Uterine Transplant for Women With Absolute Uterine Factor Infertility (AUFI)
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ClinicalTrials.gov Identifier: NCT05263076 |
Recruitment Status :
Recruiting
First Posted : March 2, 2022
Last Update Posted : June 5, 2023
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Absolute Uterine Factor Infertility (AUFI) is due to congenital or surgical absence of a uterus or the presence of a nonfunctional uterus. Until 2014, the only option for women affected by Absolute Uterine Factor Infertility (AUFI) was adoption or surrogate motherhood. Uterine transplant is a new form of transplant to treat AUFI. The technique of uterus transplant was developed in Sweden with the transplantation of the uterus from a living donor to a woman affected by AUFI. Approximately 80 uterine transplantations have been performed, more than 50 of which have occurred within the past 3 years. To date, 34 children have been born from mothers who have received a living donor uterine transplant.
This is a prospective study to treat Absolute Uterine Factor Infertility (AUFI) through uterine transplantation utilizing a uterus from a living or deceased donor resulting in live birth. A total of 10 biologically female (XX Karyotype) subjects will receive a uterine transplant.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Mayer Rokitansky Kuster Hauser Syndrome Absence of Uterus Infertility of Uterine Origin | Other: Uterine Transplant | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 10 participants |
Allocation: | N/A |
Intervention Model: | Single Group Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Uterine Transplantation and Pregnancy Induction in Women Affected by Absolute Uterine Factor Infertility |
Actual Study Start Date : | June 3, 2022 |
Estimated Primary Completion Date : | December 2030 |
Estimated Study Completion Date : | December 2030 |
Arm | Intervention/treatment |
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Experimental: Uterine Transplant
uterus transplantation from living or deceased donor.
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Other: Uterine Transplant
Transplant of a uterus from a live or deceased donor. |
- Number of participants that have successful procurement of a viable uterus for transplant. [ Time Frame: Day of organ procurement immediately post-operative ]A viable uterus is a uterine allograft that is fully procured and is suitable for transplantation into the recipient. This is measured at the time of procurement by visible inspection to ensure the vascular structures (uterine artery and vein) are not injured and the vaginal cuff is intact.
- Number of participants that have a score of II or less on the Clavian-Dindo Scale. [ Time Frame: 30 days post-operative ]Each patient will be reviewed and any complications scored using the Clavian Dindo Scale.
- Successful transplantation of a human uterus with achievement of menstrual cycles [ Time Frame: 3 months post-operative ]As determined by 1. Achievement of menstrual cycles at 3 months post-operative, and 2. Graft viability measured by assessing blood flow via ultrasound and using cervical biopsies to look for ischemia or allograft rejection.
- Successful establishment of a pregnancy via in vitro fertilization [ Time Frame: 6 weeks post IVF ]Visibility of a gestational sac on US at 6 weeks
- Successful live birth [ Time Frame: at birth ]Viable infant born ≥ 23 weeks gestation
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Ages Eligible for Study: | 20 Years to 65 Years (Adult, Older Adult) |
Sexes Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
RECIPIENT INCLUSION CRITERIA
- Women who are diagnosed with Absolute Uterine Factor Infertility (AUFI) and who have at least one functioning ovary.
- Women of childbearing age (20-40 years old) who are biologically female (XX karyotype).
- Subjects will not have active human 142 papillomavirus (HPV) or active cervical dysplasia present.
- Subjects will have negative testing for Gonorrhea Chlamydia and Syphilis and will not have any active bacterial vaginosis or candida infection. (Subjects with previously treated STDs will be included if the infection is no longer present and has no impact. If a subject develops an STD/infection pre-operatively, she will be treated and monitored for a period of 3 months until she is no longer affected. She will then become eligible for transplant. If a subject develops an STD/infection after transplant/during pregnancy she will be treated appropriately. Prior to the embryo transfer the patient will be tested and treated if necessary. Any patient with an active STD/infection will be ineligible for any elective procedure until she is tested and treated appropriately.)
- Subjects who are HSV-2 negative or who have a history of HSV-2 with no current symptoms. Subjects may require preventative maintenance per study doctor discretion.
- Subjects have received counseling regarding all fertility options and alternatives to uterine transplant such as adoption or surrogate pregnancy.
- Subjects are willing to undergo in-vitro fertilization to obtain the necessary 4 viable embryos required for eligibility for transplant if they have not already banked 4 viable embryos.
- Subjects have been evaluated by a fertility specialist and determined to have good ovarian reserve and reproductive potential.
- Subjects must agree that in the event of withdrawal from the study while the transplanted uterus is in place, unless she is enrolled in an equivalent uterine transplant program, she will be required to undergo a hysterectomy for her own safety.
- Subject meets psychological recipient criteria.
- Subject must be willing to complete questionnaires about their infant's growth and development and return them to the study team.
RECIPIENT EXCLUSION CRITERIA
- Subject with Diabetes Mellitus Type I and II by medical history or elevated hemoglobin A1c blood test.
- Subject has known hypersensitivity to Tacrolimus, Thymoglobulin or Everolimus.
