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Uterustransplantation

chirurgischer Eingriff
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Vorlage:Cleanup The uterine transplant is the surgical procedure whereby a healthy uterus is transplanted into a female organism the uterus of which is absent or diseased. As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile. This phenomenon is known as Absolute uterine factor infertility (AUFI). Uterine transplant is a potential treatment to this form of infertility.

History

In 1896 Emil Knauer, a 29-year-old Austrian working in one of Vienna's gynecological clinics, published the first study of ovarian autotransplantation documenting normal function in a rabbit. This led to the investigation of uterine transplantation in 1918.[1][2] In 1964 and 1966, Eraslan, Hamernik and Hardy, at the University of Mississippi Medical Center in Jackson, Mississippi, were the first to perform an animal (dog) autotransplantation of the uterus and subsequently deliver a pregnancy from that uterus.[3] In 2010 Diaz-Garcia and co-workers, at Department of Obstetrics and Gynecology, University of Gothenburg in Sweden, demonstrated the world's first successful allogenic uterus transplantation, in a rat, with healthy offspring.[4]

In humans

In 1931 Lili Elbe in Denmark died from organ rejection three months after receiving one of the world's earliest uterine transplants.[5] With the availability of in vitro fertilization in 1978, uterine transplantation research was deferred.[6]

In Saudi Arabia in 2000, a uterine transplant was performed by Dr. Wafa Fagee from a 46 year old hysterectomy patient into a 26 year old recipient.[7] whose own uterus had hemorrhaged after childbirth. The transplanted uterus functioned for 99 days; however it ultimately needed to be removed after its failure due to blood clotting. Within the medical community there is some debate as to whether or not the transplant can truly be considered successful.[8] Post-operatively, the patient had two spontaneous menstrual cycles, followed by amenorrhoea; exploratory laparotomy confirmed uterine necrosis. The procedure has raised some moral and ethical concerns, which have been addressed in the literature.[9]

In Turkey 9th of August 2011 The world's first uterus transplant from a deceased donor was conducted by a team of doctors from Akdeniz University Hospital in southern Turkey.[10][11][12][13][14][15][16][17] A 21-year-old Turkish woman named Derya Sert, who was born without a uterus, was the first woman in history to have received a womb from a deceased donor. The operation, performed by Dr. Ömer Özkan, Dr. Munire Erman Akar and their team at Akdeniz University Hospital in Antalya, was the world's first uterus transplant surgery gaining long term function as evident by the fact that Ms. Sert has had 6 menstrual periods post-surgery and it is said that the uterus is fully functioning. However, the Turkish medical team who performed the delicate surgery is still cautious about declaring the operation a complete success. "The surgery was a success. But we will be successful when she has her baby", Ozkan said. "For now, we are happy that the tissue is living".[18] On 12 April 2013, Akdeniz University announced that Derya Sert was pregnant.[19][20][21] The statement made by the university hospital also added that Ms Sert would give birth by C-section to prevent any complications. On 14 May 2013, it was announced that Ms Sert terminated her pregnancy in its 8th week following a routine examination where doctors failed to detect a fetal heartbeat.[22]


In Sweden in 2012, the first mother-to-daughter[23] womb transplant was done by Swedish doctors at Sahlgrenska University Hospital at Gothenburg University led by Mats Brännström.[24][25][26] The Uterus transplantation trial encompasses a total of 9 recipients.

First human born following an uterus transplant

In October of 2014, it was announced that for the first time that a healthy baby, a premature boy delivered by cesarean section (the mother had developed pre-eclampsia) at about 31 weeks of gestation (a normal human pregnancy lasts around 39-40 weeks), had been born to an uterine transplant recipient. The Swedish woman had received a uterus in 2013 from a live donor. Brännström led the operation. The woman had healthy ovaries but lacked an uterus, a condition that affects about one in 4,500 women. The procedure used an embryo from a laboratory created using the woman's ovum and her husband's sperm, which was then implanted into the transplanted uterus. The uterus may have been damaged in the course of the C-section delivery; it may or may not be suitable for future pregnancies. Three mild rejection episodes, one during the pregnancy, occurred but were successfully suppressed with medication. Some other women were also reported to be pregnant at that time using transplanted uteruses. The option remains the last resort - it is expensive and not likely to be covered by insurance and as opposed to other methods of fertility assistance and treatment, is a relatively new and somewhat experimental procedure only performed by certain specialist surgeons in select centers, in which the attendant risks of a relatively invasive organ transplant operation (among them infection and organ rejection). Some ethics specialists regard the risks to a live donor, as opposed to a post-mortem donation, as being too great, and some find the entire procedure ethically questionable, especially since the transplant is not a life-saving procedure.[27][28][29]

Procedure

Uterus transplantation starts with uterus retrieval surgery on the donor. Working techniques for this exist for animals, including primates and more recently humans.[30][31][32][33][34][35] It may need to be stored, e.g., for transportation to the location of the donor. Studies on cold-ischemia/reperfusion indicate an ischemic tolerance of >24 h.[31]

