Surgical, Reproductive, and Child Developmental Outcomes After 10 Years of Uterus Transplantation in the United States

OBJECTIVE: To review the surgical, reproductive, and child developmental outcomes after uterus transplants performed in the United States over the past decade. METHODS: In this prospective cohort study, data on donors, recipients, and children born after uterus transplantation were collected at the four centers performing uterus transplants in the United States from February 2016 to December 2025. Interventions included donor hysterectomy, uterus transplantation, postoperative immunosuppression and monitoring, fertility and obstetric care, recipient graft hysterectomy, and neonatal and pediatric follow-up. Survival analyses evaluated trends and compared outcomes between living donor and deceased donor transplants. RESULTS: Among 60 uterus transplants, the most common indication was Mayer–Rokitansky–Küster–Hauser syndrome (n=52), followed by prior hysterectomy (n=6), dysfunctional uterus (n=1), and androgen insensitivity syndrome (n=1). Most transplants (42, 70.0%) involved living donors; 18 (30.0%) involved deceased donors. No life-threatening complications or mortality occurred. Complications necessitating reoperation occurred in 17 of 60 recipients (28.3%), including graft loss attributable to vascular thrombosis, and in 6 of 42 living donors (14.3%), including ureteral injury and vaginal cuff dehiscence. As of December 2025, 42 of 60 recipients (70.0%) had achieved at least one live birth or ongoing clinical pregnancy, and nine (15.0%) had two live births. Among the 48 neonates born, median gestational age at delivery was 36 5/7 weeks (IQR 34 3/7–37 1/7 weeks), with 58.3% born preterm. Neurodevelopment was normal at discharge and 6 months; at 3-year follow-up (n=29), two children had been diagnosed with autism, and no other diagnoses or growth disorders were observed. CONCLUSION: Uterus transplantation offers a viable path to childbearing for women with absolute uterine factor infertility. These aggregate data from active U.S. programs provide a contemporary reference for clinicians counseling patients on treatment options.