Ten years of uterus transplantation in the United States: births in 70%, reoperation in 28%

Design

Prospective multicentre cohort

Population

60 uterus transplant recipients and their donors at four US centres, 2016-2025

Primary outcome

Surgical complications, live birth and child development

Effect

Live birth or ongoing pregnancy 70%; recipient reoperation 28.3%; living donor reoperation 14.3%; 58.3% of 48 babies preterm

All four US uterus transplant centres pooled their prospective data from February 2016 to December 2025 (published 29 September 2026). Of 60 recipients, 52 had Mayer-Rokitansky-Küster-Hauser syndrome; 42 grafts came from living donors and 18 from deceased donors.

There were no deaths or life-threatening complications. Reoperation was needed in 17 recipients (28.3%), including graft loss from vascular thrombosis, and in 6 of 42 living donors (14.3%), including ureteric injury and vaginal cuff dehiscence. By the end of 2025, 42 recipients (70%) had at least one live birth or an ongoing pregnancy, and nine had two live births.

Among 48 babies, median gestation at delivery was 36 weeks 5 days and 58% were preterm. Neurodevelopment was normal at discharge and six months; of 29 children followed to three years, two had an autism diagnosis. For women with absolute uterine factor infertility, these figures give a realistic basis for counselling, including the donor's risks.

• Counsel women with absolute uterine factor infertility that about 7 in 10 US recipients achieved a birth or ongoing pregnancy.
• Tell them roughly 1 in 4 recipients needed further surgery, including graft loss.
• Include living donor risk: 1 in 7 donors needed reoperation in this series.
• Plan for preterm delivery; over half of babies were born before 37 weeks.
• Surrogacy and adoption remain the main alternatives to discuss alongside transplant.

Why it matters

It moves uterus transplantation from case reports to a decade of aggregate outcomes clinicians can quote.

Don't overread it

Two autism diagnoses in 29 children is too few to show any link with transplantation.

The statistics, in plain English

These are counts from 60 patients without a comparison group, so they describe what happened in these centres rather than estimating precise risks.

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