Swedes Perform Pioneering Uterine Transplants; Americans Not Far Behind | KUER 90.1

Swedes Perform Pioneering Uterine Transplants; Americans Not Far Behind

Sep 21, 2012
Originally published on September 21, 2012 7:39 am

A Swedish medical team has transplanted uteruses from two women in their 50s to their daughters. Meanwhile, Shots has learned that an Indiana group is recruiting women willing to undergo womb transplants in this country.

"We could go ahead tomorrow if we found the perfect candidate," Dr. Giuseppe Del Priore told Shots.

Del Priore says he has already interviewed a number of women, and has the approval of the ethics committee at Indiana University in Indianapolis.

While the Swedes did mother-to-daughter transplants, the Indiana group plans to rely on cadaver donors. Del Priore says he believes there would be an ample supply of suitable uteruses from current multiorgan cadaver donors.

He says tens of thousands of American women are potential candidates for uterine transplants. They include young women who have had hysterectomies for cancer, endometriosis and uterine trauma. Another group is women born without a uterus.

Other medical centers in the U.S. and Britain also hope to begin offering uterine transplants after a decade or so of animal research. It's the latest frontier in a medical field launched almost six decades ago with the first successful kidney transplant.

The Procedure

Uterine transplants have one unique feature: They'll be temporary.

Once a transplant recipient has achieved a successful pregnancy — or two, in the Swedish protocol — she will undergo a hysterectomy to remove the foreign uterus. That way, she won't be exposed to a lifetime of immunosuppressive drugs with their risks of increased infection and other disorders.

A 10-person team at the University of Gothenburg in Sweden did the first mother-to-daughter uterine transplants last weekend.

One of the recipients lost her uterus to cervical cancer. The other was born without a uterus.

"They're doing fine, both the donors and the recipients," transplant surgeon Michael Olausson told Shots. "All four women are doing fine."

But Olausson acknowledges that the success of the experiment is far from assured. The recipients will be monitored for a year to see if the transplants settle in and behave like normal uteruses — cycling through menstrual periods, avoiding signs of rejection.

Then the doctors will implant previously frozen embryos from these women and hope all goes well. By that schedule, the outcome of the experiment will be known sometime in mid-2014.

Olausson says he's confident the transplanted uteruses can withstand the mechanical stresses of pregnancy, as well as undergo the growth and complicated remodeling necessary to carry and sustain a fetus.

A long series of experiments with mice, rats, sheep, pigs and baboons showed that these animals could accept uterine transplants and give birth to healthy offspring. "So we don't think there will be a problem," he says.

One of the women who donated her uterus to her daughter is past menopause.

"It does not really matter if they are menopausal or not because the uterus can be sort of refurbished with hormones," Olausson says. "So that's not a problem in itself."

'Don't Get Too Excited Just Yet'

Some experts are concerned about the risks of anti-rejection drugs during pregnancy — not only because of possible infection but also because of other problems, such as high blood pressure and premature delivery. But Olausson points out that as many as 15,000 women have had successful pregnancies after undergoing other organ transplants.

The Swedish uterine transplants are not the first. In 2000, a Saudi Arabian group transplanted a uterus from a live donor. But within three months, it developed blood clotting problems and had to be removed.

Last year Turkish doctors said they had transplanted a uterus into a 21-year-old woman from a cadaver donor, but experts in the field don't believe that has resulted in a pregnancy yet.

One leading U.S. obstetrician-gynecologist, Dr. Michael Green of Massachusetts General Hospital, cautioned against premature enthusiasm about uterine transplants.

"Don't get too excited quite yet," he told Shots. "[It's] too soon to make a judgment."

Green questions whether this kind of transplant is really necessary. When doctors began transplanting organs in the 1950s, '60s and '70s, they started with organs essential for life — kidneys, hearts and livers. Lately they've been doing what Green calls "optional" transplants — of limbs, voice boxes, even faces.

"Nobody needs a uterus to live, OK?" Green says. "Nobody needs a hand or a face to live, in fairness. It's a quality-of-life issue. This is in that same category. So we've opened the door. We've stepped through it. And this is one of the next logical things that people might do."

