Risks of uterus transplantation: a scoping review

To map risks related to uterus transplantation.

Scoping review based on the Joanna Briggs Institute method. Were included studies published in scientific journals that described complications, adverse events, and risks in women who were uterine transplant recipients, living uterine donors, and newborns, infants and children born from transplanted uteri. A modified version of Failure Modes and Effects Analysis was used for data collection, and the data were quantitatively analyzed through the development of risk categories and risks rates calculation.

In total 44 studies from 13 countries were included. Mapped 115 patients, 62 recipients, 34 donors, and 19 newborns, infants, and children born from transplanted uteri, 324 complications and adverse events across 25 risk categories. An online system (UTx Observatory) was developed. Among recipients, 77.5% received uteri from living donors, and 22.5% from deceased donors with most prevalent immunological, vascular, infectious, and prematurity risks. Recipients of deceased donor uteri had a higher adjusted risk rate. Among living donors, most prevalent risks were neurological, infectious, and urological risks. Laparotomy (76.5%) was associated with a higher adjusted risk rate than robotic-assisted surgery (23.5%) for uterus donation. Mainly risks mapped from newborns, infants, and children were respiratory, development-related, and malformations.

The study and the UTx Observatory provide a foundation for developing targeted risk-mitigation strategies, shaping future studies and interventions, and informing health teams, authorities, and patients involved in uterus transplantation.Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/524UT.