Uterus transplantation in the United States: analysis of patients and early postoperative outcomes in the national organ procurement and transplantation network.

PURPOSE: Uterus Vascularized Composite Allotransplantation (UTx) offers a solution for individuals with uterine factor infertility to enable pregnancy. This exploratory retrospective study evaluates adverse postoperative outcomes in UTx recipients in the U.S. using data from the Organ Procurement and Transplantation Network (OPTN) to identify potential risk factors.

METHODS

Data from the OPTN database were analyzed for 55 patients who underwent UTx in the U.S. Due to missing outcome data, 15 cases were excluded, resulting in a final cohort of 40 patients (73%) eligible for outcome analysis. Variables such as the number of acute rejection (AR) episodes, hospitalizations, and complications were assessed to determine associations with patient related risk factors.

RESULTS

Among the 40 recipients with a mean age of 31 ± 4.7 years, 24 (60%) received grafts from living donors and 16 (40%) from deceased donors. The 12 AR episodes [median 0.0 (IQR 0.0-0.25)] were significantly associated with increased BMI (p = 0.038). The 20 post-transplant hospitalizations [median 0.0 (IQR: 0.0-1.0)] were less frequent in patients who received grafts from living donors (p = 0.016). 9 patients (23%) experienced at least one postoperative complication, with a trend toward higher incidence in patients with increased BMI (p = 0.066) and significantly higher rates linked to prolonged warm ischemia time (p = 0.031).

CONCLUSIONS

This study provides insights into adverse postoperative outcomes in UTx recipients, highlighting the impact of higher BMI, donor status, and warm ischemia time on AR, hospitalizations, and complications.