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Live Donors of the Initial Observational Study of Uterus TransplantationPsychological and Medical Follow-Up Until 1 Year After Surgery in the 9 Cases

Kvarnström, Niclas MD; Järvholm, Stina Psych; Johannesson, Liza MD, PhD; Dahm-Kähler, Pernilla MD, PhD; Olausson, Michael MD, PhD; Brännström, Mats MD, PhD

doi: 10.1097/TP.0000000000001567
Original Clinical Science-General

Background: The first prospective observational study of uterus transplantation was initiated in 2013 with live donation to 9 women with absolute uterine factor infertility. We explored the medical complications and psychosocial wellbeing of the donors during the first postoperative year.

Methods: Complications were registered and graded according to the Clavien-Dindo (C-D) classification. Symptoms related to the surgery were registered. Data on length of hospital stay, sick leave, socioeconomic parameters, and life events were obtained. Psychological evaluations (Psychological General Well-Being, Dyadic Adjustment Scale, Hospital Anxiety and Depression Scale [HADS], SF-36) questionnaires focusing on quality of life, mood, and relationship, were conducted at inclusion and at 3, 6, and 12 months after uterus donation.

Results: One major surgical complication (C-D IIIb) occurred. A ureteric-vaginal fistula developed 2 weeks after uterus procurement. The fistula was surgically repaired. Two self-reported and transient complications (C-D I) were noted (nocturia, meralgia paresthetica). Hospital stays of all donors were 6 days and median sick leave was 56 days (range, 14-132). At inclusion, median scores exceeded the normative values of the Swedish population in Psychological General Well-Being and Dyadic Adjustment Scale. HADS-Anxiety was detected preoperatively in 1 donor. Two donors exceeded 10-point declines in SF-36 summary scores and increased their HADS scores by 6 points during the observation period. All donors returned to their predonation levels of physical health.

Conclusions: The results support that it is feasible to retrieve a uterus safely from a live donor. Further studies are needed to better evaluate the method.

In this observational study, the authors report on psychological and medical 1-year follow-up in 9 live uterus donors. Even though the numbers are very small, it is possible to conclude that it is an overall safe procedure.

1 Department of Transplantation, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

2 Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

3 Stockholm IVF, Stockholm, Sweden.

Received 9 May 2016. Revision received 12 October 2016.

Accepted 19 October 2016.

The authors declare no conflict of interest.

Funded by the Jane and Dan Olsson Foundation for Science and the Swedish Research Council.

N.K. is the main author of the article, participated in the preparations of the study including donor screening, and participated in the surgical procedures and the follow-up of the donors in the study. S.J. is a coauthor of the article, participated in the design and preparations of the study including donor screening, responsible for the psychosocial follow-up of the donors in the study. L.J. is a coauthor of the article, participated in the design and preparations of the study including donor screening, participated in the surgical procedures and the follow-up of the donors in the study. P.D.-K. is a coauthor of the article, participated in the design and preparations of the study including donor screening and selection, participated and responsible for the surgical procedures and the follow-up of the donors in the study. M.O. is a coauthor of the article, participated in the design and preparations of the study including donor selection, participated and responsible for the surgical procedures in the study. M.B. is the senior author of the article, responsible for the design and preparations of the study including donor screening and selection, participated and responsible for the surgical procedures and the follow-up of the donors in the study.

Correspondence: Niclas Kvarnström, MD, Department of Transplantation, Bruna Stråket 5, Sahlgrenska University Hospital, 43545 Göteborg, Sweden. (niclas.kvarnstrom@transplant.gu.se).

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