Anesthetic challenges of the first successful living-donor uterus transplantation in Latin America: a case report

• First successful living-donor uterus transplantation in Latin America is reported. • Proactive, multimodal pain control is crucial for the healthy living donor. • Hemodynamic stability in the recipient is paramount during graft reperfusion. • A proactive anesthetic strategy is a critical pillar for a successful outcome. Uterus transplantation is an emerging treatment for absolute uterine factor infertility. While surgically complex, the procedure also presents unique challenges for anesthetic management, particularly in living-donor scenarios, where two major operations proceed in close succession with partial temporal overlap. The authors report the anesthetic management and challenges of the first successful living-donor uterus transplantation in Latin America. A 34-year-old female recipient with Mayer-Rokitansky-Küster-Hauser syndrome and her 31-year-old sister, with two previous vaginal births, as the living-donor. The donor's anesthesia was challenging due to the prolonged surgical time, requiring extended general anesthesia with extended mechanical ventilation and continuous invasive monitoring. Another key challenge was managing the donor's significant postoperative pain, necessitating a robust multimodal approach. The recipient's anesthetic course focused on maintaining hemodynamic stability, normothermia, and appropriate fluid balance during major fluid shifts, vascular clamping, and graft reperfusion. Both patients remained hemodynamically stable without vasopressor support throughout their respective procedures. This landmark case demonstrates that successful living-donor uterus transplantation is feasible in a new clinical setting but underscores the critical importance of a specialized, proactive anesthetic strategy. Anesthesiologists must be prepared for prolonged surgical times, control postoperative pain in the donor, and complex hemodynamic management in the recipient. A multidisciplinary approach, psychological support, and comprehensive strategies to minimize perioperative discomfort for the donor, are crucial for optimizing outcomes for both donor and recipient.