- Design
- prospective multicentre cohort study, four American centres, no comparator arm
- Population
- 60 uterus transplants with donor, recipient and child follow-up, February 2016 to December 2025
- Primary outcome
- surgical complications, live birth, and child development
- Effect
- 42/60 recipients (70.0%) with live birth or ongoing pregnancy; 17/60 recipients (28.3%) and 6/42 living donors (14.3%) needed reoperation
A prospective cohort collected donor, recipient and child outcomes from the four American centres performing uterus transplantation between February 2016 and December 2025. Sixty transplants were done, 70% from living donors. Mayer-Rokitansky-Kuster-Hauser syndrome was the indication in 52 women, prior hysterectomy in six.
By December 2025, 42 of 60 recipients had achieved at least one live birth or an ongoing pregnancy, and nine had two live births. Of 48 neonates, median gestational age was 36 5/7 weeks (IQR 34 3/7 to 37 1/7) and 58.3% were preterm. Neurodevelopment was normal at discharge and at six months; among 29 children followed to three years, two had been diagnosed with autism and no growth disorders were seen.
The harms are the part worth carrying into a counselling room. There were no deaths and no life-threatening complications, but 17 of 60 recipients (28.3%) needed reoperation, including graft loss from vascular thrombosis, and six of 42 living donors (14.3%) had a complication requiring reoperation — ureteral injury and vaginal cuff dehiscence among them. A living donor undergoing a hysterectomy for someone else's fertility faced roughly a one in seven chance of going back to theatre.
For a gynaecologist in India this is not yet a referral pathway — the procedure is done at a small number of centres worldwide and remains investigational in most settings. It is, however, the first dataset large enough to quote honestly to a young woman with absolute uterine factor infertility who has read about it.
- Quote a roughly 70% chance of a live birth or ongoing pregnancy per recipient, not a per-transplant success rate
- Counsel that most deliveries were preterm — median gestation was just under 37 weeks
- Set out the donor's risk explicitly: about one in seven living donors needed reoperation
- Explain that graft loss from vascular thrombosis is the main early failure mode and can happen despite an uncomplicated operation
- Position the option as available at a handful of specialist centres rather than as an established treatment
Why it matters
The question patients ask is no longer whether this works but what it costs the donor, and now there is a number for that.
Don't overread it
A single-arm national series cannot say how these outcomes compare with surrogacy or adoption, and the developmental follow-up is too small to detect a signal.
The statistics, in plain English
These are counts from a complete national series rather than a comparison, so there is no control group and no confidence interval to read. Rates from 60 procedures are imprecise by nature: a single extra event shifts a percentage point or two. The three-year developmental follow-up covered 29 of 48 children, so the two autism diagnoses cannot be compared with a background rate in any meaningful way.
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