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In the coming months, two women aged 30 to 35 who can not have children should have uterine transplants from deceased donors at the Hospital das Clínicas (HC ) of the Faculty of Medicine of the University (19659003) The prospect is due to the good results of the first transplant of this type carried out by the team of the department of gastroenterology of the faculty: the girl born 15 months later this successful operation, 1 year on December 15, 2018, is in good health, like the mother.
The deceased donor's uterine transplant held at the USP was the first to succeed in the world, after about 10 attempts, with the same approach, in the United States, Turkey and Canada. Czech republic. With living donors, since 2013, there have been 39 transplants, resulting in 11 live births. Since it reaches a broader scale and is legitimized as a therapeutic modality by the public health system, this procedure may constitute an alternative treatment for infertility, which affects 10 to 15% of women.
is a major breakthrough for Brazilian gynecology and obstetrics, although indications are very limited, "said fetal surgeon Antonio Moron, a professor at the Federal University of São Paulo (Unifesp), who not involved in the study.This type of transplant is indicated in women without uterus because of conbad problems or surgical operations.
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The 32-year-old woman who underwent a transplant at HC on September 20, 2016, had no organ because of the so-called Mayer-Rokitansky-Küster-Hauser syndrome, although that the ovaries produced eggs.The donor had three naturally-born children and had died of cerebral hemorrhage at the age of 45.
The first menstrual period had its period 37 days after the transplantatio n, then two months later, she had become pregnant by transferring the embryo. One of the scientific contributions of this work was to indicate that the implantation of embryos could be carried out before the end of a year of uterine transplantation, expected by other living donor teams, which reduces the cost of drugs and medical care [19659004] The implanted uterus was not rejected after transplantation or during pregnancy and was removed after delivery that the woman can stop taking immunosuppressive drugs and badfeed, according to the article published by the HC team on December 4, 2018. "The risk of giving problems seems low," said Wellington surgeon Wellington Andraus of the Liver Transplant Service of the Department of Gastroenterology of FM-USP.
On his desk, he keeps a photo of 2.5 kilograms of the girl born during 36 weeks by caesarean section.
"The uterus is a very resistant organ," noted Andraus. This work, which he coordinated with gynecologist Dani Ejzenberg, also from the USP, indicated that the pear-shaped organ can remain in good condition for eight hours after being removed from the donor. ; it's the same time as other organs, such as liver and pancreas, and almost triple the heart.
Brazilian Strategy
In 2015, an article in The Lancet described the first live donor uterus transplant performed in February. in 2013 and the birth of a baby in September 2014, both led by a group of the University of Gothenburg in Sweden. After reading the work, Ejzenberg asked Andraus if they could not work together to do this type of transplant. "From the beginning, I thought it was an innovative topic and deserved special attention," said Luiz Carneiro surgeon Albuquerque, a professor at FM-USP and head of the Liver Transplant Division and organs of the digestive system. HC.
The group preferred to work with deceased donors, based on the donation of organs from people who died in Brazil, which resulted in the capture of 3,625 kidneys, 1,485 livers, 266 hearts and 31 pancreas. January to September 2018. The Brazilian Association of Transplantation of Organs (Abto). In addition, organ harvesting would be faster and cost less than with living donors.
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group, which performs 120 liver transplants per year, for Ejzenberg and Andraus to be accepted for a practical internship in sheep in 2016 at the University of Gothenburg. On the basis of one of the cases that they saw in Sweden – the woman did not get pregnant as her husband and she separated and he did not allow the girl to get pregnant. implantation of the embryo – the HC team adopted an ethical innovation in the consent form: the husband can make decisions with the woman until the time of transplantation, but then it is up to her only decide whether the implant will be implanted or not. transplanted and interviewed families of potential donors, "commented Andraus.Already to prepare, they removed the uterus from seven dead donors, usually done work at dawn, after the transplant team removed the liver and kidneys, organs considered priority.
The Brazilian team presented the results of the work done in September 2017 at a congress in Gothenburg.In December, a week before the birth of the girl in Sao Paulo, doctors from the University of Dallas in the United States announced the first birth, in the Americas, of a baby – a boy – born after the transplantation of the # 39, uterus of a living donor The lack of living or dead donors, who are under 45 years of age and have had children, as proof of the fertility of the uterus, remains one of the problems to be solved. According to D'Albuquerque, after accumulating a larger n shadow case, another fight will be the incorporation of surgery by the unified health system (SUS). "Among the stents [prótese expansível usada para desobstruir artérias] to appear and be approved by the SUS, there were eight years," he illustrated.
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