UK’s First Uterine Transplant Is Performed Successfully

Surgeons in the UK have completed the country’s first successful uterine transplant at the Oxford Transplant Centre.

Why do we need womb transplants?

Five thousand women are born without a uterus each year in the UK, the most common cause of which is Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), a condition that affects the female reproductive system. Added to which, complications during childbirth, cancer treatment and other medical emergencies might require a woman to undergo a hysterectomy, a surgical procedure that removes the uterus and results in infertility.

Absolute uterine/womb factor infertility (AUFI or AUWI) is used to describe a woman that does not have a viable uterus, and therefore cannot become pregnant and carry children. This can be devastating for individuals that long to have a child.

Over the last 25 years, scientists have explored the prospect of uterine transplantation (UTx), an approach that could offer women who are not able to conceive through surrogacy or IVF the opportunity to have a child. While several UTxs have been performed across the world, this case report is the first in the UK. Published in BJOG: An International Journal of Obstetrics & Gynaecology, this case involved two sisters, who wish to remain anonymous. The recipient, a 34-year-old woman, has Type 1 MRKH. Her sister, who was 40 years old at the time of the surgery, had previously experienced two healthy pregnancies. Both donor and recipient are said to be recovering well.

How is a uterine transplant conducted?

The surgical team behind the transplant were co-led by Professor Richard Smith, a consultant gynecological surgeon at Imperial College Healthcare NHS Trust and professor of practice at Imperial College London, and Miss Isabel Quiroga, an Oxford University Hospital consultant, transplant and endocrine surgeon and clinical lead for organ retrieval at the Oxford Transplant Centre.

The procedure involves transplantation of a donor’s uterus, cervix, surrounding tissues, blood vessels and a vaginal cuff into an individual with a non-viable womb. “The surgery is highly complex for both donor and recipient and requires the use of anti-rejection drugs taken by the recipient for the duration of the transplant,” Dr. Adam Balen, professor of reproductive medicine and surgery at Leeds Teaching Hospitals – who was not involved in the surgery – described.

To achieve pregnancy, embryos developed using IVF are then transferred. Once the baby reaches full term, a cesarean section is required for delivery. The transplanted uterus is typically removed once the family is complete to avoid continued use of anti-rejection medication.

This is the first case of a uterus transplant surgery using an immunosuppressant drug called alemtuzumab, a monoclonal antibody therapy that can be prescribed to treat several types of cancer, including leukemia. Previous surgeries have used a polyclonal antibody, called anti-thymocyte globulin, or ATG. “It [alemtuzumab] is associated with less biopsy-proven rejection when compared with ATG and has been demonstrated to reduce maintenance immunosuppression and steroid exposure post-transplantation,” the UK team explain. “Although it is not licensed for use in solid organ transplantation, given the theoretical advantages over ATG, it should be considered in uterine transplantation.”

Increasing opportunities for women to have children

The sisters’ donor and transplant operations overlapped, requiring almost 18 hours of surgery. The recipient will reportedly undergo embryo transfer later this year at the Lister Fertility Clinic in London, and if pregnancy is achieved, they will be monitored at Queen Charlotte’s and Chelsea Hospital, where the baby will be delivered.

Oxford University Hospitals emphasizes that the surgeries occurred on a Sunday earlier this year, when National Health Service (NHS) facilities were not in use by NHS patients. The entire surgical and anesthetic team present had volunteered their time to be involved. 

"It was a privilege to carry out the UK's first womb transplant. The operations, while long and complex, went according to plan and I am delighted to see that the donor and recipient are recovering well,” said Quiroga. "I look forward to the time when this procedure becomes more common and more women have the opportunity to have their own baby."

“When clinical UTx programes are established, it is essential to be in the context of appropriate expertise and regulation,” the transplant team said. To prepare for the operation, the surgeons completed the surgery in a number of animal models. They also collaborated with a team of UTx surgeons in Dallas, who shared their experience and expertise.

“This is an excellent and highly significant achievement, being the first uterine transplant to be performed in the UK and I congratulate the Oxford/London team,” said Balen.

Reference: Jones BP, Vali S, Saso S, et al. Living donor uterus transplant in the UK: A case report. BJOG: Int J Obstet Gy. 2023. doi:10.1111/1471-0528.17639