Anesthesia for uterine transplantation.

Abstract

Uterine transplantation (UTx) represents a groundbreaking fertility-restorative procedure for women with absolute uterine factor infertility. Since the first successful live birth in 2014, the field has advanced rapidly, supported by accumulating clinical experience and evolving surgical techniques. As a complex and multidisciplinary operation, UTx requires meticulous coordination among specialties such as gynecology, transplant surgery, reproductive medicine, and anesthesiology. Anesthesiologists play a pivotal role in maintaining physiological stability throughout the surgical process, from donor organ retrieval to recipient graft implantation, reperfusion, and immediate postoperative recovery. This review examines the historical background, current status, and future directions of UTx, with a particular emphasis on anesthetic management. Key aspects include preoperative assessment and intraoperative management strategies. Additionally, the review discusses anesthetic considerations for pregnancy and cesarean delivery following successful transplantation. As clinical programs expand, anesthetic protocols must continue to adapt based on emerging evidence, collaborative research, and increasing procedural experience. Through comprehensive perioperative care, anesthesiologists contribute significantly to the success of UTx and the realization of childbirth in women previously considered infertile.