He wonders whether health care dollars should be spent on uterine transplants when a woman who lacks a uterus can turn to a surrogate mother to provide her with a child — if she can afford it, that is.

But Dr. James Grifo of New York University Medical School says he hopes the Swedish experiment and other such efforts succeed.

Grifo has done his own research on uterine transplants but abandoned that work to pursue other priorities. He said in an interview that he was uncomfortable with the possible risks. But he sympathizes with women who might want a uterine transplant.

"I don't think it's a simple discussion by any stretch," Grifo told Shots. "You know, when you're the patient, then you fully understand the issues. When you're just theoretically discussing these things, unless it actually hits home, I think you don't really fully understand it."

The Swedes plan to do 10 more uterine transplants. The next two could be in a matter of weeks.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

STEVE INSKEEP, HOST:

Doctors in Sweden have begun writing another chapter in the story of human organ transplants. They've taken uteruses from two women in their 50s, and transplanted them into their daughters. One of the younger women had previously lost her uterus to cancer, while the other was born without one. NPR's Richard Knox says the doctors are confident the daughters will be able to bear children.

RICHARD KNOX, BYLINE: Transplant surgeon Michael Olausson says the idea was born a dozen years ago, when his colleague Mats Brannstrom had to do a hysterectomy on a young woman with cervical cancer.

DR. MICHAEL OLAUSSON: And she asked, why can't you just transplant the uterus? You can transplant other organs, why isn't it possible to do that? That got him started in the research project.

KNOX: Olausson, speaking on a cellphone, says the team transplanted uteruses in many different animals.

OLAUSSON: Mice, rats, sheep, pigs and primates.

KNOX: The transplanted animals were able to have normal pregnancies and healthy offspring. So last weekend, the team moved into humans. The patients haven't been identified, but Olausson says the mothers were happy to participate.

OLAUSSON: They're done with their baby-making, and so they have decided to donate their uterus to the daughters.

KNOX: One of the mothers was past menopause.

OLAUSSON: It does not really matter if they are menopausal - or not - because the uterus can be sort of refurbished with hormones. So that's not a problem, in itself.

KNOX: That's remarkable - but not as amazing as the possibility these women may be able have a baby. To do that, the transplanted wombs will have to withstand the stresses and strains of pregnancy. No other organ has to undergo such enormous changes. But Olausson confidently predicts success on the basis of animal experiments. So far, the patients are recovering nicely.

OLAUSSON: They're doing fine - both the donors and the recipients. All four of them are doing fine.

KNOX: But the real test will come late next year, and in 2014. That's when doctors will put previously frozen embryos from these women into the transplanted uteruses, and cross their fingers that all goes well.

DR. MICHAEL GREEN: Don't get too excited quite yet; too soon to make a judgment.

KNOX: That's Dr. Michael Green of Massachusetts General Hospital. Green says no one knows whether these women will avoid the many perils of pregnancy. They'll have to take anti-rejection drugs, which may pose a hazard. But he raises a broader question: Is this kind of transplant really necessary? When doctors began transplanting nearly six decades ago, they started with organs essential for life - kidneys, hearts and livers. Lately, they've been doing what Green calls optional transplants.

GREEN: Nobody needs a uterus to live, OK? Nobody needs a hand or a face to live, in fairness. It's a quality-of-life issue. This is in that same category. So we've opened the door; we've stepped through it. And this is one of the next, logical things that people might do.

KNOX: Now, if a woman who lacks a uterus wants a baby, she can turn to a surrogate mother - if she can afford it. Green wonders if health-care dollars should be spent on uterine transplants. But Dr. James Grifo hopes the Swedish experiment succeeds. He's a fertility expert at New York University who's done his own research on uterine transplants, but abandoned that work to pursue other priorities. Grifo sympathizes with women who might want a uterine transplant.

DR. JAMES GRIFO: I don't think it's a simple discussion, by any stretch. You know, when you're the patient, then you fully understand the issues. When you're just theoretically discussing these things, unless it actually hits home, I think you don't really, fully understand it.

KNOX: The Swedes plan to do 10 more uterine transplants. The next two could be sometime this fall.

Richard Knox, NPR News. Transcript provided by NPR, Copyright NPR.