Giuliano Testa M.D.

Testa, G. and L. Johannesson (2018). “Correspondence: Future direction of uterine transplantation.” Curr Opin Organ Transplant Dec 3. [Epub ahead of print].

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We would like to direct your attention to a statement written in the article “Current status and future direction of uterus transplantation” authored by Dr. Mats Brannstrom and published in Current Opinion in Organ Transplantation, October 2018. In the Section, “Live Donor Uterus Transplantation: Results”, it is stated that “Although the case proved to be successful, it has to be pointed out that bilateral use of utero-ovarian veins will necessitate donor oophorectomy and this will lead to premature menopause, with may lead to increase morbidity in this 32-year-old altruistic donor.” This statement is incorrect. In the publication announcing the first live birth after uterus transplantation in the United States, G. Testa et al. American Journal of Transplantion, May 2018, we clearly specified that “The utero ovarian veins were identified as they run closely to the fallopian and dissected free from the ovary. The ovaries were left in situ.” This donor surgical technique has been used routinely by us. In fact, the second mother to give birth in our programme also received a uterus transplant in which the venous outflow was based exclusively on the utero-ovarian vein segment and who donor did not require and oophorectomy. We thank you for the attention given to reporting the correct information. (Excerpt from text of this correspondence; no abstract available.)

Jarvholm, S., A. M. Warren, M. Jalmbrant, N. Kvarnstrom, G. Testa and L. Johannesson (2018). “Preoperative psychological evaluation of uterus transplant recipients, partners, and living donors: Suggested framework.” Am J Transplant 18(11): 2641-2646.

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Uterus transplant has become a real option for women with uterine-factor infertility to become pregnant and give birth. The screening before uterus transplant consists of a multidisciplinary evaluation and includes the potential recipient, living donor, and, to some extent, the recipient’s partner and future co-parent. The psychological evaluation has evolved from broad-based screening in the first uterus transplant trial, where the aim was to find suitable candidates for a novel experimental procedure with an unknown outcome, to a more directed screening with specific psychological domains for a complex infertility treatment with promising results. This report outlines a consensus by investigators with pioneering experience in the field of the key factors and suggests a framework for psychological evaluation of recipients and their partners as well as for live uterus donors before uterus transplant. We identify the main areas of particular value to the recipient screening (general psychological health, factors associated with infertility, and medication adherence), the partner (general psychological health and factors associated with infertility), and the living donor (psychological health and motivation to donate, especially in the case of the nondirected donor).

Jarvholm, S., A. M. Warren, M. Jalmbrant, N. Kvarnstrom, G. Testa and L. Johannesson (2018). “Preoperative psychological evaluation of uterus transplant recipients, partners, and living donors: suggested framework.” Am J Transplant Jul 30. [Epub ahead of print].

Full text of this article.

Uterus transplantation has become a real option for women with uterine-factor infertility to become pregnant and give birth. The screening prior to uterus transplantation consists of a multidisciplinary evaluation and includes the potential recipient, living donor, and to some extent the recipient’s partner and future co-parent. The psychological evaluation has evolved from broad-based screening in the first uterus transplantation trial, where the aim was to find suitable candidates for a novel experimental procedure with an unknown outcome, to a more directed screening with specific psychological domains for a complex infertility treatment with promising results. This paper outlines a consensus by investigators with pioneering experience in the field of the key factors and suggests a framework for psychological evaluation of recipients and their partners as well as for live uterus donors prior to uterus transplantation. We identify the main areas of particular value to the recipient screening (general psychological health, factors associated with infertility, and medication adherence), the partner (general psychological health and factors associated with infertility), and the living donor (psychological health and motivation to donate, especially in the case of the nondirected donor).

Bayer, J., C. A. Moulton, K. Monden, R. M. Goldstein, G. J. McKenna, G. Testa, R. M. Ruiz, T. L. Anthony, N. Onaca, G. B. Klintmalm and P. T. W. Kim (2018). “The role of multiorgan procurement for abdominal transplant in general surgery resident education.” Am J Surg 216(2): 331-336.

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BACKGROUND: To assess the impact of participation of multiorgan procurement (MP) by general surgery (GS) residents on surgical knowledge and skills, a prospective cohort study of GS residents during transplant surgery rotation was performed. METHODS: Before and after participation in MPs, assessment of knowledge was performed by written pre and post tests and surgical skills by modified Objective Structured Assessment of Technical Skill (OSATS) score. Thirty-nine residents performed 84 MPs. RESULTS: Significant improvement was noted in the written test scores (63.3% vs 76.7%; P < 0.001). Better surgical score was associated with female gender (15.4 vs 13.3, P = <0.01), prior MP experience (16.2 vs 13.7, P = 0.03), and senior level resident (15.1 vs 13.0, P = 0.03). Supraceliac aortic dissection (P = 0.0017) and instrument handling (P = 0.041) improved with more MP operations. CONCLUSIONS: Participation in MP improves residents' knowledge of abdominal anatomy and surgical technique.

Teixeira, P. G. R., C. V. R. Brown, B. Emigh, M. Long, M. Foreman, B. Eastridge, S. Gale, M. S. Truitt, S. Dissanaike, T. Duane, J. Holcomb, A. Eastman and J. Regner (2018). “Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury.” J Am Coll Surg 226(5): 769-776.e761.

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BACKGROUND: Tourniquet use has been proven to reduce mortality on the battlefield. Although empirically transitioned to the civilian environment, data substantiating survival benefit attributable to civilian tourniquet use is lacking. We hypothesized that civilian prehospital tourniquet use is associated with reduced mortality in patients with peripheral vascular injuries. STUDY DESIGN: We conducted a multicenter retrospective review of all patients sustaining peripheral vascular injuries admitted to 11 Level I trauma centers (January 2011 through December 2016). The study population was divided into 2 groups based on prehospital tourniquet use. Baseline characteristics were compared and factors associated with mortality identified. Logistic regression, adjusting for demographic, physiologic and injury-related parameters, was used to evaluate the association between prehospital tourniquet use and mortality. Delayed amputation was the secondary end point. RESULTS: During 6 years, 1,026 patients with peripheral vascular injuries were admitted. Prehospital tourniquets were used in 181 (17.6%) patients. Tourniquet time averaged 77.3 +/- 63.3 minutes (interquartile range 39.0 to 92.3 minutes). Traumatic amputations occurred in 98 patients (35.7% had a tourniquet). Mortality was 5.2% in the non-tourniquet group compared with 3.9% in the tourniquet group (odds ratio 1.36; 95% CI 0.60 to 1.65; p = 0.452). After multivariable analysis, the use of tourniquets was found to be independently associated with survival (adjusted odds ratio 5.86; 95% CI 1.41 to 24.47; adjusted p = 0.015). Delayed amputation rates were not significantly different between the 2 groups (1.1% vs 1.1%; adjusted odds ratio 1.82; 95% CI 0.36 to 9.99; adjusted p = 0.473). CONCLUSIONS: Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.