Montreal Criteria

The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation was developed at McGill University and published in Transplant International.[9] The Montreal Criteria are a set of criteria deemed to be required for the ethical execution of the uterine transplant in humans. These findings were presented at the International Federation of Gynecology and Obstetrics' 20th World Congress in Rome in October 2012.[36] An update to "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation" has since been published in Fertility and Sterility[37]

References

Vorlage:Reflist

Vorlage:Organ transplantation Vorlage:Female genital procedures

  1. ↑ Emil Knauer: Einige Versuche über Ovarientransplantation bei Kaninchen. In: Zentralblatt für Gynäkologie. 20. Jahrgang, 1896, S. 524–8.
  2. ↑ D Nugent, D Meirow, PF Brook, Y Aubard, RG Gosden: Transplantation in reproductive medicine: Previous experience, present knowledge and future prospects. In: Human Reproduction Update. 3. Jahrgang, Nr. 3, 1997, S. 267–80, doi:10.1093/humupd/3.3.267, PMID 9322102.
  3. ↑ S Eraslan, RJ Hamernik, JD Hardy: Replantation of uterus and ovaries in dogs, with successful pregnancy. In: Archives of surgery. 92. Jahrgang, Nr. 1, 1966, S. 9–12, doi:10.1001/archsurg.1966.01320190011002, PMID 5948103.
  4. ↑ César Díaz-García, Shamima N. Akhi, Ann Wallin, Antonio Pellicer, Mats Brännström: First report on fertility after allogeneic uterus transplantation. In: Acta Obstetricia et Gynecologica Scandinavica. 89. Jahrgang, Nr. 11, S. 1491–1494, doi:10.3109/00016349.2010.520688.
  5. ↑ Nicole Kidman as the world's first reported woman with surgically corrected Harry Benjamin Syndrome. Shb-info.org, abgerufen am 20. November 2012.
  6. ↑ Confino, E', Vermesh, M., Thomas, W', Gleicher, N. "Unilateral rabbit uterus transplantation model", Int J Obstet Gynaecol, 24: 1986; pp, 321-325.
  7. ↑ Anjana Nair, Jeanetta Stega, J. Richard Smith, Giuseppe Del Priore: Uterus Transplant. In: Annals of the New York Academy of Sciences. 1127. Jahrgang, 2008, S. 83–91, doi:10.1196/annals.1434.003, PMID 18443334.
  8. ↑ Denise Grady: Medical First: A Transplant Of a Uterus In: The New York Times, March 7, 2002 
  9. ↑ a b Ariel Lefkowitz, Marcel Edwards, Jacques Balayla: The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. In: Transplant International. 25. Jahrgang, Nr. 4, 2012, S. 439–47, doi:10.1111/j.1432-2277.2012.01438.x, PMID 22356169.
  10. ↑ Nurse hopes to have world's first baby from a transplant womb donated by her own MOTHER In: The Daily Mail, 18. Oktober 2011 
  11. ↑ Turkish woman has world's first womb transplant. timesofmalta.com, abgerufen am 21. November 2012.
  12. ↑ Revolutionary ‘Womb Transplant’ performed in Turkey - World’s First. Allvoices.com, abgerufen am 21. November 2012.
  13. ↑ World’s first successful uterus transplant performed in Turkey — RT. Rt.com, abgerufen am 21. November 2012.
  14. ↑ World’s first womb transplant in Turkey promises hope for women. Alarabiya.net, 1. Oktober 2011, abgerufen am 21. November 2012.
  15. ↑ HEALTH - Doctors hopeful for uterus transplant. Hurriyetdailynews.com, 13. September 2011, abgerufen am 21. November 2012.
  16. ↑ World's first uterus transplant performed in Turkey/TRT-English. Trt-world.com, 27. Februar 2012, abgerufen am 21. November 2012.
  17. ↑ Turkish surgeons perform world's first uterus transplant | Family & Health. World Bulletin, abgerufen am 21. November 2012.
  18. ↑ World's first successful uterus transplant performed in Turkey. Rt.com, Oktober 2011, abgerufen am 20. November 2012.
  19. ↑ Womb transplant recipient Derya Sert pregnant, 13. April 2013 
  20. ↑ Yahoo Health. Abgerufen am 5. Oktober 2014.
  21. ↑ World’s first woman with uterus transplant gets pregnant - HEALTH. Abgerufen am 5. Oktober 2014.
  22. ↑ Derya Sert'in gebeliği sonlandırıldı. CNNTurk.com. Vorlage:Tr
