BY LENNY BERNSTEIN
THE WASHINGTON POST
Doctors at the Cleveland Clinic Monday described the first uterus transplant in the United States, a procedure that involved removing the organ from a deceased donor and implanting it in a 26-year-old woman, who appeared with her partner to thank the medical team for providing her “with a gift.”
About a year after transplantation, the doctors expect to implant an embryo in the uterus of the woman — introduced Monday as “Lindsey” — and deliver a baby by Caesarean section about 37 weeks later. The transplant, performed Feb. 26, is part of a clinical trial that surgeons hope will result in uterus transplants for 10 carefully screened recipients.
The news conference was held about two years after the world’s first uterine transplant was conducted in Sweden. In October 2014, doctors there announced that one of the patients had delivered a healthy boy. Four more children have been born to the women there since.
Ruth M. Farrell, an obstetrician and gynecologist who headed the ethical review of the procedure, said that despite the surgery’s name “the focus is not on the uterus, it’s on women and children and families.”
Tommaso Falcone, chairman of the clinic’s OB/GYN department, called the successful completion of the nine-hour transplant “very euphoric for all of us.”
About one in 5,000 women is born without a uterus, doctors said. For those whose beliefs do not allow surrogacy or who do not want to adopt, uterine transplants offer the possibility of pregnancy and delivery. Lindsey, who appeared at the news conference with her partner, “Blake,” said she has three children whom the couple adopted through the foster-care system.
The major difference between the U.S. and Swedish approaches was the use of a deceased donor, in this case a woman in her 30s who had previously given birth and consented in advance to donate her organs, the doctors said. Farrell said there have been “some complications” for live uterus donors.
The process begins with doctors harvesting eggs from the women, who have ovaries but no Fallopian tubes, and therefore nowhere for the eggs they produce to go. The lack of Fallopian tubes also precludes pregnancy through sexual intercourse. The eggs are mixed with their partner’s sperm to form early embryos, called blastocysts, and banked, said Rebecca Flyckt, another obstetrician-gynecologist who was part of the team.
The uterus is harvested from a donor, cooled and transplanted quickly to minimize its time outside the body, said Andreas G. Tzakis, the surgeon who led the U.S. effort. The procedure is more difficult than other kinds of transplantation because the blood vessels that must be reattached are deeper inside the body, he said.
There is no blood test that allows doctors to monitor the health of the transplanted organ, Tzakis said, so that is done visually and through biopsies. The patient must be on anti-rejection drugs while she has the transplanted uterus. Doctors said they envisioned one or two pregnancies over about five years before the uterus is removed.
The newborns are delivered by C-section because doctors are uncertain about how well the surgical connections would fare during labor and delivery. The team said it plans to monitor the women and children for years after the deliveries.
