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Inicio Medicina Clínica (English Edition) Uterine transplantation. First viable case in Southern Europe
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Vol. 156. Issue 6.
Pages 297-300 (March 2021)
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Vol. 156. Issue 6.
Pages 297-300 (March 2021)
Clinical report
Uterine transplantation. First viable case in Southern Europe
Trasplante uterino. Primer caso viable en el sur de Europa
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Francisco Carmonaa,b,
Corresponding author
fcarmona@clinic.cat

Corresponding author.
, Mariona Riusa, Berta Díaz-Feijooa,b, Mireia Musquerac, Jaume Tortd, Antonio Alcarazc
a Service of Gynecology, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
b Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
c Service of Urology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
d Organització Catalana de Trasplantaments (OCATT), Passeig del Taulat, 106-116, 08005 Barcelona, Spain
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Abstract
Introduction and objectives

To describe the development and characteristics living donor uterine transplantation program of the Hospital Clínic (Barcelona, Spain) and to report the first successful procedure in Southern Europe.

Patients and methods

A 31-year-old female suffering of Rokitansky Syndrome underwent uterus transplant from her living sister, as a part of our research protocol. Before the transplant, the patient underwent an in vitro fertilization procedure and twelve embryos were obtained and cryopreserved. The uterus obtention procedure was performed entirely by robotic surgery and lasted 10h, being the main objective to obtain arterial and venous pedicles of good quality in order to ensure the vitality of the graft. The surgical procedure in the recipient was performed by laparotomy and the vascular anastomoses were performed in a terminolateral fashion, with polypropylene 8-0, the vaginal cuff of the graft was sutured to the recipient vaginal vault and the round and utero-sacral ligaments were fixed to the remaining recipient ligaments. Immunosuppressive treatment was prescribed following the protocols from other groups modified according to the solid organ transplantation protocols from our center.

Results

The donor and recipient were discharged without any major complications. The recipient ultrasound scan showed a normal flow in both uterine arteries and veins. A grade II rejection was treated with high dose corticoids with subsequent normal biopsies and a vaginal stricture was treated with the placement of an esophageal stent for 4 weeks. The patient had her first menstrual period 47 days after the surgery.

Conclusions

The case reported here open new options in Spain for a wide group of patients that had no medical solution for a disease that deeply impairs their quality of life.

Keywords:
Uterine transplantation
Rokitansky syndrome
Absolute uterine factor
Infertility
Vaginal stent
Resumen
Introducción y objetivos

Describir el desarrollo y las características del programa de trasplante uterino de donante vivo del Hospital Clínic (Barcelona) y reportar el primer procedimiento exitoso en el sur de Europa.

Pacientes y métodos

Una paciente de 31 años que padecía el síndrome de Rokitansky se sometió, como parte de nuestro protocolo de investigación, a un trasplante de útero de su hermana viva. Antes del trasplante, la paciente siguió un procedimiento de fecundación in vitro y se obtuvieron y criopreservaron 12 embriones. El procedimiento de obtención del útero se realizó íntegramente mediante cirugía robótica y tuvo una duración de 10h, siendo el objetivo principal obtener pedículos arteriales y venosos de buena calidad para asegurar la vitalidad del injerto. La cirugía de la receptora se realizó por laparotomía y las anastomosis vasculares se realizaron de forma término-lateral, con polipropileno 8-0, se suturó el manguito vaginal del injerto a la cúpula vaginal de la receptora y se fijaron los ligamentos redondos y útero-sacros a los remanentes ligamentarios de la receptora. El tratamiento de inmunosupresión se prescribió siguiendo los protocolos de otros grupos modificados según los protocolos de trasplante de órgano sólido de nuestro centro.

Resultados

La donante y la receptora fueron dados de alta sin mayores complicaciones. La ecografía de la receptora mostró un flujo sanguíneo normal tanto en las arterias como en las venas uterinas. A las 3 semanas del procedimiento, apareció un rechazo de grado II que se trató con corticoides a dosis altas con biopsias posteriores normales y una estenosis vaginal se trató con la colocación de un stent esofágico durante 4 semanas. La paciente tuvo su primer período menstrual 47 días después de la cirugía.

Conclusiones

El caso aquí reportado abre nuevas opciones terapéuticas en nuestro país para un amplio grupo de pacientes que no tenían solución médica para una enfermedad que perjudica profundamente su calidad de vida.

Palabras clave:
Trasplante uterino
Síndrome de Rokitansky
Factor uterino absoluto
Infertilidad
Stent vaginal

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