- Subject with a diagnosis of hypertension, or any other significant medical condition that makes this procedure unsafe or is a contraindication to surgery or anesthesia.
- Subject who has a history of solid organ or bone marrow transplant, per investigator's discretion.
- Subject who has a history of cancer, per investigator's discretion.
- Subject with a body mass index >30.
- Subject with an active infection including candida and/or bacterial vaginosis.
- Subject who is seropositive for HIV, HBV, HCV.
- Subject with technical obstacles as per anatomical malformations, which pose a high surgical risk in the judgment of the investigator.
- Subject unwilling or unable to comply with study requirements.
- Subject unable to undergo in-vitro fertilization or not cleared for transplant.
- Subject who has smoked within the last 6 months.
- Subject who has alcohol or drug abuse within 12 months of screening.
- Subject with any pre-existing clinical or medical conditions that would put the subject at an increased risk. Of note, for Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, the investigators will favor Type 1 variants as Type 2 is associated with skeletal/spinal and renal anomalies, making them higher risk candidates.
DONOR INCLUSION CRITERIA
- Women must be between 25-65 years of age. If a subject is less than 40 years old she must be certain that she does not wish to carry more children, and she will attest to this decision.
- Subjects will not have active human 142 papillomavirus (HPV) or active cervical dysplasia present.
- Subjects will have negative testing for Gonorrhea, Chlamydia and Syphilis and will not have any active bacterial vaginosis or candida infection. (Subjects with previously treated STDs will be included if the infection is no longer present and has no impact. If a subject develops an STD/infection pre-operatively, she will be treated and monitored for a period of 3 months until she is no longer affected. Any patient with an active STD/infection will be ineligible for any elective procedure until she is tested and treated appropriately.)
- Subjects who are HSV-2 negative, or have a history of HSV-2 but with no current symptoms. Subjects may require preventative maintenance per study doctor discretion.
- Subjects will have a normal uterus on sonogram and CT.
- Subjects will have normal psychological donor criteria (if living).
- Subjects will have had at least one prior full term live birth.
DONOR EXCLUSION CRITERIA
- Donor over the age of 65.
- Body mass index >30.
- Subject with an active infection including candida and/or bacterial vaginosis.
- Subject who is seropositive for HIV, HBV, HCV
- Subject who has had cancer in the last five years.
- Subject with any pre-existing clinical or medical condition that would place the subject at an increased risk or would be a contraindication to surgery or anesthesia.
- Subject who has smoked within the last 6 months.
- Subject who has alcohol or drug abuse within 12 months of screening.
- Subject unwilling or unable to comply with study requirements.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05263076
Contact: Transplant Services Coordinator | 832-822-1551 | uterustransplant@texaschildrens.org |
United States, Texas | |
Texas Children's Hospital | Recruiting |
Houston, Texas, United States, 77030 | |
Contact: Transplant Services Coordinator 832-822-1551 uterustransplant@texaschildrens.org | |
Principal Investigator: John Goss, M.D. | |
Sub-Investigator: N. Thao Galvan, M.D., MPH | |
Sub-Investigator: Michael A Belfort, M.D., PhD | |
Sub-Investigator: Jennifer Dietrich, M.D., MSc | |
Sub-Investigator: Caitlin Sutton, M.D. | |
Sub-Investigator: Xiaoming Guan, M.D., PhD. | |
Sub-Investigator: Thierry Huisman, M.D. | |
Sub-Investigator: James Versalovic, M.D., PhD. | |
Sub-Investigator: Michael Coburn, M.D. | |
Sub-Investigator: Jan Sunde, M.D. | |
Sub-Investigator: Kristina Reber, M.D. | |
Sub-Investigator: Jenna Ramirez, PhD. | |
Sub-Investigator: Jean Raphael, M.D. | |
Sub-Investigator: Karen Horst, M.D. | |
Sub-Investigator: Prakash Masand, M.D. | |
Sub-Investigator: Magdalena Sanz Cortes, M.D., PhD | |
Sub-Investigator: Dean Andropoulos, M.D. | |
Sub-Investigator: Lara Shekerdemian, M.D. | |
Sub-Investigator: Larry Hollier Jr., M.D. | |
Sub-Investigator: Peter Jindra, PhD, D(ABHI) | |
Sub-Investigator: Theonia Boyd, M.D. | |
Sub-Investigator: Laura Detti, M.D. | |
Sub-Investigator: Eumenia Castro, M.D., PhD, MS | |
Sub-Investigator: Julie Hakim, M.D. | |
Sub-Investigator: Ninad Patil, M.D. |
Principal Investigator: | John Goss, M.D. | Baylor College of Medicine |
Responsible Party: | John Goss, Professor and Chief, Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine |
ClinicalTrials.gov Identifier: | NCT05263076 |
Other Study ID Numbers: |
H-49601 |
First Posted: | March 2, 2022 Key Record Dates |
Last Update Posted: | June 5, 2023 |
Last Verified: | June 2023 |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Uterine Transplant AUFI Absolute Uterine Factor Infertility Infertility MRKH |
Infertility Genital Diseases Urogenital Diseases |