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1st Human Uterus Transplant Reported

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WebMD Health News

March 7, 2002 -- A 26-year-old Saudi Arabian woman who had a hysterectomy when she was 20 received the first and only uterus transplant in a surgery performed almost two years ago. The results were revealed today. The uterus had to be removed after three months due to complications, but those involved are calling the transplant a qualified success.

Supporters of the groundbreaking research hope uterine transplant will some day restore fertility to women in their childbearing years who had hysterectomies due to injury or illness. But many experts question the ethics of such surgery since the uterus is not necessary to sustain a woman's life. Like most transplant patients, uterine recipients would have to take strong anti-rejection drugs that suppress the immune system and could lead to severe illness or death.

"There are serious ethical concerns about this procedure. These are serious drugs that can have long-term effects," says Kutluk Oktay, MD, of Cornell University's Center for Reproductive Medicine and Fertility. "Taking them can result in serious infections and possibly even an increase in malignancies."

The uterine transplant was reported March 7 in the International Journal of Gynecology and Obstetrics. It was performed on April 6, 2000, by researchers at the King Fahad Hospital and Research Center in Jeddah, Saudi Arabia. The woman had an emergency hysterectomy six years earlier as a result of severe bleeding after giving birth. The donor was a 46-year-old woman who was having her uterus removed because of ovarian cysts, which doesn't affect the health of the uterus.

According to researchers, the transplanted uterus responded well and exhibited normal menstrual bleeding following hormonal therapy. But it had to be removed 99 days after implantation because of a common complication following transplant -- formation of clots in the blood vessels supplying the transplanted uterus.

"In the sense that there was no pregnancy established, this transplant was unsuccessful," says uterine transplant researcher Guiseppe Del Priore, MD, of New York Medical Center. "But it was successful in the sense that a first step was taken. This uterus was viable for 99 days and performed normally in response to administered hormones."

Del Priore, who was not involved with the Saudi research, has been conducting uterine transplant studies in animals for several years. So far, he tells WebMD, none of the animals has achieved pregnancy.

He predicts that a second human uterine transplant will be performed within the next year.

Del Priore says those who question the ethics of uterine transplants because the uterus is not a life-sustaining organ minimize the importance of fertility to many couples. Currently available options, such as surrogate gestation, are prohibited by religious or cultural mores in many areas such as Saudi Arabia.

"To some individuals, childbearing is the greatest event of a lifetime," Del Priore wrote in an editorial published with the Saudi findings. "To such persons, transplantation of organs of reproduction would not be considered frivolous or unnecessary, even though these organs do not sustain life."

But Oktay counters that uterine transplants will only be ethically defensible after better and safer organ rejection methods are available.

"I don't think this is the direction we should go in," he says. "This transplant was far from a success. Studying this in animals is one thing, but trying it in people with the current [anti-rejection] drugs is taking too many risks."

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