Uterine transplantation: the status quo in 2024
- For patients with congenital or acquired absence of uterus or defective uterus, uterus transplantation & surrogate motherhood can be used to achieve fertility.
- The first uterine transplant occurred in 2000.
- The first uterine transplant & successful birth of a baby took place in Sweden in 2014.
- Live or dead uterus donors are ABO matched & tested for cytomegalovirus (CMV).
- Cytomegalovirus infection increases morbidity and mortality in patients and requires antiviral prophylaxis.
- During the removal of the uterus, important blood vessels such as the uterine arteries and ovarian arteries must be carefully separated from the left and right sides of the uterus.
- Venous thrombosis dramatically increases the failure rate of that uterus uterus transplant, and every effort should be made to avoid venous thrombosis during the procedure.
- During the removal of the uterus, the donor's uterine arteries must be isolated to avoid damage to the ureter.
- The most important thing is that your uterus is cut. The most important thing is that your uterus is cut and the uterus is docked very efficiently. It's important that you have both donor and recipient surgery at the same time.
- First of all, the vagina of the recipient is separated from the rectum and the bladder, and after the vagina is identified, the important connecting vessels are labeled.
- The donor cuts off the uterus, then immediately takes it over and immediately connects the important blood vessels, and the blood vessels are also found out, and then as soon as the uterus is taken over, the blood vessels are immediately connected to the blood vessels, and there are 8 blood vessels in total, including the upper, lower, left, right, and upper ones, which are the ovarian arterial veins, and the lower two, which are the uterine ligaments, near the uterine arteries and veins.
- Suturing of the blood vessels must be done by suturing a cross-section of the uterine blood vessels to the side of the recipient's blood vessels. The entire procedure must be done quickly and efficiently, and all efforts must be made to prevent the formation of blood clots throughout the entire procedure, which must be accomplished in as little as possible within two hours. It may also be necessary to use a low-temperature environment for the transplantation of the organ, and to suture the vaginal wall after the blood vessels have been sutured.
- After the operation, ultrasound must be used to evaluate the Doppler penetration to assess the uterine blood perfusion ha the difference between the blood flow in and out of the blood flow, if necessary, must do angiography ah, to see his blood supply, in addition to the need to assess whether there is the production of some rejection of the antibody ah.
- After the surgery, some preventive anti-rejection, like some anti-rejection drugs, like steroids, azathioprine. It's the same as a normal transplant, and it's also important to prevent it from getting infected with some of the common transplant viruses, like the CMV virus, or the herpes virus, which is HPV, EBV, etc. These viruses can increase the risk of rejection. These viruses can increase the risk of rejection.
- The patient who has had the surgery can be considered for pregnancy in about 6 months to a year. The patient who has had a uterus transplant will not be able to get pregnant naturally because part of her fallopian tube has been removed. If the fallopian tubes were not removed during the transplant, it should be possible to try to get pregnant naturally, but at present all transplanted uteruses are used for in vitro fertilization, and no attempts are made to get pregnant naturally. In addition, the vagina and uterus may be narrowed after a uterus transplant and may need to be dilated.
- Anti-rejection medication will be required throughout the pregnancy, and it is not clear whether it will affect the fetus. Other more common conditions are gestational hypertension, gestational diabetes, pre-eclampsia, and other conditions.
- The birth time is usually earlier than the birth, usually 2-3 weeks in advance of the benefit of about 35-36 weeks of birth, the birth must be by Caesarean section, because the vagina and the uterus are sutured, there is no way to carry out a natural birth, because the natural birth of the process of the fetus through the uterus and vagina suture is easy to support the opening of the rupture from where it is, so it will definitely be a Caesarean section!
- At present, the transplantation of the uterus has not been tracked for a long time, the need for transplantation of the uterus of the indications of the patient may start from the lack of uterus, and slowly expand into some of the patients, such as endometrial damage, or uterine abnormalities, such as some of the double uterus ah, or male transgender girls transgender people, this kind of patients may slowly become a need for uterus transplantation of a target.
- The results of the anti-rejection medications taken during pregnancy do not seem to be very clear as to whether or not they will have any adverse effects on the fetus.
- Another thing is that after the transplantation of the uterus, is it necessary to keep the uterus as much as possible, at present, some patients are sure that he will not give birth in the future, because he has to maintain the uterus, must be taken for a long time these anti-rejection stimulation, and some people do not want to continue to take this anti-rejection agents, will be removed again the uterus.