Giuliano Testa M.D.

Panaro, F., Al Taweel, B., Leon, P., Ghinolfi, D., Testa, G., Kalisvaart, M., Muiesan, P., Romagnoli, R., Lesurtel, M., Cassese, G., Truant, S., Addeo, P., Sainz-Barrica, M., Baccarani, U., De Simone, P., Belafia, F., Herrero, A. and Navarro, F. (2021). “Morbidity and mortality of iatrogenic hemothorax occurring in a cohort of liver transplantation recipients: a multicenter observational study.” Updates Surg Jul 3;1-8. [Epub ahead of print]. 1-8.

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Hemothorax (HT) is a life-threatening condition, mainly iatrogenic and poorly explored in Liver Transplantation (LT) recipients. The aim of this study is to report and analyze for the first time incidence and outcomes of HT in LT recipients, as well as to suggest a management strategy. Data concerning 7130 consecutive adult liver and liver-kidney transplant recipients were retrospectively collected from ten Transplantation Centers’ institutional databases, over a 10-year period. Clinical parameters, management strategies and survival data about post-operative HT were analyzed and reported. Thirty patients developed HT during hospitalization (0.42%). Thoracentesis was found to be the most common cause of HT (16 patients). A non-surgical management was performed in 17 patients, while 13 patients underwent surgery. 19 patients developed thoracic complications after HT treatment, with an overall mortality rate of 50%. The median length of stay in Intensive Care Units was 22 days (IQR(25-75) 5-66.5). Postoperative hemothorax is mainly due to iatrogenic causes in LT recipients. Despite rare, it represents a serious complication with a high mortality rate and a challenging medical and surgical management. Its occurrence should always be prevented.

Georgevsky, D., Li, Y., Pather, S., Tejada-Berges, T., Robinson, D., Laurence, J., Campbell, N., Wyburn, K., Liyanagama, K., Narayan, R., Lutz, T., Chan, A., Heaney, S.A., Kitzing, Y.X., Anderson, L., Testa, G., Johannesson, L. and Marren, A. (2021). “Uterus transplantation and pregnancy induction: Approved protocol at the Royal Prince Alfred Hospital.” Aust N Z J Obstet Gynaecol may 6. [Epub ahead of print].

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Absolute uterine factor infertility (AUFI) is defined as the absence of a uterus or the presence of a non-functional uterus. Before the first live birth from a uterus transplant in 2014, the only fertility options for women with AUFI were surrogacy and adoption. In November 2019, our team was granted approval for the first uterus transplant trial in Australia using known living donors. Our program is based on that of our overseas collaborators in Dallas, Texas; this team will also be proctoring us for our first two cases.

Rosenzweig, M., Wall, A., Spak, C.W., Testa, G. and Johannesson, L. (2021). “Pregnancy after CMV infection following uterus transplantation: A case report from the Dallas Uterus Transplant Study.” Transpl Infect Dis May 26;e13653. [Epub ahead of print].

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Uterus transplantation is a repeatedly proven treatment for women with absolute uterine-factor infertility, which is the congenital or acquired absence of the uterus, who desire to carry, and ultimately deliver, a child. No stranger to the field of transplant or obstetrics is cytomegalovirus. Cytomegalovirus is both a frequent complication after transplant, presenting as an opportunistic infection, as well as a common congenital disease in the newborn child from pregnancy. To date, there have been no reported cases of pregnancy following uterus transplantation from cytomegalovirus-positive donors into cytomegalovirus-negative recipients. We present a case report describing our experience of a cytomegalovirus-negative recipient, transplanted with a uterus from a cytomegalovirus-positive living donor, and subsequently diagnosed with active cytomegalovirus infection despite prophylactic treatment. She was treated for infection prior to embryo transfer and carried a healthy child to term. This case suggests transplanting a cytomegalovirus-positive uterus into a negative donor is possible to do safely.

Testa, G. and Johannesson, L. (2021). “The Value of a Nulliparous Uterus.” Transplantation 105(5): 958-959.

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One of the recommendations for both deceased and living uterus donors has been previous completion of an uncomplicated pregnancy.2 The reason for being cautious is the risk that the uterus might have undiagnosed pathologies that might impede a successful pregnancy. In the available literature, the prevalence of primary female infertility is calculated as 1.9% of women aged 20–44 y.5 If normal uterine anatomy is verified, the likelihood of transplanting a uterus unable to implant an embryo and carry a pregnancy is slim. [No abstract; excerpt from article].

Putman, J.M., Zhang, L., Gregg, A.R., Testa, G. and Johannesson, L. (2021). “Clinical pregnancy rates and experience with in vitro fertilization after uterus transplantation: Dallas Uterus Transplant Study.” Am J Obstet Gynecol Mar 12;S0002-9378(21)00165-4. [Epub ahead of print].

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BACKGROUND: The clinical pregnancy rates among patients with uterus transplantation have been reported by only a limited number of centers, and those centers have not used preimplantation genetic testing for aneuploidy in their protocol. OBJECTIVE: This study examined clinical pregnancy rates among women with absolute uterine-factor infertility undergoing in vitro fertilization using good-quality, expanded-blastocyst-stage, euploid embryos after uterus transplantation. STUDY DESIGN: This cohort observational study involved 20 women who underwent uterus transplantation over 3 years. Notably, 14 of these patients had successful transplants and were followed prospectively for a median of 14.1 months (range, 11-34.8 months). In vitro fertilization was performed before subjects underwent uterus transplantation, and good-quality expanded-blastocyst-stage euploid embryos were obtained and frozen for future embryo transfer. Interventions consisted of in vitro fertilization, preimplantation genetic testing for aneuploidy, uterus transplantation, and frozen embryo transfer. RESULTS: All 14 subjects with successful transplants underwent single embryo transfer of a warmed, good-quality, euploid, expanded blastocyst and had at least 1 documented clinical pregnancy within the uterus. In 71.4%, the first embryo transfer resulted in clinical pregnancy. The median time from successful uterus transplantation to first embryo transfer was 4.5 months; from successful uterus transplantation to first clinical pregnancy, 7.3 months; and from successful uterus transplantation to first live birth, 14.1 months. A total of 13 live births have occurred in 12 subjects. CONCLUSION: Women with absolute uterine-factor infertility who have surgically successful uterus transplantation and in vitro fertilization using preimplantation genetic testing for aneuploidy can achieve high clinical pregnancy rates. We have reduced the time interval from uterus transplantation to embryo transfer by at least 50% and the interval from uterus transplantation to clinical pregnancy by >6 months compared with previous studies. We believe our approach may shorten the time from transplant to clinical pregnancy and therefore decrease patient exposure to immunosuppressant therapies.