The daughter of the first woman who received a uterus transplant in Italy was born
An experimental procedure The uterus transplant is an experimental procedure, conducted in different countries of the world, indicated mainly for absolute infertility by factor uterine, or when (according to various studies, in 8% of cases in infertile couples) anatomical anomalies of the uterus, congenital or acquired, totally prevent the possibility of pregnancy. In particular, the experimental uterus transplantation protocol is indicated for the Mayer-Rokitanski-Kuser-Hauser syndrome (a rare congenital pathology, which affects about one woman in 4500-10.000, in which the uterus and the part upper vagina) or following removal of the uterus for tumors or obstetric complications. Unlike other organ transplants, this procedure consists of a temporary transplant, aimed at procreation: the experimental protocol, in fact, aims at the end of a pregnancy and the women eligible for this procedure (aged between 18 and 40 years old) must also meet the legal requirements for assisted reproduction.
The first step of the protocol, in fact, provides for the success of the uterus transplant from a functional point of view, similar to other organ transplants. Once the first goal is achieved, about a year after the surgery, the medically assisted procreation process is started. If the pregnancy then proceeds successfully, the baby is delivered by caesarean section and, once the birth has taken place, the uterus is surgically removed, to avoid rejection phenomena and to prevent the transplanted patient from continuing to undergo therapies. immunosuppressive.
The activation of this experimental protocol is quite recent: the national uterus transplant program, in fact, was authorized on an experimental basis by the Superior Health Council in 2018 and has been active, since 2019, in the Transplant Center of the Policlinico of Catania. So far, two interventions have been carried out in Italy: the first in August 2020 (that of Alessandra's mother) and the second in January 2022. The birth of the girl, therefore, represents the first case in Italy of a successful pregnancy. from this type of procedure.
The story of Alessandra's birth Let's go back to that August 2020: the mother of the child, now 31, was born without a uterus due to Rokitansk syndrome and the transplant was performed in Transplant Center of the Catania Polyclinic by a multidisciplinary team composed of Pierfrancesco Veroux, Paolo Scollo, Massimiliano Veroux and Giuseppe Scibilia. The transplanted uterus came from a 37-year-old Tuscan woman who died of sudden cardiac arrest and who had expressed her consent to the donation during her lifetime when she renewed her identity card.
"It was an extremely complex transplant - says Veroux - which presented from the beginning the technical difficulties that limit its extensive use in the world". Despite this, in this case the uterus immediately showed great vitality, which allowed the patient to begin and carry out a pregnancy.
About a year and a half after the operation, the transplanted woman and her husband began the process of homologous assisted fertilization (which involves the use of spermatozoa and oocytes from the couple, the latter taken before intervention and stored in a biobank). Fertilization was successful and a regular pregnancy was established, at the thirtieth week, the patient contracted Sars-cov-2 infection and was admitted to the Cannizzaro hospital. Although the infection was initially asymptomatic, an episode of high fever and subsequent contractions prompted doctors to proceed with a caesarean section. The patient, therefore, gave birth at the thirty-fourth week of a baby girl weighing one kilo and 725 grams, to which she and her father wanted to give the name of the uterus donor. "Mother and daughter - says Scollo - were then transferred to intensive care: the woman in the adult ward, the girl in the neonatal intensive care unit, where she is subjected to antibiotic therapy as usual for premature babies and non-invasive respiratory assistance . Both are in stable conditions ”.
“Over the past two years, the transplant center I direct has followed the future mother on a weekly basis in order to monitor the clinical conditions and modulate immunosuppressive therapy, especially in the delicate final phase conditioned by Covid” adds Veroux. "The transplanted uterus, at the time of the birth of 'our' little Alessandra, confirmed its full functionality, giving us hope for the future".
According to Massimo Cardillo, director of the National Transplant Center, "the birth of this little girl is an extraordinary result", above all because it is one of the few operations performed from deceased donors, who represent only 20% of the already few uterus transplants carried out so far in the world. "Little Alessandra today represents for women born without a uterus a concrete hope of being able to lead a pregnancy and is yet another testimony of how transplant medicine and organ donation are a value to be promoted more and more", concludes Cardillo .
