Baylor University Medical Center opens access to uterus transplantation
The Uterus Transplant Program at Baylor University Medical Center at Dallas (Baylor Dallas), part of Baylor Scott & White Health, was one of the first programs in the world to study uterus transplantation and has quickly become the largest program in the world. With 20 transplants and 14 healthy babies, the Baylor Dallas Uterus Transplant Program is now the first in the world to offer uterus transplantation outside of a clinical trial.
Uterus transplantation is a fertility option for women with absolute uterine factor infertility, which means the woman has an absent or nonfunctional uterus. Uterine factor infertility can be a congenital condition or acquired, such as through hysterectomy.
Improving access to uterus transplantation
Liza Johannesson, MD, PhD, medical director of Uterus Transplantation at Baylor Dallas, describes the motivation for moving uterus transplantation into clinical care. “We started in 2016 and delivered the first baby born to a mother after uterus transplantation in the US. Now, after only 4 years, we have done more surgeries and delivered more babies than anyone else in the world. However, our goal from the beginning was to reach out to as many women as possible. We had only 20 spots for our experimental study and over 1000 applicants, so we have been looking forward to this opportunity to expand.”
The expansion of the Uterus Transplant Program into clinical care also creates opportunities for women who live outside Dallas. For the experimental study, women were required to move to Dallas for the duration of the transplant and pregnancy. Now it is possible to extend this treatment to women throughout the US, and even throughout the world. According to Dr. Johannesson, “Patients will have the option of coming to Dallas for the whole procedure or coming here for evaluation and surgery then having follow-up elsewhere, in collaboration with our team. It is decided on a patient-by-patient basis.”
The Uterus Transplant Program is part of the Annette C. and Harold C. Simmons Transplant Institute at Baylor Dallas, an internationally recognized destination center for transplant care across a variety of subspecialties. The Uterus Transplant Team includes specialists in transplant, gynecology, obstetrics, and maternal fetal medicine.
Dr. Johannesson describes the situations that might lead a woman to consider uterus transplantation: “For the experimental study, we focused on women who had birth defects. Now we will open up to women who have lost their uterus due to malignancy or due to benign causes or childbirth. For these women, surrogacy or adoption have been the only options. We are pleased to offer an option that allows these women to carry a child through pregnancy and birth.”
Advancements in uterus transplantation
In collaboration with Baylor Scott & White Research Institute, the Baylor Dallas Uterus Transplant Program started as a landmark clinical trial to establish a strategy for safe and effective uterus transplantation. During this time, the team has pioneered new approaches to minimize the risks and discomforts of the procedure for the donor, the mother, and the child.
Dr. Johannesson speaks about their medical advances: “The donor undergoes robotic minimally invasive surgery to remove the uterus, allowing her to go home after 1 to 2 days and resume normal life. We have also safely shortened the time from transplant to delivery, reducing the amount of time the recipient spends on immunosuppressant medication. And although the children are still growing, so far they are normal, healthy babies and toddlers.”
During the experimental study, several women were able to achieve a second pregnancy with the transplanted uterus and one has already delivered a second baby. Dr. Johannesson says, “Depending on the medical condition of the mother, we will continue to offer 2 pregnancies from a single transplanted uterus as we expand access to uterus transplantation. We do not yet know if more pregnancies are possible.”
Flexible pool of uterus donors
The Baylor Dallas Uterus Transplant Program was the first program in the world to perform uterus transplant from both living and deceased donors. This flexible approach gives the potential transplant recipients more opportunities to match with a donor.
According to Dr. Johannesson, “We want families to know that they don’t need to find their own donor, though that is an option. They can also receive transplant from deceased donors or live donors unrelated to the mother. We get a lot of requests from people who want to donate their uterus.”
Dr. Johannesson describes their latest developments in the advancing the field of uterus transplantation: “In the laboratory, we are focused on immunology research to understand how to improve transplant success. We are also engaged with professional societies to raise awareness about how uterus transplantation might fit into clinical care in the community. In addition, we are working with insurers to help them understand that this is a strategy for fighting infertility.” Insurance is anticipated to cover the resulting pregnancy and delivery, though patients should talk with their individual insurers.
The Baylor Dallas Uterus Transplant Program attributes their success to the multidisciplinary team of physicians, nurses, and research investigators who are committed to advancing the science of uterus transplantation. The team has published over 30 scientific manuscripts since 2015. Dr. Johannesson says, “We are raising awareness that uterus transplantation is an important option, along with adoption and surrogacy, for infertility. We want referring physicians to be aware of this option and to inform their patients about the potential for uterus transplantation.”