Uterus transplantation - indications, technique, and results.

Abstract

Central message: Uterus transplantation was a transformative innovation in reproductive medicine and organ transplantation in general, and an alternative for the treatment of infertility. The problem of infertility affects 8-12% of the population of reproductive age, causing an enormous social impact. Uterus transplantation, a relatively new treatment, has emerged as an excellent option for couples with absolute uterine infertility. The first uterus transplant performed was in 2000, in Saudi Arabia. At this same time, a Swedish researcher began several experimental works with uterine transplantation in different animal models. Only more than a decade after the first attempt in humans was a second case performed, in Turkey, in 2011. The first transplant in the Americas was performed in the United States of America, in 2016, with a deceased donor. In the same year, in Brazil, the group from Hospital das Clínicas, Faculty of Medicine, University of São Paulo, performed the first uterus transplant in Latin America, also with a deceased donor. This Brazilian case resulted in the world's first birth from a deceased donor uterus transplant in December 2017, making Brazil and Hospital das Clínicas in a vanguard position in the world transplant scenario. Even so, we have today more than 100 transplants performed on the planet, with the birth of more than 70 children. Uterus transplantation was a transformative innovation in reproductive medicine and organ transplantation. It is an alternative for the treatment of absolute uterine factor infertility. Mayer-Rokitansky-Küster-Hauser syndrome is the main cause of uterine agenesis. This Brazilian case resulted in the world's first birth from a deceased donor uterus transplant in December 2017. Today, more than 100 transplants are performed on the planet, with the birth of more than 70 children. Uterus transplantation has undoubtedly been a transformative innovation in reproductive medicine and organ transplantation. It comes as an alternative for treating infertility of an absolute uterine cause. Among these causes, we have women who were born without this organ, or there was a need to perform a hysterectomy, or they have a non-functioning uterus, such as severe malformations (severe bicornuate uterus, Asherman syndrome). Modern society has increasingly respected each individual's decision, provided they are informed of all alternatives and risks involved. In this way, uterine transplantation has become an important alternative for patients with infertility due to uterine causes.

Perspectives: Uterus transplantation is a new modality among organ transplants. It has undoubtedly brought great innovation and excellent results to the therapeutic armamentarium for infertility of uterine cause. Uterus transplantation is a great example where multidisciplinarity, in which each one contributes with their expertise, enables the realization of a greater feat. The gain of experience, technology, and minimally invasive surgeries will certainly bring even better results.