Uterus Transplantation as an Innovative Therapeutic Strategy for Absolute Uterine Factor Infertility: Implications for Women's Health and Quality of Life
DOI:
https://doi.org/10.12775/QS.2026.69.74304Keywords
absolute uterine factor infertility, AUFI, Uterus transplantation, UTx, Mayer-Rokitansky-Kuster-Hauser syndrome, MRKH, Uterine agnesis, Histerectomy, Living donor uterine transplant, Deceased donor uterine transplant, immunosuppression after UTx, Women's health, Pregnancy after UTxAbstract
Background: Uterus transplantation (UTx) is currently the only therapeutic option for women with absolute uterine factor infertility (AUFI) caused by congenital or acquired absence of the uterus or impaired uterine function. Experimental studies in animal models provided the foundation for the successful clinical introduction of UTx. Until the first live birth following UTx in 2014, this form of infertility was considered untreatable. Since then, significant advances have been been achieved, making UTx one of the few transplant procedures performed primarily to improve quality of life rather than prolong survival.
Aim: This review summarizes the current evidence on uterus transplantation as a treatment for AUFI, focusing on clinical outcomes, surgical techniques, donor and recipient selection, immunosuppressive management, obstetric outcomes, and procedure-related complications.
Material and Methods: A narrative literature review was conducted using publications indexed in PubMed and Google Scholar. The search included the following terms and their combinations: absolute uterine factor infertility, AUFI, uterus transplantation, UTx, Mayer–Rokitansky–Küster–Hauser syndrome, MRKH, uterine agenesis, hysterectomy, living donor uterine transplant, deceased donor uterine transplant, immunosuppression after UTx, and pregnancy after UTx.
Conclusions: Uterus transplantation is a promising therapeutic option that enables selected women with AUFI to achieve pregnancy and childbirth. However, it remains a technically demanding procedure associated with significant surgical and immunological challenges. Further research is needed to optimize donor and recipient selection, minimize perioperative risks, and confirm the long-term safety and efficacy of UTx to support its broader clinical application.
References
[1] Brännström M. Uterus transplantation and beyond. J Mater Sci Mater Med. 2017;28(5). https://doi:10.1007/s10856-017-5872-0
[2] Steptoe PC, Edwards RG. BIRTH AFTER THE REIMPLANTATION OF A HUMAN EMBRYO. Lancet. 1978;312(8085):366. https://doi:10.1016/S0140-6736(78)92957-4
[3] Dubernard J-M, Owen E, Lefrançois N, et al. First human hand transplantation Case report. Transpl Int. 2000;13:S521-S527. https://doi:10.1007/s001470000288
[4] Brännström M, Dahm Kähler P, Greite R, Mölne J, Díaz-García C, Tullius SG. Uterus Transplantation.Transplantation.2018;102(4):569-577.https://doi:10.1097/TP.0000000000002035
[5] Tardieu A, Dion L, Collinet P, et al. Uterus transplantation: Questions and future prospects. J Gynecol Obstet Hum Reprod. 2019;48(1):1-3. https://doi:10.1016/j.jogoh.2018.11.011
[6] Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet. 2015;385(9968):607-616. https://doi:10.1016/S0140-6736(14)61728-1
[7]Brännström M, Dahm-Kähler P. Uterus transplantation and fertility preservation. Best Pract Res Clin Obstet Gynaecol. 2019;55:109-116. https://doi:10.1016/j.bpobgyn.2018.12.006
[8] Pittman J, Mogensen L, Brännström M, Chan W, Morrison N. Uterus transplantation: Perspectives of Australian women with absolute uterine factor infertility regarding desirability and utility. Aust New Zeal J Obstet Gynaecol. 2020;60(2):264-270.
