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New Advances in Uterus and Ovarian Transplantation
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New Advances in Uterus and Ovarian Transplantation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (20 May 2024) | Viewed by 3872

Special Issue Editor

Dr. Elliott G. Richards

E-Mail Website
Guest Editor
Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Interests: uterus transplantation; gynaecological surgery; endometriosis; IVF; fibroids; reproductive medicine; laparoscopic surgery; assisted reproductive technology; reproductive endocrinology

Special Issue Information

Dear Colleagues,

As the Guest Editor of this Special Issue, I invite you to submit your novel research and reviews pertaining to uterus and ovary transplantation. In this Special Issue, we will seek to explore the next questions in the field, including, but not limited to, the following: tissue bioengineering; challenging cases in reproductive transplants either due to oncologic, technical, or ethical concerns; new techniques and surgical innovation; expanding access to reproductive transplants, including transgender individuals; cost effectiveness and payment for reproductive transplant services; and calls to action for research needed in these innovative fields. As a journal of general scientific interest that is not solely restricted to transplant surgery or reproductive medicine, this Special Issue in the Journal of Clinical Medicine will bring together a multidisciplinary group of authors to highlight what is next on the horizon. Your contributions are greatly needed.

Dr. Elliott G. Richards
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • uterus transplantation
  • gynaecological surgery
  • endometriosis
  • IVF
  • fibroids
  • reproductive medicine
  • laparoscopic surgery
  • assisted reproductive technology
  • reproductive endocrinology

Published Papers (5 papers)

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Research

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9 pages, 194 KiB  
Article
Robotic Living Donor Hysterectomy for Uterus Transplantation: An Update on Donor and Recipient Outcomes
by Andrew Jacques, Giuliano Testa and Liza Johannesson
J. Clin. Med. 2024, 13(14), 4186; https://doi.org/10.3390/jcm13144186 - 17 Jul 2024
Viewed by 371
Abstract
Background/Objectives: Uterus transplantation (UTx) has evolved into a clinical reality for women with absolute uterine infertility. The international experience with UTx has predominantly utilized living donor grafts—and strategies to minimize harm to donors remain paramount. Robotic living donor hysterectomy represents a minimally invasive [...] Read more.
Background/Objectives: Uterus transplantation (UTx) has evolved into a clinical reality for women with absolute uterine infertility. The international experience with UTx has predominantly utilized living donor grafts—and strategies to minimize harm to donors remain paramount. Robotic living donor hysterectomy represents a minimally invasive approach to facilitate rapid donor recovery, improve pelvic visualization and operative access, and maintain UTx recipient outcomes. The aim of this study is to describe donor, recipient, graft, and pregnancy outcomes after adoption of a robotic living donor hysterectomy program. Methods: The Dallas UtErus Transplant Study (DUETS) incorporated a robotic living donor hysterectomy operative protocol, including transvaginal extraction, from April 2019. Prospectively collected data were analyzed, and a case series presented, to describe donor intra- and post-operative outcomes and recipient intra-operative outcomes, graft viability, established pregnancies, and live births. Early cases were compared to later cases to better describe the learning curve associated with the technique. Results: Sixteen robotic living donor hysterectomies were performed with 100% graft viability after implantation demonstrated by myometrial flow and onset of menses. Early experience (eight cases) demonstrated two cases of ureteric injury. Later experience (eight cases) demonstrated a reduction in operative time (11 h 10 min vs. 6 h 38 min), with no ureteric injuries and a reduction in major operative morbidity from 25% to 12.5% (Clavien–Dindo grade ≥3). At the time of reporting, nine successful live births have occurred, with six ongoing pregnancies. Conclusions: Robotic living donor hysterectomy represents a safe approach to minimize donor harm without compromising UTx recipient, graft, and pregnancy-related outcomes. A learning curve is demonstrated with the adoption of the novel technique—with particularly care required to prevent ureteric injuries, and ongoing vigilance and reporting necessary given the small case numbers of robotic living donor hysterectomy reported internationally. Full article
(This article belongs to the Special Issue New Advances in Uterus and Ovarian Transplantation)
12 pages, 6457 KiB  
Article
Exploring Divergent Views: A Comparative Study of Uterus Transplantation Perceptions among Transplant and Obstetrics/Gynecology Providers
by Prema Vyas, Danielle Sader, Giuliano Testa, Jinyu Du, Anji Wall and Liza Johannesson
J. Clin. Med. 2024, 13(11), 3182; https://doi.org/10.3390/jcm13113182 - 29 May 2024
Viewed by 404
Abstract
Background: Uterus transplantation (UTx) provides women with absolute uterine-factor infertility (AUFI) the opportunity to carry their own pregnancy and deliver a child. There are multiple ethical and medical concerns associated with UTx. Since the last survey of US provider perceptions of UTx [...] Read more.
Background: Uterus transplantation (UTx) provides women with absolute uterine-factor infertility (AUFI) the opportunity to carry their own pregnancy and deliver a child. There are multiple ethical and medical concerns associated with UTx. Since the last survey of US provider perceptions of UTx in 2018, there have been additional reports of successful transplantations and pregnancies. This study aimed to identify the perception of UTx among providers involved in the diagnosis of AUFI and on the transplant team to help us understand knowledge gaps and determine what barriers must be overcome for UTx to be used in general clinical practice. Methods: We administered REDCap surveys to conference attendees at the 2023 American College of Obstetricians and Gynecologists (ACOG) conference and 2023 American Transplant Congress (ATC). Participants were recruited by medical student volunteers. Results: Two hundred ACOG and ATC attendees completed the survey. Medical concerns related to UTx were reported by 42% of providers from ACOG compared to 22% of providers from ATC. Overall, 76% of participants agreed that UTx should be an option for patients with congenital AUFI. Lastly, 68% of participants agreed that the procedure should be presented as an option for transgender women. Conclusions: This study further elucidates the perception of UTx among obstetricians/gynecologists and transplant physicians. We found greater support for the procedure than in previous studies. This study also demonstrates provider support for presenting this procedure as an option for transgender women. Full article
(This article belongs to the Special Issue New Advances in Uterus and Ovarian Transplantation)
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11 pages, 1584 KiB  
Article
Awareness and Interest in Uterus Transplantation over Time: Analysis of Those Seeking Surgical Correction for Uterine-Factor Infertility in the US
by Liza Johannesson, Giuliano Testa, Menas M. Beshara, Briget da Graca, Jessica R. Walter, Cristiano Quintini, Nawar Latif, Koji Hashimoto, Elliott G. Richards and Kathleen O’Neill
J. Clin. Med. 2023, 12(13), 4201; https://doi.org/10.3390/jcm12134201 - 21 Jun 2023
Viewed by 1091
Abstract
This study describes the characteristics of women who contacted an active program performing uterus transplantation (UTx) in the US, expressing interest in becoming a uterus transplant recipient or a living donor. Basic demographic and self-reported clinical information was collected from women who contacted [...] Read more.
This study describes the characteristics of women who contacted an active program performing uterus transplantation (UTx) in the US, expressing interest in becoming a uterus transplant recipient or a living donor. Basic demographic and self-reported clinical information was collected from women who contacted any of the three US UTx programs from 2015 to July 2022. The three centers received 5194 inquiries about becoming a UTx recipient during the study timeframe. Among those reporting a cause of infertility, almost all of the reports (4066/4331, 94%) were absence of a uterus, either congenitally (794/4066, 20%) or secondary to hysterectomy (3272/4066, 80%). The mean age was 34 years, and 49% (2545/5194) had at least one child at the time of application. The two centers using living donors received 2217 inquiries about becoming living donors. The mean age was 34 years, and 60% (1330/2217) had given birth to ≥1 child. While most of the UTx clinical trial evidence has focused on young women with congenital absence of the uterus, these results show interest from a much broader patient population in terms of age, cause of infertility, and parity. These results raise questions about whether and to what extent the indications and eligibility criteria for UTx should be expanded as the procedure transitions from the experimental phase to being offered as a clinical treatment. Full article
(This article belongs to the Special Issue New Advances in Uterus and Ovarian Transplantation)
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Review

