A New Frontier in Living Donor Transplantation: Uterus Transplantation

Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. Living donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. In this systematic review, 52 articles concerning the safety and efficacy of living donor uterus transplantation were analyzed. A total of 59 living donor hysterectomies have been reported in literature, including 35 performed with laparotomic approach, 20 with robotic approach and 4 with laparoscopic approach. Robotic living donor hysterectomy had the longest operative time,but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, 4 after robotic living donor hysterectomy and 25 after laparotomic procedure. Living donor uterus transplantation offers the extraordinary opportunity for women with infertility to deliver a live birth. However, many concerns about the ethics and the risks related to living donation should be addressed, including the potential risk for life-threatening complications in living donors.