https://doi:10.1111/ajo.13114
[9] Williams NJ, Scott R, Wilkinson S. The ethics of uterus transplantation. Bioethics. 2018;32(8):478-480. https://doi:10.1111/bioe.12530
[10] Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynecol Obstet. 2002;76(3):245-251. https://doi:10.1016/S0020-7292(01)00597-5
[11] Ozkan O, Akar ME, Ozkan O, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril. 2013;99(2):470-476.e5. https://doi:10.1016/j.fertnstert.2012.09.035
[12] Brännström M, Wranning CA, Altchek A. Experimental uterus transplantation. Hum Reprod Update. 2010;16(3):329-345. https://doi:10.1093/humupd/dmp049
[13] HANAFY A, DIAZ-GARCIA C, OLAUSSON M, BRÄNNSTRÖM M. Uterine transplantation: one human case followed by a decade of experimental research in animal models. Aust New Zeal J Obstet Gynaecol. 2011;51(3):199-203. https://doi:10.1111/j.1479-828X.2010.01283.x
[14] El-Akouri RR. Successful uterine transplantation in the mouse: pregnancy and post-natal development of offspring. Hum Reprod. 2003;18(10):2018-2023. https://doi:10.1093/humrep/deg396
[15] El-Akouri RR. Pregnancy in transplanted mouse uterus after longterm cold ischaemic preservation. Hum Reprod. 2003;18(10):2024-2030. https://doi:10.1093/humrep/deg395
[16] Mihara M, Kisu I, Hara H, et al. Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery. HumReprod. 2012;27(8):2332-2340. https://doi:10.1093/humrep/des169
[17] Dahm-Kähler P, Diaz-Garcia C, Brännström M. Human uterus transplantation in focus. Br Med Bull. 2016;117(1):69-78. https://doi:10.1093/bmb/ldw002
[18] Fontana L, Gentilin B, Fedele L, Gervasini C, Miozzo M. Genetics of Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. ClinGenet. 2017;91(2):233-246. https://doi:10.1111/cge.12883
[19] Herlin MK, Petersen MB, Brännström M. Mayer-Rokitan-sky-Küster-Hauser (MRKH) syndrome: A comprehensive up-date. Orphanet J Rare Dis. 2020;15(1):1-16. https://doi:10.1186/s13023-020-01491-9
[20] Herlin M, Bjørn AMB, Rasmussen M, Trolle B, Petersen MB. Prevalence and patient characteristics of Mayer-Rokitansky-Küster-Hauser syndrome: A nationwide registry-based study. Hum Reprod. 2016;31(10):2384-2390. https://doi:10.1093/humrep/dew220
[21] Kobayashi A, Behringer RR. Developmental genetics of the female reproductive tract in mammals. Nat Rev Genet. 2003;4(12):969-980. https://doi:10.1038/nrg1225
[22] Cunha GR, Robboy SJ, Kurita T, et al. Development of the human female reproductive tract. Differentiation. 2018;103:46-65. https://doi:10.1016/j.diff.2018.09.001
[23] Herlin M, Højland AT, Petersen MB. Familial occurrence of Mayer-Rokitansky-Küster-Hauser syndrome: A case report and review of the literature. Am J Med Genet Part A. 2014;164(9):2276-2286. https://doi:10.1002/ajmg.a.36652
[24] Williams LS, Demir Eksi D, Shen Y, et al. Genetic analysis of Mayer-Rokitansky-Kuster-Hauser syndrome in a large cohort of families. Fertil Steril. 2017;108(1):145-151.e2. https://doi:10.1016/j.fertnstert.2017.05.017
[25] Oppelt P, Renner SP, Kellermann A, et al. Clinical aspects of Mayer-Rokitansky-Kuester-Hauser syndrome: Recommendations for clinical diagnosis and staging. Hum Reprod. 2006;21(3):792-797. https://doi:10.1093/humrep/dei381
[26] Deng S, He Y, Chen N, Zhu L. Spectrum of Type I and Type II Syndromes and Associated Malformations in Chinese Patients with Mayer-Rokitansky-Küster-Hauser Syndrome: A Retrospective Analysis of 274 Cases. J Pediatr Adolesc Gynecol. 2019;32(3):284- 287. https://doi:10.1016/j.jpag.2018.07.007
[27] Brett KM, Higgins JA. Hysterectomy Prevalence by Hispanic Ethnicity: Evidence From a National Survey. Am J Public Health. 2003;93(2):307-312. https://doi:10.2105/AJPH.93.2.307
[28] Grimbizis GF. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161-174. https://doi:10.1093/humupd/7.2.161
[29] Del Priore G, Stega J, Sieunarine K, Ungar L, Smith JR. Human Uterus Retrieval From a Multi-Organ Donor. Obstet Gynecol. 2007;109(1):101-104. https://doi:10.1097/01.AOG.0000248535.58004.2f
[30] Gauthier T, Piver P, Pichon N, et al. Uterus retrieval process from brain dead donors. Fertil Steril. 2014;102(2):476-482. https://doi:10.1016/j.fertnstert.2014.04.016
