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Uterus transplantation: A scoping review focused on obstetric outcomes
Megan Barragan-Wolff1, Martha S Espinosa-Cervantes1, Sandra Acevedo-Gallegos2
1Public Health and Epidemiology Division, Universidad Panamericana School of Medicine, Mexico City, Mexico.
Background:
Congenital uterine anomalies include a wide diversity of uterine malformations that can compromise reproductive potential. Uterus transplantation (UTx) proposes an innovative treatment for absolute uterine factor infertility; however, there is a lack of standardized protocols to guide clinical management among this population.
Objectives:
To describe recipient and donor characteristics and obstetric outcomes in patients undergoing UTx.
Search Strategy:
We performed a literature search using the PubMed database to retrieve available scientific articles. We analyzed the references of included articles to assess additional articles that could be eligible to be included in the review. Likewise, we identified further studies using other methods, including Google Scholar.
Selection Criteria:
Titles and abstracts were screened in duplicate to select original reports with information available for the outcomes of interest.
Data Collection And Analysis:
This review assessed the advantages and disadvantages of the techniques used, patient characteristics, obstetric and non-obstetric complications, functional duration of the organ, and neonatal outcomes.
Main Results:
Among the 36 reports included in this review we found 55 pregnancies and 38 live births following UTx and a higher success rate for in vivo uterine donations. The most common obstetric complications reported included miscarriage, pre-eclampsia, and gestational hypertension. The most common non-obstetric complications reported include episodes of rejection, acute kidney injury, anemia, and cholestasis. Living donors required a comprehensive preoperative workup, decreasing organ rejection, infection, and vascular complications.
Conclusions:
More studies are needed to standardize the UTx procedure and improve obstetric, fetal, and neonatal outcomes. Further understanding of which recipient and donor characteristics minimize complications will significantly decrease the risk of adverse outcomes.
