancy difficult or facilitate the development of a ectopic pregnancy, for example.

Risks of uterus transplant

Although it makes a pregnancy possible, the uterus transplant is very risky, as it can bring several complications for the mother or the baby.

The risks of a uterus transplant include:

  • Loss of large volumes of blood, which may require blood transfusion;
  • Blood clot formation;
  • Infection or rejection of the new uterus;
  • Allergic reaction to anesthesia;
  • Weak response to immunosuppressive drugs;
  • Increased risk of preeclampsia;
  • Increased risk of miscarriage at any stage of pregnancy;
  • Baby growth restriction;
  • Premature birth.

In addition, the use of immunosuppressive drugs to prevent organ rejection can cause other complications, which are not yet fully known.

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