Case analysis of clinical pregnancy and successful deliver living neonate after human uterus transplantation

Objective To explore the feasibility of clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation, as well as the maternal and neonatal outcomes. Methods The literature of clinical pregnancy in the transplanted uterus and successful deliver living neonate after uterus transplantation were selected as research subjects. Using " uterine transplantation" or " uterus transplantation" as English search terms, and " uterine transplantation" and " live birth" as Chinese search terms, we searched literature about clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation from PubMed, Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure databases, and the search period was set from the establishment of each database to December 2018. The clinical case data of reported patients who received uterus transplantation (recipients) from these literature were analyzed, including general clinical data, complications during pregnancy, childbirth and postpartum conditions of the recipients, also maternal and fetal outcomes, and conditions of live birth neonates. Results ① A total of 15 pieces of literature which met the inclusion and exclusion criteria of this study were selected, and all of which were reported from abroad. A total of 12 recipients who had clinical pregnancy and successfully deliver living neonate after uterus transplantation were involved in, and they delivered 12 live birth neonates. ② General clinical data of recipients: 66.7% (8/12) of recipients received a uterus transplantation in Sweden and successfully delivered living neonate. 90.9% (10/11) of recipients received uterus transplantation due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. 58.3% (7/12) of recipients and the donors were related. 91.7% (11/12) adopted living donor transplantation, and 1 case adopted dead donor transplantation. 12 recipients were pregnant through in vitro fertilisation-embryo transfer (IVF-ET) and all had single embryo transfers. During pregnancy of recipients, immunosuppressive therapy was used to prevent graft versus host reaction, and cervical biopsy was used for immune monitoring. ③ Recipients′ conditions of pregnancy period, childbirth and postpartum: The main obstetric complications during pregnancy were hypertensive disorders of pregnancy and intrahepatic cholestasis of pregnancy (ICP). The average gestational age at delivery of 10 recipients was 34+ gestational weeks. The delivery modes of 12 recipients were cesarean section, and there were no serious complications, such as intraoperative bleeding and postpartum hemorrhage after 24 h of cesarean section, death etc., 75.0% (9/12) of recipients continued to retain uterus, and one of them succeeded in pregnancy again. ④ Live birth neonatal conditions: The average weight of 11 neonates was 2 497 g among 12 live birth neonates; no birth defects were found in 12 neonates, only 1 neonate had mild respiratory distress and the rest did not have complications. The follow-up age of 8 neonates in Sweden ranged from 2 months to 3 years, and no obvious abnormalities were found. Conclusions There is a possibility of clinical pregnancy in the transplanted uterus and successful deliver living neonate after human uterus transplantation, and both recipient and neonate have good prognosis. Recipients must be taken active management in strict accordance with high-risk pregnancy. Key words: Humans; Live birth; Pregnancy; Transplant recipients; Living donors; Graft vs host reaction; Single embryo transfer; Uterus transplantation