[31] Brännström M, Johannesson L, Dahm-Kähler P, et al. First clinical uterus transplantation trial: a six-month report. Fertil Steril. 2014;101(5):1228-1236. https://doi:10.1016/j.fertnstert.2014.02.024
[32] Brucker SY, Brännström M, Taran F-A, et al. Selecting living donors for uterus transplantation: lessons learned from two transplantations resulting in menstrual functionality and another attempt,aborted after organ retrieval. Arch Gynecol Obstet. 2018;297(3):675-684. https://doi:10.1007/s00404-017-4626-z
[33] Favre-Inhofer A, Rafii A, Carbonnel M, Revaux A, Ayoubi JM. Uterine transplantation: Review in human research. J Gynecol Obstet HumReprod. 2018;47(6):213-221. https://doi:10.1016/j.jogoh.2018.03.006
[34] Brännström M, Dahm-Kähler P, Kvarnström N. Robotic-assisted surgery in live-donor uterus transplantation. Fertil Steril. 2018;109(2):256-257. https://doi:10.1016/j.fertnstert.2017.12.007
[35] Wei L, Xue T, Tao K-S, et al. Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months. Fertil Steril. 2017;108(2):346-356.e1. https://doi:10.1016/j.fertnstert.2017.05.039
[36] Testa G, Koon EC, Johannesson L, et al. Living Donor Uterus Transplantation: A Single Center’s Observations and Lessons Learned From Early Setbacks to Technical Success. Am J Transplant. 2017;17(11):2901-2910. https://doi:10.1111/ajt.14326
[37] Mölne J, Broecker V, Ekberg J, Nilsson O, Dahm-Kähler P, Brännström M. Monitoring of Human Uterus Transplantation With Cervical Biopsies: A Provisional Scoring System for Rejection. Am J Transplant. 2017;17(6):1628-1636. https://doi:10.1111/ajt.14135
[38] Hammond-Browning N. UK criteria for uterus transplantation: a review. BJOG An Int J Obstet Gynaecol. 2019;126(11):1320-1326. https://doi:10.1111/1471-0528.15844
[39] Flyckt R, Kotlyar A, Arian S, Eghtesad B, Falcone T, Tzakis A. Deceased donor uterine transplantation. Fertil Steril. 2017;107(3):e13. https://doi:10.1016/j.fertnstert.2016.12.009
[40] Froněk J, Janousek L, Chmel R. Deceased donor uterus retrieval -The first Czech experience. Rozhl Chir. 95(8):312-316. http://www.ncbi.nlm.nih.gov/pubmed/27650562
[41] Chmel R, Novackova M, Janousek L, et al. Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations. Am J Transplant. 2019;19(3):855-864. https://doi:10.1111/ajt.15096
[42] Ejzenberg D, Andraus W, Baratelli Carelli Mendes LR, et al. Live birth after uterus transplantation from a deceased donor in a recipient with uterine infertility. Lancet. 2018;392(10165):2697-2704. https://doi:10.1016/S0140-6736(18)31766-5
[43] Arora KS, Blake V. Uterus Transplantation. Obstet Gynecol. 2015;125(4):971-974. https://doi:10.1097/AOG.0000000000000707
[44] Tomkiewicz, J., Tomkiewicz, M., Olko, P., Radulski, J., Licak, G., Bętkowska, P., … Szczuraszek, H. (2023). Mayer-Rokitansky-Küster-Hauser syndrome - a review based on recent advances in medicine. Journal of Education, Health and Sport, 13(3), 262–270. https://doi.org/10.12775/JEHS.2023.13.03.035
[45] Sobolewska, A., Gierulska, N., Stachowicz, H., Iwaniuk, K., Białkowska, Z., Daniluk, A., … Gawłowicz, Łukasz. (2024). Variability of the origin and course of the uterine artery in clinical practice. Journal of Education, Health and Sport, 69, 49390. https://doi.org/10.12775/JEHS.2024.69.49390
[46] Bogdan , . K. ., Jankowski, M., Janicka, U., Ciepluch, N., Słomiński, S., & Toczek, W. (2025). Fertility - preserving treatment strategies for adult and pediatric malignancies - current state of knowledge. Quality in Sport, 48, 67006. https://doi.org/10.12775/QS.2025.48.67006
[47] Szymańska, W. M., Wójcik, J., Kantor, K. K., Plewniok, J., Partyka, M., Pamuła, K. W., … Kuca, M. (2024). Understanding the pathogenesis of infertility in endometriosis - literature review. Quality in Sport, 28, 55644. https://doi.org/10.12775/QS.2024.28.55644
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Copyright (c) 2026 Natalia Trędota, Julia Chmielowiec, Zuzanna Czyżewicz , Kinga Dworak , Dominika Posid, Michał Lewczuk, Karol Dańda, Aleksandra Chludek, Barbara Chobot, Marta Wachowska
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