Transfusion Medicine

The researches  find that the Uterus transplantation (UTx) is a quality-of-life enhancing transplantation and the first available treatment for absolute uterine factor infertility (AUFI), which affects around 20 000 women of fertile age in a general population of 100 million (Milliez, 2009; Sieunarine et al., 2005). The success of this type of transplantation was initially demonstrated in September 2014, when the first live birth after UTx took place (Brännström et al., 2015) in a woman who received a transplant in early 2013, as one of nine women undergoing live donor UTx in a Swedish trial (Brännström et al., 2014), which includes the cohort of the present study.

Life enhancing transplantation

The initial proof of concept of UTx as a realistic AUFI treatment has later been confirm within this initial Swedish trial (Brännström et al., 2016) and also in a live donor UTx trial in the USA (Testa et al., 2018); and deceased donor UTx trial in Brazil (Ejzenberg et al., 2018). Prior to the initial Swedish trial; two separate single UTx cases had been perform with the first one in 2000 involving a live donor case (Fageeh et al., 2002) ;and the second case involving a deceased donor (Ozkan et al., 2013). Live births were not reported from these cases.

In recent years, the activity in the UTx field has increased considerably and published cases; covering the results of surgery, now exist from live donor trials in China (Wei et al., 2017); Germany (Brucker et al., 2018); the USA (Testa et al., 2018) and the Czech Republic (Chmel et al., 2018); as well as from deceased donor trials initiated in the USA (Flyckt et al., 2017), Brazil (Ejzenberg et al., 2018); and the Czech Republic (Chmel et al., 2018). The majority of the published cases of UTx has involved live donors; both related and non-related.

The psychosocial health

The ethical debate associated with UTx is evolving; with the risk–benefit ratio now considered acceptable for live donor UTx; although the debate also includes deceased versus live donor UTx (Olausson et al., 2014; Testa and Johannesson, 2017). Living donation in transplantation is established in the areas of kidney and liver transplantation and may also be applied in lung transplantation. There is extensive research following up on the psychological well-being and health-related quality-of-life of donors, particularly kidney donors.

A systematic review of the psychosocial health of live kidney donors included around 50 studies with an average follow-up of 4 years (Clemens et al., 2006).  A clear majority (between 75% and 95%); reported no depression or anxiety post donation and relationships with partners generally remained good and stable. However; adverse outcomes such as reduce quality of relationships, reduced quality-of-life and an increase of psychiatric symptoms are find in a small proportion of donors; and it was suggest that careful selection, with good donor support and follow-up; are essential to ensure successful outcomes (Clemens et al., 2006).