Uterus Transplant — Procedure Guide, Recovery & Risks | MyMedicPlus

Uterine transplantation (UTx) is an advanced experimental surgical procedure that represents the only treatment capable of enabling biological pregnancy for women with absolute uterine factor infertility (AUFI) — the complete absence or irreversible dysfunction of the uterus that prevents gestation. AUFI affects approximately 1 in 500 women and arises from several causes: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (congenital absence of the uterus, the most common cause), hysterectomy for uterine cancer, cervical cancer, or massive postpartum haemorrhage, Asherman syndrome with severe intrauterine adhesions obliterating the uterine cavity, and uterine structural abnormalities incompatible with pregnancy. Unlike other solid organ transplants — kidney, liver, heart — uterine transplantation is unique in being a non-vital transplant performed solely to restore reproductive function, with planned elective removal of the transplanted organ after the recipient has completed her desired pregnancies, thereby limiting the duration and risk of ongoing immunosuppression. The first successful live birth from a uterine transplant was reported in Sweden in 2014 by Brannstrom and colleagues; since then, over 100 uterine transplants have been performed globally with approximately 50 live births reported, establishing the procedure as feasible but still requiring specialised centre expertise and ethical framework oversight.

Uterine transplantation is indicated for women with confirmed absolute uterine factor infertility (AUFI) who have functioning ovaries or stored oocytes, wish to experience a biological gestational pregnancy, and are prepared to undergo complex multistage treatment including IVF, major abdominal surgery, and long-term immunosuppression. The Dallas Criteria and similar international frameworks require candidates to be in excellent overall health, of reproductive age (typically under 38–40 years), free from contraindications to immunosuppression (active infection, malignancy, uncontrolled hypertension, diabetes, or renal disease), and supported by a partner or co-parent for the demanding treatment period. Comprehensive psychological evaluation is mandatory given the experimental nature, the potential for disappointment, and the requirement for two major surgical procedures. Candidates must have completed pre-transplant IVF to create and freeze embryos before the transplant, as ovarian stimulation cannot be performed safely while on immunosuppression. Gestational surrogacy is discussed as an alternative or additional option for all candidates.

Uterine transplantation is a two-stage surgical procedure spanning several years. In the first stage — donor uterine procurement — the donor uterus is obtained either from a living donor (most commonly a mother, sister, or other close relative) or from a deceased brain-dead donor. Living donor procurement is performed via open abdominal surgery (laparotomy) or robotically-assisted laparoscopy, requiring meticulous dissection of the uterine blood supply — including the uterine arteries and veins with their precise anastomotic anatomy — along with sufficient lengths of the paracervical and parametrial tissue to enable tension-free vascular anastomosis in the recipient. The living donor operation takes 6-10 hours and carries significant risks, as the uterine vascular pedicle is short and anatomically variable; the donor retains her ovaries and can become pregnant naturally after donation, but loses the ability to carry a pregnancy herself. In the second stage — transplantation into the recipient — the procured uterus is anastomosed to the recipient's iliac vessels (internal iliac artery and vein, or external iliac vessels) and the vaginal cuff is sutured to the transplanted cervix to reconstruct a functional vaginal vault. The recipient begins immunosuppressive therapy (tacrolimus, mycophenolate mofetil, methylprednisolone) perioperatively and continues throughout the period of uterine function. After a waiting period of 6-12 months to confirm uterine viability, menstrual function, and cervical biopsy evidence of absence of rejection, previously banked embryos (produced by IVF before the transplant) are transferred to the transplanted uterus. Planned caesarean section is mandatory for delivery, as the uterine nerve supply is not restored and uterine contractions cannot be reliably sensed. The transplanted uterus is surgically removed after the recipient completes her desired pregnancies, discontinuing the need for immunosuppression.

Uterine transplantation offers women with AUFI the unique possibility of experiencing biological pregnancy and birth — an outcome available through no other means, as surrogacy provides a biological but not gestational connection, and adoption provides neither. Over 100 UTx procedures have been performed worldwide since the first live birth was reported in Sweden in 2014, with more than 100 live births documented internationally as of 2026. At experienced centres, approximately 60–70% of successfully transplanted uteri result in at least one live birth. Living donor UTx achieves higher graft survival and birth rates than deceased donor UTx, reflecting the quality and vascularity of the procured organ. The transplant is temporary by design — immunosuppression is discontinued after uterine removal following childbearing, distinguishing UTx from all other solid organ transplants and removing the long-term burden of immunosuppressive medication and its associated health risks.

Uterine rejection — the recipient's immune system attacking the transplanted organ — occurs in approximately 25–30% of cases, typically manageable with increased immunosuppression doses if detected early on routine uterine biopsy surveillance. Vascular thrombosis of the anastomosed vessels causing graft loss is the most feared acute complication (occurring in 10–15% in early series), though rates have improved with surgical experience. Immunosuppression carries risks of serious opportunistic infection, medication toxicity (calcineurin inhibitor nephrotoxicity, hypertension), and theoretical increased cancer risk over the treatment period. All pregnancies in UTx recipients are delivered by Caesarean section, as there is no evidence of cervical function in the transplanted uterus. Foetal growth restriction is reported in some series. Living donors face significant surgical risk from the 6–8 hour procurement including ureteric and vascular injury, prolonged recovery, and rare long-term complications. Psychological burden of failure is substantial given the complexity of the procedure.

After the transplant surgery, the recipient is hospitalised for 7–10 days and monitored closely for signs of uterine rejection, vascular complications, and infection. Immunosuppressive medication (tacrolimus, mycophenolate mofetil, corticosteroids) is taken daily and blood drug levels monitored weekly initially, then monthly once stable. Regular cervical biopsy sampling allows early histological detection of rejection episodes before they become clinically apparent. Menstruation typically returns within 4–8 weeks of transplantation, confirming adequate uterine perfusion. Embryo transfer via the cervix is planned 6–12 months post-transplant once two consecutive normal menstrual cycles have occurred and drug levels are stable. All deliveries are by planned Caesarean section at 37–38 weeks gestation. After the planned family is complete — usually one or two pregnancies — the uterus is surgically removed under general anaesthesia, and immunosuppression is discontinued, ending the transplant treatment.