title: Livebirth after uterus transplantation.
abstract: BACKGROUND
  Uterus transplantation is the first available treatment for absolute uterine infertility, which is caused by absence of the uterus or the presence of a non-functional uterus. Eleven human uterus transplantation attempts have been done worldwide but no livebirth has yet been reported.
  
  
  METHODS
  In 2013, a 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) underwent transplantation of the uterus in Sahlgrenska University Hospital, Gothenburg, Sweden. The uterus was donated from a living, 61-year-old, two-parous woman. In-vitro fertilisation treatment of the recipient and her partner had been done before transplantation, from which 11 embryos were cryopreserved.
  
  
  RESULTS
  The recipient and the donor had essentially uneventful postoperative recoveries. The recipient's first menstruation occurred 43 days after transplantation and she continued to menstruate at regular intervals of between 26 and 36 days (median 32 days). 1 year after transplantation, the recipient underwent her first single embryo transfer, which resulted in pregnancy. She was then given triple immunosuppression (tacrolimus, azathioprine, and corticosteroids), which was continued throughout pregnancy. She had three episodes of mild rejection, one of which occurred during pregnancy. These episodes were all reversed by corticosteroid treatment. Fetal growth parameters and blood flows of the uterine arteries and umbilical cord were normal throughout pregnancy. The patient was admitted with pre-eclampsia at 31 full weeks and 5 days, and 16 h later a caesarean section was done because of abnormal cardiotocography. A male baby with a normal birthweight for gestational age (1775 g) and with APGAR scores 9, 9, 10 was born.
  
  
  CONCLUSIONS
  We describe the first livebirth after uterus transplantation. This report is a proof-of-concept for uterus transplantation as a treatment for uterine factor infertility. Furthermore, the results show the feasibility of live uterus donation, even from a postmenopausal donor.
  
  
  BACKGROUND
  Jane and Dan Olsson Foundation for Science.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Stockholm IVF, Stockholm, Sweden. Electronic address: mats.brannstrom@obgyn.gu.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Brännström
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Stockholm IVF, Stockholm, Sweden.
authors.forename: Liza
authors.initials: L
authors.lastname: Johannesson
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Bokström
authors.affiliation: Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Kvarnström
authors.affiliation: Department of Clinical Pathology and Genetics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Mölne
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Stockholm IVF, Stockholm, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Dahm-Kähler
authors.affiliation: Department of Anesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Enskog
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Stockholm IVF, Stockholm, Sweden.
authors.forename: Milan
authors.initials: M
authors.lastname: Milenkovic
authors.affiliation: Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jana
authors.initials: J
authors.lastname: Ekberg
authors.affiliation: Department of Obstetrics and Gynecology, La Fe University Hospital, University of Valencia, Valencia, Spain.
authors.forename: Cesar
authors.initials: C
authors.lastname: Diaz-Garcia
authors.affiliation: Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Markus
authors.initials: M
authors.lastname: Gäbel
authors.affiliation: Department of Obstetrics and Gynecology, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Ash
authors.initials: A
authors.lastname: Hanafy
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; King's Health Partners, St Thomas' Hospital, London, UK.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hagberg
authors.affiliation: Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Olausson
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Stockholm IVF, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Nilsson
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000601:surgery*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001034:Apgar Score; D001379:Azathioprine / Q000627:therapeutic use; D002585:Cesarean Section; D000013:Congenital Abnormalities / Q000601:surgery*; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007231:Infant, Newborn; D007234:Infant, Premature; D050498:Live Birth; D019520:Living Donors; D008297:Male; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000601:surgery; D011225:Pre-Eclampsia; D011247:Pregnancy; D013548:Sweden; D016559:Tacrolimus / Q000627:therapeutic use; D014599:Uterus / Q000637:transplantation*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D001379:Azathioprine; D016559:Tacrolimus