Today Jesús, a seven-month-old baby who has been admitted to the Neonatal Unit of the Hopistal Clinic in Barcelona for just over two months, has been discharged and will be able to return home to Murcia, which is a great reason for happiness for his parents, but also for the medical center and the Catalan health system since it is the baby of Tamara Franco, the first woman to receive a uterus transplant in Spain.
The road has been hard, long and full of challenges but at last, four years after the first birth by a transplanted woman took place in Göteborg, it is possible to say that in Spain you can also have a child despite not counting with a uterus, as is the case with Tamara. This path began in 2015, when the professionals at the Hospital Clínic submitted to the Ethics Committee the request to carry out this type of surgery and, after receiving approval from the Department of Health of Catalonia to carry out five cases within the framework of a experimental program, on October 5, 2020 Tamara became the protagonist of the first uterus transplant in Spain, which was a success since just a month and a half later, the patient reported that she had had her first menstruation.
A highly complex intervention
She dreamed of being a mother since she was a child, however, she is one of those 50,000 women in the world who suffer from Rokitansky syndrome, a congenital disorder of the female reproductive system for which those affected are born without a uterus or fallopian tubes, so that the transplant was the only option to be able to give birth to a baby.
The intervention, in which a multidisciplinary team led by doctors Antonio Alcaraz, head of the Urology Service and Transplant surgeon, and Francisco Carmona, head of the Gynecology Service, took part, lasted a total of 21 hours, and, as indicated during the presentation of the case of Jesús, Dr. Carmona, “it is a highly complex surgery”. In this regard, Dr. Alcaraz indicated that “the veins and arteries of the uterus are very small, they have a diameter of between three and four millimeters, so that during transplant planning we consult experts in kidney transplantation and especially pediatrics, since that they have a lot of experience in handling such small vessels”.
Faced with this difficulty, the solution was to go “upward in search of larger arteries and veins, but without compromising the vascularization of other organs or cutting the ureter”, commented the urologist, who in this regard pointed out that “perhaps the easiest thing in these cases is to go looking for the veins of the ovary, but we did not want to do that because it means sacrificing the patient”. In addition, as Alcaraz pointed out, in the case of uterine transplantation, “you risk everything on black or white, because if we lose, we lose everything, unlike what happens with other organs, which can be useful despite to have lost a part”.
The dream of being a mother
The fact is that the intervention was a success and, after a first abortion at eight weeks of gestation, on September 5, 2022 Tamara underwent a new embryo transfer and, on this occasion, the pregnancy continued its course with almost completely normal, except for a complication that was within the expected. “Tamara had preeclampsia, which is an alteration of the dialogue between the placenta and the endothelium, which is modulated by the drugs associated with the transplant” and which are aimed at avoiding rejection, explained Dr. Francesc Figueras, head of the Maternal-Fetal Service at the Clínic , which is why the appropriate treatment was administered to prevent further complications.
Thus, after having implemented all those measures to lengthen the gestation as much as possible and favor the maximum possible maturation of the fetus in the maternal womb, on March 10 of this year, after seven months of gestation, Jesus was born by caesarean section. The baby weighed 1,100 grams and was admitted to the neonatal ICU with parenteral nutrition for one week and respiratory support. “During childbirth, it was not necessary to modify any of the techniques that are commonly used in cesarean sections, which is a sign of the quality of the transplant,” Figueras commented. And when those theoretical 40 weeks of gestation would be completed, Tamara, her husband Jesús and the baby, who already weighs 3,200 grams and still has a little help with oxygen intermittently, can now return to their home in Murcia, where their hospital of reference and the Clínic will follow up on them.
a medical milestone
In this regard, it should be noted that in the case of uterine transplants, the removal of the organ is indicated when the patient’s reproductive cycle has already finished and, in this sense, at the express wish of Tamara, this removal has already occurred. . In any case, the birth of Jesus is, as the Minister of Health, Manel Balcells, pointed out in the presentation of the baby, it is “a small miracle of science, which makes you feel proud of the Catalan public system and the Clínic”. For his part, Josep María Campistol, general director of the center, indicated that “the molds have been broken”, while Alcaraz pointed out that “with this transplant we have not only rebuilt, but we have created the circumstances for life to emerge again “.
And not only that, but also, as the urologist also revealed, “this uterine transplant, in which it has been necessary to manage very small arteries and veins, has not helped in the field of pediatric transplants” . “If before we began to transplant when the children reached 15 kilos in weight, now we dare with children weighing 10 kilos.”
Thus, Tamara was the first woman to receive a transplant and the first to give birth to a baby thanks to this intervention, but as of today the Clínic has completed the second transplant of these characteristics and there are two more women under study, one of them in a very advanced phase. In addition, there are a couple of patients among the 107 who have shown interest in this intervention who seem to be able to be selected, but it must be remembered that uterine transplantation today, within the Catalan health system, is part of a experimental program approved for five cases, so it is necessary to wait until it generally enters clinical practice.
