Indications and surgical technique for hysterectomy after uterus transplantation

Abstract

A uterine allograft should at some stage be removed, even after proved functionality, in terms of harbouring a pregnancy with live birth. Thus, uterus transplantation is the first type of allogeneic organ transplantation that is ephemeral, with the graft not intended for life-long use. There are several situations when removal of an allogenic transplant is indicated, including early post-operative graft failure, severe and therapy-resistant rejection of the graft, severe non-uterine-specific complications/side-effects of immunosuppression, severe somatic illness, cases when the uterus has delivered the desired number of babies, and failure to successful pregnancy, usually after large number of implantation failures/miscarriages. Any hysterectomy should be performed by a gynaecologist together with a transplant surgeon that has participated in uterus transplantation surgery, so that the understanding of the specific and altered anatomy is secured.