Departments: Letters to the Editor
To the Editor:
Surgical techniques for uterine transplantation may become routine. The concern we have with studies on pregnancy outcomes posttransplantation1 is that they downplay the effects immunosuppressant drugs have on fetal health. The authors stated that fetal risk posttransplant appears acceptable based on the low numbers of malformations in self-reported data from essential organ transplants. Although authors of similar human studies noted an increased rate of combined therapeutic and spontaneous abortions and stillborns (ie, non–live births), the focus was on the low rate of birth defects, where “malformation risk in their newborns did not seem to be significantly different from the general population rate.”2 Given the increased rate of non–live births, the evaluation of immunosuppressant drugs should not be based solely on fetal malformations.
Of 11 commonly used immunosuppressant drugs,2 nine are Pregnancy Category C (ie, uncertain safety; no human and animal studies) or D (ie, unsafe; evidence of fetal risk). In transplant studies, reasons for the high rate of non–live births were not given2 or not included in the analysis.3 Also, none of the referenced animal studies of pup births posttransplantation4 used immunosuppressant drugs. Immunosuppressant drugs may have played a key role in the increased rate of human non–live births. Expecting to have data from animal posttransplantation birth studies using Pregnancy Class C and D immunosuppressant drugs is reasonable. Future publications should not get too ahead of the unresolved issue of immunosuppressant drugs’ influence on fetal health. Guaranteed, couples who go through a uterine transplant procedure to have a child will want to know this information.
Virginia Burnett, DO
Obstetrics and Gynecology, St. John Detroit Riverview Hospital, Detroit, Michigan
Richard McDonald, PhD
Biomedical Health Sciences Division, Genovar Bioscience, St. Clair Shores, Michigan
1. Del Priore G, Stega J, Sieunarine K, Ungar L, Smith JR. Human uterus retrieval from a multi-organ donor. Obstet Gynecol 2007;109:101–4.
2. Armenti VT, Radomski JS, Moritz MJ, Gaughan WJ, McGrory CH, Coscia LA. Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl 2003;131–41.
3. Jain AB, Reyes J, Markos A, Mazariegos G, Eghtesad B, Fontes PA, et al. Pregnancy after liver transplantation with tacrolimus immunosuppression: a single center’s experience update at 13 years. Transplantation 2003;76:827–32.
4. Racho El-Akouri R, Wranning CA, Molne J, Kurlberg G, Brannstrom M. Pregnancy in transplanted mouse uterus after long-term cold ischaemic preservation. Hum Reprod 2003;18:2024–30.