Screening and evaluation of potential recipients and donors for living donor uterus transplantation: results from a single-center observational study
We report our experience with screening and selection of potential living donors and recipients in the first-ever German uterus transplantation program. Meticulous preoperative screening is mandatory to maximize transplantation success.
Volume 111, Issue 1, Pages 186–193
Florin-Andrei Taran, M.D., Dorit Schöller, M.D., Katharina Rall, M.D., Silvio Nadalin, M.D., Alfred Königsrainer, M.D., Melanie Henes, M.D., Hans Bösmüller, M.D., Falko Fend, M.D., Konstantin Nikolaou, M.D., Mike Notohamiprodjo, M.D., Christian Grasshoff, M.D., Eckhard Heim, M.D., Stephan Zipfel, M.D., Norbert Schäffeler, Ph.D., Tamam Bakchoul, M.D., Nils Heyne, M.D., Martina Guthoff, M.D., Bernhard Krämer, M.D., Christl Reisenauer, M.D., Markus Hoopmann, M.D., Karl-Oliver Kagan, M.D., Mats Brännström, M.D., Diethelm Wallwiener, M.D., Sara Y. Brucker, M.D.
To report our experience with the screening and selection of potential recipients and living donors of our uterus transplantation (UTx) program.
Part of an observational program.
Patients with absolute uterine factor infertility (AUFI).
Screening by e-mail and telephone, selection during surgical consultation, and preoperative investigations according to a multistep procedure for living donation.
Main Outcome Measure(s)
Age, cause of AUFI, exclusion reasons, and preoperative workup.
A total of 212 potential recipients expressed interest in participation. Among the 46 potential recipients and 49 directed donors were 4 potential recipients, each with 2 directed donors. Mean (range) age of potential recipients was 29.6 (19–41) years. Of the potential recipients, 39 (84.8%) had congenital AUFI and 7 (17.3%) had acquired AUFI. Ultimately, 15 potential recipients with 16 directed donors were selected for participation, with 1 potential recipient having 2 directed donors. Mean age of included potential recipients was 28.9 (22–35) years, and mean donor age was 51.3 (37–62) years. Fourteen potential recipients (93.3%) had congenital AUFI, and one potential recipient (6.7%) had undergone hysterectomy for obstetric complications.
The number of potential candidates for UTx is not inconsiderable, with congenital AUFI being the leading cause of AUFI in our cohort. However, our findings highlight that large numbers of AUFI patients need to be screened, considering our exclusion rates were >50%, owing to ABO incompatibility, unavailability of a directed donor, and self-withdrawal. Moreover, meticulous preoperative screening, including in-depth psychological assessment, is mandatory to maximize living donor safety and UTx success.