Infection Caused Failure|of Uterus Transplant

     (CN) – The clinic that conducted the first uterus transplant in the United States in February said a common yeast infection led to the organ’s failure and ultimate removal two weeks later.
     The transplant was performed on Feb. 24 at the Cleveland Clinic, and seemed to be successful until a complication prompted the removal of the uterus two weeks later. The clinic did not state the specific issue at the time.
     But doctors at the clinic said Friday that the organ failure stemmed from a yeast infection, which could not be treated due to antirejection drugs that the patient had to take following the procedure.
     “Preliminary results suggest that the complication was due to an infection caused by an organism that is commonly found in a woman’s reproductive system. The infection appears to have compromised the blood supply to the uterus, causing the need for its removal,” the clinic said in a statement.
     The doctors who performed the surgery said that a type of yeast called Candida albicans caused an infection that extended to an artery that was connected to provide blood flow to the transplanted uterus.
     While vaginal yeast infections are fairly common and treatable with over-the-counter medicines, transplant recipients are at enhanced risk since the drugs that are used to prevent rejections in uterus transplants also inhibit the immune system’s ability to fight the infection.
     The recipient, 26-year-old Lindsey McFarland of Lubbock, Texas, underwent the nine-hour procedure that appeared to be successful until she began to bleed heavily on March 7. Emergency surgery was performed the following day due to the risk that the yeast infection could spread to the bloodstream, which can be fatal.
     “The health of our patient is and has always been our primary concern,” the clinic said.
     McFarland underwent an additional operation to stop further bleeding, and was treated with antifungal medicines. Her immune system recovered to control the infection once she stopped taking the antirejection drugs, doctors said.
     McFarland’s case was the first of 10 experimental uterus transplants that the clinic had planned in the hope of making pregnancy and childbirth possible for women who were born without a uterus, or lacked one due to an illness or injury.
     Dr. Tommaso Falcone, chairman of obstetrics and gynecology at the Cleveland Clinic, said that the surgical team would hold off on doing any more uterus transplants until procedures were in place to prevent complications like McFarland experienced.
     The transplants are supposed to be temporary – implanted just long enough to allow a woman to have one or two babies, after which the uterus is removed and the woman is able to stop taking antirejection medicines.
     McFarland was born without a uterus, and has stated that she wanted to experience pregnancy and childbirth. She has three adopted children.
     Successful uterus transplants have only been performed at the University of Gothenburg in Sweden, using live uterus donors.
     Of the nine women who had transplants at the university, five were able to give birth. Two of the transplants failed during the first year after the surgery, one due to bacterial infection and the other due to blood clots.
     Unlike the medical team in Sweden, the Cleveland Clinic used uteruses from cadavers for the transplants.
     Three other American medical centers have also planned to perform uterus transplants on an experimental basis: Baylor University Medical Center at Dallas, Nebraska Medicine in Omaha and Brigham and Women’s Hospital in Boston.
     Dr. Goran Klintmalm, chief of transplantation at Baylor, told The New York Times that having the option to use cadaver donations “makes a lot of sense.”
     “The deceased donor piece of it, the way we have approached this is if an excellent recipient doesn’t have the potential related donor, we may have to go the deceased donor,” Klintmalm said. “To have both possibilities available makes a lot of sense.”
     Klintmalm said that doctors at the Cleveland Clinic had discussed their failed transplant with his team, and explained that the medical team at Baylor will also be screening donors and recipients for exposure to the Zika virus due to its link to a series of birth defects.
     “What they experienced is something that helps us to fine-tune our protocol and approach, to hopefully avoid having the same situation,” Klintmalm said.
     

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