title: Uterus transplantation trial: 1-year outcome.
abstract: OBJECTIVE
  To report the 12-month outcome of seven patients with viable uteri after uterus transplantation (UTx).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Seven patients with absolute uterine infertility and viable uteri for 12 months after live-donor UTx.
  
  
  METHODS
  Predetermined immunosuppression was with tacrolimus and mychophenolate mofetil (MMF) during 6 months, whereupon MMF should be withdrawn. Frequent ultrasound examinations were performed to assess uterine appearance and uterine artery blood flow. Cervical biopsies (for histological detection of rejection) were obtained at preset time points, with temporary adjustments of immunosuppression if there were signs of rejection. Menstruations were systematically recorded.
  
  
  METHODS
  Menstruation, uterine artery blood flow, histology of cervical biopsies, and blood levels of tacrolimus.
  
  
  RESULTS
  All patients showed regular menses after 1-2 months. Uterine artery blood flow was unchanged, with a median pulsatility index of 1.9 (range, 0.5-5.4). Blood levels of tacrolimus were approximately 10, 9, and 8 (μg/L) during months 2, 9, and 12, respectively. Four recipients showed mild inflammation in biopsies after MMF withdrawal and were treated with corticosteroids and azathioprine during the remainder of the 12 months. Subclinical rejection episodes were detected on ectocervical biopsies in five recipients. Histology showed apoptotic bodies and occasional spongiosis in the squamous epithelium. Moderate infiltration of lymphocytes and neutrophils was seen in the epithelial/stromal interface. All rejection episodes were successfully treated for 2 weeks with corticosteroids or dose increments of tacrolimus.
  
  
  CONCLUSIONS
  We demonstrate long-term uterine viability after UTx, with continued menstruation and unaltered uterine artery blood flow. Subclinical rejection episodes were effectively reversed by temporary increase of immunosuppression.
  
  
  BACKGROUND
  NCT01844362.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Liza
authors.initials: L
authors.lastname: Johannesson
authors.affiliation: Department of Transplantation, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Niclas
authors.initials: N
authors.lastname: Kvarnström
authors.affiliation: Department of Clinical Pathology and Genetics, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Mölne
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Dahm-Kähler
authors.affiliation: Department of Anesthesiology and Intensive Care, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Enskog
authors.affiliation: Department of Gynecology and Obstetrics, 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 at University of Gothenburg, Göteborg, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Olausson
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Stockholm IVF, Stockholm, Sweden. Electronic address: mats.brannstrom@obgyn.gu.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Brännström
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation; D006084:Graft Rejection / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007247:Infertility, Female / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D008137:Longitudinal Studies; D016377:Organ Transplantation / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000503:physiopathology* / Q000637:transplantation*
chemical_list: D007166:Immunosuppressive Agents
keywords: Infertility; MRKH; rejection; transplantation; uterus