First U.S. Uterine Transplant Fails

In a sad development for the patient, the medical team at the Cleveland Clinic and prospective parents, comes news the first uterine transplant performed in the US has failed. The complex, eight-hour surgery took place on February 24 and the patient -- Janice, 26 -- was initially in stable condition. She was healthy enough just a few days later to briefly appear at the hospital's press conference to announce the groundbreaking surgery. The failure occurred the next day although a biopsy performed earlier had shown no signs of rejection.

The Cleveland Clinic stated a "sudden and serious complication" developed and the transplanted uterus had to be removed for the patient's health. While doctors are not yet stating what led to the transplant failure, pathologists are analyzing the uterus to determine what went wrong. A transplant surgeon at another facility that also has permission to perform the procedure suggested there are multiple reasons why the transplant might have failed including rejection by the patient's immune system, infection or a problem with the veins and arteries that were connected to the uterus to provide it with blood flow.

Until several weeks ago, uterine transplants had only been performed in Sweden. Doctors at the University of Gothenburg in Sweden have performed nine uterus transplants, resulting in five births. Two of the nine transplants failed during the first year after the surgery and had to be removed.

One major difference between the US and Swedish procedures is the latter performed the transplant using the uterus from a live donor. The US surgery used an organ from a deceased donor as removing a uterus from a live donor is complicated. Cleveland Clinic had previously done so which led to "some complications." However, there is no suggestion the use of a deceased donor uterus was involved in treatment failure, and the team says it might consider using live donors for future transplantations.

The Cleveland Clinic has permission to perform another nine transplants as part of a clinical trial. Three other American medical centers also have plans to perform uterus transplants on an experimental basis -- Baylor Medical Center at Dallas, Brigham and Women's Hospital in Boston and the University of Nebraska Medical Center in Omaha.

Cleveland Clinic and the three other US hospitals plan to move ahead with performing uterine transplants, offering hope to women with uterine factor infertility (UFI) who are unable to conceive or carry a pregnancy due to congenital abnormalities, fibroids, scarring inside the uterus or other related problems. And, it may also be an option for women who required surgery to remove their uterus due to cancer or other illness. Until now, the only other option for having a genetically related child was to use a surrogate mother.

Dr. Alexander Maskin from the University of Nebraska expects that once the Cleveland Clinic team knows what happened and is ready to discuss it, they'll share and all the transplant teams will learn from it. "It's a steep learning curve." He added the four medical centers working on uterus transplantation have been sharing information and they joined fifteen other medical teams from Europe to attend a January conference about the procedure sponsored by the Swedish team.

"We're still moving forward," Dr. Maskin said. "Sweden had such a positive experience, we hope it will translate to future positive experiences." So, too, do the estimated 3-5% percent of women worldwide looking for help to overcome their UFI and have healthy babies.

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