PCMS_Philadelphia_Medicine_Spring2018 - 16

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Current Events in Medicine:

The University of Pennsylvania Starts
Uterine Transplant Program
By: Nicholas Nowotarski, MD

"This is the first potential treatment for uterine
factor infertility (UFI) that would allow a woman to
carry her own pregnancy," Dr. Kathleen O'Neill says
to me in her office at the University of Pennsylvania.
She is an Ob/Gyn physician that serves as one of the
principal investigators for the Penn Uterine Fertility
for Uterine Factor Infertility Trial (UNTIL). We were
discussing the advantages of the uterine transplant in
contrast to the alternative methods for pregnancy in
women with UFI such as adoption or surrogacy. Dr.
O'Neill believes that it is a more gratifying experience
for a woman to undergo the pregnancy herself, which
will happen in uterine transplantation, as opposed to
surrogacy or adoption.
UFI is a condition in which the uterus is absent, or
it is present but not capable of sustaining a pregnancy.
Estimates suggest that up to seven million women
between 15 and 34 in the United States suffer from
UFI. Until recently, women with UFI who desired
pregnancy had to rely on surrogacy or adoption if
they wanted a baby. That changed in 2012, when
a team in Sweden started the first human uterine
transplantation trial. In 2014, the first live birth
after uterine transplant occurred. Other centers have also embarked
on uterine transplantation trials, such as Baylor and the Cleveland
Clinic. Penn will be the first center in the Northeast U.S. to perform
uterine transplants.
Penn is still in the early stages of the clinical trial. The first potential
birth following uterine transplant will not take place until sometime
in 2020. The clinical trial subjects can be in the study from five to
10 years depending on whether they want to have one baby or two.
A key part of the study is that the donor uteruses will be from
cadavers as opposed to living donors, who are donating at other
centers. Before the subjects are given the transplanted uterus, they
must be considered psychologically and medically eligible for the
study. After the uterus is transplanted, subjects are monitored for
six to 12 months to make sure there are no complications from the
transplantation. If there are no complications, an embryo formed
from in vitro fertilization (IVF) is implanted into the transplanted
uterus and the pregnancy process begins. After birth, the transplanted
16 Philadelphia Medicine : Spring 2018

uterus is removed if the patient does not desire another
pregnancy. This reduces the amount of time that the
patient has to be on anti-rejection medications. If the
patient desires another pregnancy, the transplanted
uterus remains in the patient and the process resumes.
There have been mixed results with uterine transplants around the world. The data available suggests
that there have been roughly 30 uterine transplants
performed and 10 live births coming from the transplanted uteruses. As with any surgery, there are risks
involved. "In terms of the surgical risk of the recipient,
the primary ones are infectious complications and
more seriously, thrombotic complications, meaning
blood flow to or from the transplant is interrupted,"
Dr. Paige Porrett remarks. She is a trauma surgeon
who is also a principal investigator for UNTIL. If
either of these complications occur, the transplanted
uterus must be removed. It is encouraging to note
that none of the anti-rejection medications used
after transplantation are associated with congenital
anomalies such as heart defects, spine defects, cleft lip,
and cleft palate. This is well known because there have
been many women with transplanted livers or kidneys
on these medications who have had babies without congenital defects.
There are very stringent qualifications to be eligible both as a donor
and recipient for the trial. Most importantly, the donor must have
given birth before and must be between the ages of 21 and 50. It has
been observed that there is a narrowing of the pelvic blood vessels in
women over 50, which could complicate the surgery. The recipient
must have UFI, functional ovaries to generate eggs, and no history
of significant abdominal surgeries among other things.
Both Dr. O'Neill and Dr. Porrett are very encouraged that uterine
transplants will become mainstream in the future based on the
current indicators. I am very intrigued to see what the future holds
for uterine transplantation. It is always great to see medicine have
breakthroughs like this, but it's also imperative that the rewards
outweigh the risks. *
To learn more about this trial, visit: https://clinicaltrials.gov/

https://philamedsoc.org/ct2/show/study/NCT03307356 https://www.clinicaltrials.gov/ https://philamedsoc.org/ct2/show/study/NCT03307356

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