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10 pages, 590 KiB  
Review
Ovarian Tissue Cryopreservation for Fertility Preservation in Patients with Hemoglobin Disorders: A Comprehensive Review
by Catherine Haering, Kathryn Coyne, Katherine Daunov, Samuel Anim, Mindy S. Christianson and Rebecca Flyckt
J. Clin. Med. 2024, 13(13), 3631; https://doi.org/10.3390/jcm13133631 - 21 Jun 2024
Viewed by 459
Abstract
Hemoglobin diseases like sickle cell disease (SCD) and β-thalassemia (BT) present fertility challenges for affected patients. SCD and BT result from abnormal hemoglobin production or structure and pose numerous health concerns. Despite medical advancements improving the quality of life or even providing cures, [...] Read more.
Hemoglobin diseases like sickle cell disease (SCD) and β-thalassemia (BT) present fertility challenges for affected patients. SCD and BT result from abnormal hemoglobin production or structure and pose numerous health concerns. Despite medical advancements improving the quality of life or even providing cures, SCD and BT pose unique fertility concerns for women. Young women with these disorders already contend with reduced ovarian reserve and a narrower fertile window, a situation that is compounded by the gonadotoxic effects of treatments like medications, transfusions, stem cell transplants, and gene therapy. While crucial for disease control, these interventions may lead to reproductive health issues, increasing infertility and early menopause risks. Ovarian tissue cryopreservation (OTC) offers potential for future motherhood to women with hemoglobin disorders facing infertility related to curative treatments. OTC involves surgically removing, preparing, and freezing ovarian tissue containing primordial follicles capable of producing mature oocytes, offering advantages over oocyte cryopreservation alone. However, the application of OTC for patients with hemoglobin disorders presents unique challenges, including special health risks, financial barriers, and access to care. This comprehensive literature review delves into the current state of ovarian tissue cryopreservation for fertility preservation in patients with hemoglobin disorders. Empowering patients with informed reproductive choices in the context of their hemoglobin disorders stands as the ultimate goal. Full article
(This article belongs to the Special Issue New Advances in Uterus and Ovarian Transplantation)
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13 pages, 294 KiB  
Review
Living-Donor Uterus Transplantation: A Clinical Review
by Massimiliano Veroux, Paolo Scollo, Martina Maria Giambra, Giuseppe Roscitano, Alessia Giaquinta, Francesco Setacci and Pierfrancesco Veroux
J. Clin. Med. 2024, 13(3), 775; https://doi.org/10.3390/jcm13030775 - 29 Jan 2024
Cited by 2 | Viewed by 1070
Abstract
Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is [...] Read more.
Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother’s sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer–Rokitansky–Küster–Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ. Full article
(This article belongs to the Special Issue New Advances in Uterus and Ovarian Transplantation)
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