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Uterus transplantation: state of the art in 2021

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Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To provide a comprehensive review of uterus transplantation in 2021, including a discussion of pregnancy outcomes of all reported births to date, the donor and recipient selection process, the organ procurement and transplant surgeries, reported complications, postoperative monitoring, preimplantation preparation, and ethical considerations.

Methods

Literature review and expert commentary.

Results

Reports of thirty-one live births following uterus transplantation have been published from both living and deceased donors. The proper selection of donors and recipients is a labor-intensive process that requires advanced planning. A multidisciplinary team is critical. Reported complications in the recipient include thrombosis, infection, vaginal stricture, antenatal complications, and graft failure. Graft rejection is a common occurrence but rarely leads to graft removal. While most embryo transfers are successful, recurrent implantation failures in uterus transplant patients have been reported. Rates of preterm delivery are high but appear to be declining; more data, including long-term outcome data, is needed.

Conclusions

Uterus transplantation is an emerging therapy for absolute uterine factor infertility, a condition previously without direct treatment options. It is paramount that reproductive health care providers are familiar with the uterus transplantation process as more patients seek and receive this treatment.

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Funding

Cleveland Clinic.

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Authors and Affiliations

  1. Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Desk A-81, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Elliott G. Richards, Ruth M. Farrell, Stephanie Ricci, Uma Perni & Tommaso Falcone

  2. Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Cristiano Quintini & Andreas Tzakis

Authors
  1. Elliott G. Richards
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  2. Ruth M. Farrell
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  3. Stephanie Ricci
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  4. Uma Perni
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  5. Cristiano Quintini
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  6. Andreas Tzakis
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  7. Tommaso Falcone
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Contributions

All authors contributed to the study conception and design. The manuscript was co-written by Elliott G. Richards, Ruth M. Farrell, Stephanie Ricci, Uma Perni, Cristiano Quintini, Andreas Tzakis, and Tommaso Falcone, with the portions compiled by Elliott G. Richards and Tommaso Falcone. All authors read and approved the final manuscript.

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Correspondence to Tommaso Falcone.

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Richards, E.G., Farrell, R.M., Ricci, S. et al. Uterus transplantation: state of the art in 2021. J Assist Reprod Genet 38, 2251–2259 (2021). https://doi.org/10.1007/s10815-021-02245-7

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  • DOI: https://doi.org/10.1007/s10815-021-02245-7

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