Rebecca Deans, Brigitte Gerstl, Antonia W Shand, Sarah Lyons, Aaron Budden, Helen L Barrett, Grant Luxton, Mangalee Fernando, Kenneth Yong, Karen Keung, Kaushalya Arulpragasam, Henry Pleass, King Man Wan, Eva Kehag, Jana-Emily Pittman, Mianna Lotz, Maria Fenn, Erin Nesbitt-Hawes, Lily Byun, Katrina Tang, Mats Brannstrom, Jason Abbott
{"title":"澳大利亚子宫移植后首例足月活产。","authors":"Rebecca Deans, Brigitte Gerstl, Antonia W Shand, Sarah Lyons, Aaron Budden, Helen L Barrett, Grant Luxton, Mangalee Fernando, Kenneth Yong, Karen Keung, Kaushalya Arulpragasam, Henry Pleass, King Man Wan, Eva Kehag, Jana-Emily Pittman, Mianna Lotz, Maria Fenn, Erin Nesbitt-Hawes, Lily Byun, Katrina Tang, Mats Brannstrom, Jason Abbott","doi":"10.5694/mja2.52682","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To report the first live birth following uterus transplantation in Australia.</p><p><strong>Study design: </strong>Case report.</p><p><strong>Setting, participant: </strong>The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.</p><p><strong>Main outcome measures: </strong>Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.</p><p><strong>Results: </strong>The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.</p><p><strong>Conclusion: </strong>The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.</p><p><strong>Trial registration: </strong>Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.</p>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":" ","pages":""},"PeriodicalIF":6.7000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The first live term birth following uterus transplantation in Australia.\",\"authors\":\"Rebecca Deans, Brigitte Gerstl, Antonia W Shand, Sarah Lyons, Aaron Budden, Helen L Barrett, Grant Luxton, Mangalee Fernando, Kenneth Yong, Karen Keung, Kaushalya Arulpragasam, Henry Pleass, King Man Wan, Eva Kehag, Jana-Emily Pittman, Mianna Lotz, Maria Fenn, Erin Nesbitt-Hawes, Lily Byun, Katrina Tang, Mats Brannstrom, Jason Abbott\",\"doi\":\"10.5694/mja2.52682\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To report the first live birth following uterus transplantation in Australia.</p><p><strong>Study design: </strong>Case report.</p><p><strong>Setting, participant: </strong>The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.</p><p><strong>Main outcome measures: </strong>Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.</p><p><strong>Results: </strong>The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.</p><p><strong>Conclusion: </strong>The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.</p><p><strong>Trial registration: </strong>Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.</p>\",\"PeriodicalId\":18214,\"journal\":{\"name\":\"Medical Journal of Australia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.7000,\"publicationDate\":\"2025-05-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medical Journal of Australia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5694/mja2.52682\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Journal of Australia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5694/mja2.52682","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
The first live term birth following uterus transplantation in Australia.
Objective: To report the first live birth following uterus transplantation in Australia.
Study design: Case report.
Setting, participant: The first participant in the uterus transplantation research study program at the Royal Hospital for Women, the Prince of Wales Hospital, and Westmead Hospital in Sydney.
Main outcome measures: Clinical course after uterus transplantation; course of the subsequent pregnancy until delivery.
Results: The immunosuppression regimen following uterus transplantation on 10 January 2023 was similar to that used for low immunologic risk kidney transplantation. It included induction therapy (basiliximab on days 0 and 4, methylprednisolone on days 0 and 1), followed by maintenance therapy with oral tacrolimus, prednisolone, and mycophenolate mofetil (MMF). The prednisolone dose was steadily tapered over twelve weeks to a low maintenance dose (from 25 mg to 5 mg daily); MMF was replaced with azathioprine during week 9, and tacrolimus was continued throughout the pregnancy. There was no evidence of rejection. A frozen grade 1 blastocyst was transferred during a natural ovulatory cycle 101 days (fifteen weeks) after transplantation; clinical pregnancy was successfully initiated. The woman developed gestational diabetes at 20 weeks and was treated with insulin. A healthy boy was born by planned caesarean delivery at 37 weeks; he weighed 2990 g, with Apgar scores of 7 at one minute and 9 at five minutes. Intrapartum haemorrhage (estimated 2500 mL) led to iron infusion after delivery. The woman and her infant were discharged from the hospital five days after the birth. The infant was breastfed, but the woman experienced recurrent episodes of mastitis that were managed with oral antibiotics, and intravenous antibiotics during two hospital admissions. Eight weeks after birth she commenced weaning the infant. Neither the woman nor her infant experienced serious complications.
Conclusion: The first live birth following uterus transplantation in Australia indicates that the procedure could be adopted here as an assisted reproductive technology for women with uterine factor infertility.
Trial registration: Australian and New Zealand Clinical Trials registry, ACTRN12622000917730.
期刊介绍：
The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
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