Uterus Transplant Recipient: Operation ‘A Gift'

By Julie Edgar
WebMD Health News

Reviewed by Arefa Cassoobhoy, MD, MPH

March 7, 2016 -- A 26-year-old woman who received a donor uterus in the first U.S. uterine transplant says she considers it "a gift I will never be able to repay."

"The reason I chose to speak is, I wanted to be open and honest," the woman, identified only as Lindsey, told reporters Monday in a press conference at the Cleveland Clinic, where the 9-hour operation was done on Feb. 24.

Lindsey was born without a uterus, a condition called uterine factor infertility (UFI). It results from a problem in the uterus, preventing a successful pregnancy. It affects 3% to 5% of reproductive-aged women worldwide, including an estimated 50,000 in the U.S. The women were born without a uterus, lost their organ because of a medical condition, or have a uterus that doesn't work. Lindsey received the organ from a mother in her 30s who died suddenly.

"At 16 I was told I'd never have children," said Lindsey, who has three adopted children with her husband, Blake. "At that moment I prayed to God to allow me to experience pregnancy. I am so thankful to these doctors and nurses who worked around the clock to ensure my safety."

Lindsey has to wait a year to attempt to get pregnant to ensure the new organ is stable and there are no serious side effects from anti-rejection drugs, which suppress the immune system so it doesn't attack the "foreign" organ.

She is among 10 women who are part of a clinical trial at Cleveland Clinic. They are between the ages of 21 and 39 and don't have a uterus that can carry a pregnancy..

Each of the women donated eggs that were fertilized with their partner's sperm for later implantation through in vitro fertilization (IVF).

Lindsey will remain on anti-rejection drugs for up to two pregnancies. If she's able to get pregnant and have a child, she and her husband will have to wait a year and a half between IVF procedures if they choose to try for a second one.

Uterine transplant recipients who have successful pregnancies must also deliver by cesarean section to minimize any disruptions to the complex connections made during the transplant procedure.

Because of concerns about the risks of taking anti-rejection drugs long-term, the women can't keep the transplanted uterus longer than 5 years. After that, it will likely be surgically removed. It cannot be re-used.

"In the long term, the major side effect of every organ transplant patient is kidney damage, and in the long run, the risk of cancer," says Bijan Eghtesad, MD, one of the surgeons on the team that did the transplant.

"Patients are at higher risk of infection. But we have learned how to ... minimize these side effects. Our monitoring system for rejection is better -- as soon as we see something is happening, we know exactly what to do."

In the beginning, Lindsey will be monitored weekly for signs of rejection, then every other week, then monthly. Rejection signs are usually seen in 6 months to a year.

Asked about Lindsey's chances of getting pregnant, he says, "every embryo we implant in the uterus has about a 60% chance of success. That's why we take 6 to 10 eggs. If one fails, we have another."

If Lindsey does get pregnant, "we'd like to keep her here so we can manage her and her baby, because now we're dealing with two lives," Eghtesad says. Anti-rejection drugs don't cause problems in a pregnancy, he says.

The American surgical team collaborated with Swedish doctors who did the first uterus transplant in 2014. As of September, doctors in Sweden have performed nine uterus transplants that have resulted in four live births and five pregnancies. Sweden uses live donors; the U.S. team is relying on deceased ones but says live donors are a possibility in the future

Uterus donors must be between 18 and 40, according to the clinic. Their organ must be healthy and disease-free. They also cannot have had major surgery in the pelvic region, Eghtesad says.

Lindsey will be released from the hospital in the next few days, he says. "She's up and around. She goes to the cafeteria and eats what she wants."

The technique may someday be offered to women who lose their uterus to cancer or another condition, Eghtesad says.

But "right now, we're not pursuing it," he says. Anti-rejection drugs, which suppress the immune system, may result in aggressive cancers and might trigger the growth of cancer cells.

Doctors don't know exactly what might happen to a donated uterus when anti-rejection drugs are stopped. "There's a choice of taking it out or letting it stay there," Eghtesad says. In two Swedish patients, the uterus was removed.

And the organ can't be re-used. "There's a lot of scarring," he says.

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SOURCES: Press conference, Cleveland Clinic.Bijan Eghtesad, MD, staff surgeon, Cleveland Clinic.

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