Ten years of uterus transplantation in the United States: births, but frequent reoperation

Design

Prospective multicentre cohort, four US programmes, 2016 to 2025

Population

60 uterus transplant recipients, 42 living donors and the 48 neonates born

Primary outcome

Surgical complications, live birth or ongoing pregnancy, and child development

Effect

Live birth or ongoing pregnancy 70.0% (42/60); recipient reoperation 28.3% (17/60); preterm birth 58.3% of 48 neonates

A prospective cohort from the four US centres performing the procedure followed 60 uterus transplants between 2016 and 2025. Fifty-two recipients had Mayer-Rokitansky-Küster-Hauser syndrome, and 42 grafts came from living donors.

There were no deaths or life-threatening complications. Reoperation was needed in 17 of 60 recipients (28.3%), including graft loss from vascular thrombosis, and in 6 of 42 living donors (14.3%), with ureteral injury and vaginal cuff dehiscence among the causes. By December 2025, 42 recipients (70.0%) had a live birth or ongoing pregnancy and nine had two live births.

Among 48 neonates, median gestation at delivery was about 36.7 weeks and 58.3% were born preterm. Neurodevelopment was normal at discharge and six months. At three years (n = 29), two children had an autism diagnosis. The cohort is small and from high-volume research programmes, so these are not rates to quote for other settings.

• 70% of recipients reached a live birth or ongoing pregnancy.
• 28.3% of recipients and 14.3% of living donors needed reoperation.
• 58.3% of babies were born preterm, so obstetric care is high-risk.
• Three-year follow-up covers only 29 children.
• Counsel patients with absolute uterine factor infertility on surgical risk to the donor as well as the recipient.

Why it matters

Counselling can now draw on a decade of aggregate data rather than single-centre reports.

Don't overread it

These are results from a handful of experienced centres and say nothing about outcomes elsewhere or about availability in India.

The statistics, in plain English

With 60 transplants, a single event moves a percentage by nearly two points, so the rates are imprecise. Follow-up of the children is short and incomplete, so the absence of other diagnoses at three years does not exclude later problems.

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