  23. ↑ Mats Brännström, Liza Johannesson, Pernilla Dahm-Kähler, Anders Enskog, Johan Mölne, Niclas Kvarnström, Cesar Diaz-Garcia, Ash Hanafy, Cecilia Lundmark, Janusz Marcickiewicz, Markus Gäbel, Klaus Groth, Randa Akouri, Saskia Eklind, Jan Holgersson, Andreas Tzakis, Michael Olausson: First clinical uterus transplantation trial: a six-month report. In: Fertility and Sterility. 101. Jahrgang, Nr. 5, S. 1228–1236, doi:10.1016/j.fertnstert.2014.02.024.
  24. ↑ Mats Brännström, Cesar Diaz-Garcia, Ash Hanafy, Michael Olausson, Andreas Tzakis: Uterus transplantation: animal research and human possibilities. In: Fertility and Sterility. 97. Jahrgang, Nr. 6, S. 1269–1276, doi:10.1016/j.fertnstert.2012.04.001.
  25. ↑ Mats Brännström, Liza Johannesson, Pernilla Dahm-Kähler, Anders Enskog, Johan Mölne, Niclas Kvarnström, Cesar Diaz-Garcia, Ash Hanafy, Cecilia Lundmark, Janusz Marcickiewicz, Markus Gäbel, Klaus Groth, Randa Akouri, Saskia Eklind, Jan Holgersson, Andreas Tzakis, Michael Olausson: First clinical uterus transplantation trial: a six-month report. In: Fertility and Sterility. 101. Jahrgang, Nr. 5, S. 1228–1236, doi:10.1016/j.fertnstert.2014.02.024.
  26. ↑ M. Brannstrom, C. A. Wranning, A. Altchek: Experimental uterus transplantation. In: Human Reproduction Update. 16. Jahrgang, Nr. 3, 7. November 2009, S. 329–345, doi:10.1093/humupd/dmp049.
  27. ↑ Medical first: Baby born to woman who got new womb In: Journal Star, 2006-2014 Gatehouse Media, Inc., 4 October 2014 
  28. ↑ BBC News. In: BBC News. Abgerufen am 5. Oktober 2014.
  29. ↑ The Daily Telegraph. In: Telegraph.co.uk. 3. Oktober 2014, abgerufen am 5. Oktober 2014.
  30. ↑ Liza Johannesson, Cesar Diaz-Garcia, Henrik Leonhardt, Pernilla Dahm-Kähler, Janusz Marcickiewicz, Michael Olausson, Mats Brännström: Vascular Pedicle Lengths After Hysterectomy. In: Obstetrics & Gynecology. 119. Jahrgang, Nr. 6, S. 1219–1225, doi:10.1097/AOG.0b013e318255006f.
  31. ↑ a b M. Brannstrom, C. A. Wranning, A. Altchek: Experimental uterus transplantation. In: Human Reproduction Update. 16. Jahrgang, Nr. 3, 2009, S. 329–45, doi:10.1093/humupd/dmp049, PMID 19897849.
  32. ↑ C. A. Wranning, S. N. Akhi, C. Diaz-Garcia, M. Brannstrom: Pregnancy after syngeneic uterus transplantation and spontaneous mating in the rat. In: Human Reproduction. 26. Jahrgang, Nr. 3, 15. Dezember 2010, S. 553–558, doi:10.1093/humrep/deq358.
  33. ↑ A. Enskog, L. Johannesson, D. C. Chai, P. Dahm-Kahler, J. Marcickiewicz, A. Nyachieo, J. M. Mwenda, M. Brannstrom: Uterus transplantation in the baboon: methodology and long-term function after auto-transplantation. In: Human Reproduction. 25. Jahrgang, Nr. 8, 2. Juni 2010, S. 1980–1987, doi:10.1093/humrep/deq109.
  34. ↑ Pernilla Dahm-Kähler, Caiza Wranning, Cecilia Lundmark, Anders Enskog, Johan Mölne, Janusz Marcickiewicz, Randa Racho El-Akouri, John McCracken, Mats Brännström: Transplantation of the uterus in sheep: Methodology and early reperfusion events. In: Journal of Obstetrics and Gynaecology Research. 34. Jahrgang, Nr. 5, S. 784–793, doi:10.1111/j.1447-0756.2008.00854.x.
  35. ↑ Caiza Almen Wranning, Randa Racho El-Akouri, Cecilia Lundmark, Pernilla Dahm-Kahler, Johan Molne, Anders Enskog, Mats Brannstrom: Auto-transplantation of the uterus in the domestic pig (Sus scrofa): Surgical technique and early reperfusion events. In: Journal of Obstetrics and Gynaecology Research. 32. Jahrgang, Nr. 4, S. 358–367, doi:10.1111/j.1447-0756.2006.00426.x.
  36. ↑ A. Lefkowitz, M. Edwards, J. Balayla, O081 THE MONTREAL CRITERIA FOR THE ETHICAL FEASIBILITY OF UTERINE TRANSPLANTATION, International Journal of Gynecology & Obstetrics, Volume 119, Supplement 3, October 2012, Page S289, ISSN 0020-7292, http://dx.doi.org/10.1016/S0020-7292(12)60511-6
  37. ↑ Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation.A Lefkowitz, M Edwards, J Balayla - Fertility and Sterility, 2013. doi:10.1016/j.fertnstert.2013.05.026
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