Acta Obstetricia Et Gynecologica Scandinavica, Journal Year: 2025, Volume and Issue: unknown
Published: Feb. 19, 2025
On September 4, 2014, the birth of first child from a transplanted uterus marked monumental milestone in fields gynecology, reproductive medicine, and obstetrics.1 This historic achievement, realized Sweden, established transplantation (UTx) as groundbreaking treatment for absolute uterine factor infertility—a condition affecting approximately 1 500 women. Since that pioneering UTx birth, over 70 children have been born globally following more than 130 procedures.2 The world's eight live births after took place at Sahlgrenska University Hospital, Sweden. 5, 2024, International Society Uterus Transplantation convened Gothenburg its 4th State-of-the-Art Meeting. event began with heartwarming moment: born, who had celebrated his 10th birthday day before, addressed audience. Speaking fluent English, he described himself "an ordinary boy loves sports, especially golf ice hockey." He shared how proud parents were him encouraged attendees to continue their work make widely accessible. His words deeply moved delegates, many whom shed tears joy, reflecting on remarkable progress made just decade profound human impact this medical advancement within our field. journey concept reality is regarded prime example translational project innovative surgery, meticulously prepared monitored according highest standards outlined Moore Criteria3 IDEAL framework4 introducing major surgical innovations. As part rigorous approach, systematic animal research was conducted across several species,5 before clinical UTx-trial started 2012–2013.6 field has evolved rapidly past decade, continuous methodological advancements aimed improving both safety efficacy procedure. surgery itself, particularly donor (LD) hysterectomy, highly complex. For LD-UTx, total time—including back-table preparation, transplantation—is around 15 h.6 To reduce tissue trauma, robotic introduced LD leading shorter hospital stays reduced recovery time.7 However, approach not yet resulted reduction overall duration. In terms immunosuppression (IS), initial high-IS induction regimen antithymocyte globulin high tacrolimus levels now adjusted moderate-IS protocol using basiliximab moderate levels. Our experience modified IS does increase risk rejection episodes previously observed nephrotoxic effects patients.8 diagnosing rejection, gold standard remains histological evaluation ectocervical biopsies, method initially developed non-human primate model.9 theme issue AOGS contains 11 original papers, one bibliographic analysis, review, all common scientific goal advancing opens bibliometric analysis by Akbari coworkers covering 1960 highlighting growth expanding discipline.10 origins date back 1960s, focusing utero-tubal feasible compared isolated tubal transplantation, treat infertility. Following preclinical studies, Louise Joy Brown 1978—made possible through biologist Robert Edwards, laparoscopist Patrick Steptoe, nurse/embryologist Jean Purdy—demonstrated vitro fertilization (IVF) viable solution challenges faced Edward's team, including skepticism funding bodies, societies, media, are vividly depicted newly released recommended Netflix film Joy. Interestingly, path reality2 shares parallels IVF. While experimentation essential introduction UTx, continued area crucial further UTx. includes four animal-based studies. A new rat model preserves bicornuate shows promise immunology, maternal-fetal tolerance during pregnancies allograft, an article Polenz et al.11 Two studies investigate ways decreasing ischemia graft. pig model, Sousa al. examine hypothermic machine perfusion means prolonging cold ischemia.12 sheep Macedo Arantes study sequential revascularization decrease warm UTx.13 Collectively, will improve ischemic ischemia–reperfusion injury also highlights bioengineering, potentially could allow customized production, eliminating organ shortages rejection. technique involves creating bioreactor, patient-specific stem cells. Previous rodents demonstrated success bioengineered tissue, current De Miguel-Gómez al., exploring decellularization protocols baboon uterus, takes step closer applications.14 early stages, viewed potential infertility due concerns about risks, side recipients, impacts fetal development outcome children. proven resulting countries,2 attitudes toward procedure appear shifted recent years. explore perceptions among women infertility, gestational surrogacy (GS) would be option achieving genetic motherhood, although GS practiced these specific countries. survey Spain Rius interview France, Sweden plus Norway Carton reveal acceptance preferred full biological encompassing connections.15, 16 majority 100 worldwide undergone congenital agenesis associated Mayer-Rokitansky-Küster-Hauser syndrome (MRKHs).2 Three papers psychological aspects preparing those MRKHs. Separate Cospain Karpel provide insights into unique France,17, 18 while Gerstl offer Australian perspective UTx.19 These highlight importance comprehensive support, undergoing complex, life-changing same topic, Rabbani Birmingham, Alabama concerning mental health candidates large, deceased (DD) program.20 Preparing initiate center should long-term process.2 It establishing multidisciplinary team center. then begin conducting thorough review key literature which currently fewer papers. Collaboration experienced preparatory phase. undertake training large followed on-site visit observe procedures center.2 Finally, when ready perform surgeries, it advisable surgeons present assist cases. contribution Tan report collaborative Singapore-Sweden detailing transfer expertise surgically successful case Southeast Asia.21 considered fully until healthy baby delivered uterus. Unlike classical solid transplants, where can typically assessed few days, requires least year confirmation childbirth. Several reports series published, LD-UTx 2014 DD 2017, documented detailed articles Lancet, underscoring significance emerging field.1, 22 group maternal perinatal outcomes 40 published UTx.23 increased adverse obstetrical outcomes, emphasizing need manage high-risk. conclusion, subsequent settings. growing number globe demonstrates no longer experimental but fertility ongoing refine techniques, protocols, minimize LD, maternal, risks. illustrates, collaboration between teams researchers overcoming remaining ensuring becomes accessible safe seeking motherhood. Jane Dan Olsson Foundation Science (2020–09 MB), Swedish Research Council (2024–03487 Knut Alice Wallenberg (2017.0363 state under ALF agreement government county councils (ALFGBG-965535 MB). author declares conflicts interest.
Language: Английский