美国贝勒大学医学中心Liza Johannesson团队研究了子宫移植治疗绝对子宫因素不孕症的疗效与安全性。该项研究成果发表在2024年8月15日出版的《美国医学会杂志》上。

子宫移植为绝对子宫因素不孕的女性提供了自己怀孕的可能性。为了探讨子宫移植是否可行、安全，是否能产下健康婴儿，研究组进行了一个病例系列试验，包括20名患有子宫因素不孕和至少1个卵巢功能正常的参与者，她们在2016年9月14日至2019年8月23日期间在美国一家大型三级医疗中心接受了子宫移植。

子宫移植（来自18名活体供体和2名已故供体）通过手术放置在原位，与髂外血管吻合。参与者接受免疫抑制治疗，直到1或2例活产或移植失败后移植子宫被切除。主要结局为子宫移植物存活率和随后的活产。

在20名参与者中（中位年龄为30岁[范围，20-36]；2名亚洲人，1名黑人，16名白人），14名（70%）成功移植了子宫；所有14名接受者都产下了至少1名活产婴儿。20名受试者中有11名至少有1种并发症。50%的成功妊娠发生了孕产妇和/或产科并发症，最常见的是妊娠高血压（2[14%]）、宫颈机能不全（2[14%]）和早产（2[14%）。在16名活产婴儿中，没有先天性畸形。18名活体捐献者中有4名出现3级并发症。

研究结果表明，子宫移植在技术上是可行的，并且在移植成功后活产率很高。不良事件很常见，医疗和手术风险影响受体和供体。迄今为止，活产儿童尚未出现先天性异常和发育迟缓。

附：英文原文

Title: Uterus Transplant in Women With Absolute Uterine-Factor Infertility

Author: Giuliano Testa, Greg J. McKenna, Anji Wall, Johanna Bayer, Anthony R. Gregg, Ann Marie Warren, Seung Hee S. Lee, Eric Martinez, Amar Gupta, Robert Gunby, Liza Johannesson

Issue&Volume: 2024-08-15

Abstract:

Importance  Uterus transplant in women with absolute uterine-factor infertility offers the possibility of carrying their own pregnancy.

Objective  To determine whether uterus transplant is feasible and safe and results in births of healthy infants.

Design, Setting, and Participants  A case series including 20 participants with uterine-factor infertility and at least 1 functioning ovary who underwent uterus transplant in a large US tertiary care center between September 14, 2016, and August 23, 2019.

Intervention  The uterus transplant (from 18 living donors and 2 deceased donors) was surgically placed in an orthotopic position with vascular anastomoses to the external iliac vessels. Participants received immunosuppression until the transplanted uterus was removed following 1 or 2 live births or after graft failure.

Main Outcomes and Measures  Uterus graft survival and subsequent live births.

Results  Of 20 participants (median age, 30 years [range, 20-36]; 2 Asian, 1 Black, and 16 White), 14 (70%) had a successful uterus allograft; all 14 recipients gave birth to at least 1 live-born infant. Eleven of 20 recipients had at least 1 complication. Maternal and/or obstetrical complications occurred in 50% of the successful pregnancies, with the most common being gestational hypertension (2 [14%]), cervical insufficiency (2 [14%]), and preterm labor (2 [14%]). Among the 16 live-born infants, there were no congenital malformations. Four of 18 living donors had grade 3 complications.

Conclusions and Relevance  Uterus transplant was technically feasible and was associated with a high live birth rate following successful graft survival. Adverse events were common, with medical and surgical risks affecting recipients as well as donors. Congenital abnormalities and developmental delays have not occurred to date in the live-born children.

DOI: 10.1001/jama.2024.11679

Source: https://jamanetwork.com/journals/jama/fullarticle/2822479