2.1 Candidates

Twelve candidates were on the waiting list for uterus transplant in 2022 (Figure VCA 1). Since 2016 (the year of the first uterus transplant in the United States), most uterus transplant candidates were younger than 35 years (81.1%; Figure VCA 2) and White (86.8%; Figure VCA 3), with blood types A (56.6%) or O (34.0%; Figure VCA 4).

2.2 Transplants

As of December 2022, 37 uterus transplants were performed in the United States (Figure VCA 5). Most uterus transplants were performed in White (33 of 37 recipients; Figure VCA 7) women younger than 35 years (31 of 37 recipients; Figure VCA 6). Uterus transplant recipients predominantly had blood type A (21 of 37 recipients) or O (12 of 37 recipients; Figure VCA 8). Primary diagnosis of absolute uterine factor infertility due to congenital absence of the uterus was present in 28 of 37 recipients (Figure VCA 9).

2.3 Donors

Unlike transplants for other VCA organs that use only deceased donor organs, living donor uterus transplants are performed: 21 of 37 uterus transplants (56.8%) since 2016 used living donors (Figure VCA 10). Only one living uterus donor was older than 50 years; all other donors, living or deceased, were younger than 50 years, with most aged 18-34 years (Figure VCA 11).

2.4 Posttransplant Outcomes

Unlike other organ transplants, uterus grafts are always removed after the recipient has finished having children. Data reported to the OPTN show 25 functioning uterus grafts and 8 failed uterus grafts of 37 transplants (67.6% and 21.6%, respectively; Figure VCA 12). However, uterus transplantation is a small and growing field, and the authors are aware of 17 uterus grafts that have, in fact, been removed after successful child delivery. The essential outcome variable for a uterus transplant is a live birth. Although number of births is not yet captured in the data, as of December 2022, the authors are aware of 21 children who were born to 19 uterus transplant recipients.

2.5 Access

Uterus transplants through 2022 were performed at centers in four states: Alabama, Ohio, Pennsylvania, and Texas. Of these, most transplants were performed in Texas (22 of 37 [59.5%]; Table VCA 1).

3.1 Candidates

Since the implementation of the Final Rule and OPTN guidance in 2014, there has been an increase in the number of candidates for VCA transplant other than uterus (referred to as nonuterus VCA transplant herein). However, despite this growth, the overall number of listed candidates remained stable compared with the previous year, with a total of 17 candidates reported in 2022 (Figure VCA 13). An examination of candidate listings by organ type since 2014 reveals that the most common category is upper limb (23 of 56 [41.1%]), while the least common is scalp (1 of 56 [1.8%]). Note that due to the limited sample size, evaluating annual data remains challenging. Nevertheless, as of the end of 2022, there were nine patients listed for abdominal wall transplant, two for face transplant, four for upper limb transplant, and one for Other/multiple transplant (Figure VCA 13 and Figure VCA 14).

Despite the challenges posed by a limited sample size, the demographic data of candidates undergoing nonuterus VCA transplant are presented. Candidates were primarily aged 18-34 years (33.9%) and 50-64 years (30.4%), with a substantial portion listed in the 35-49 years age group (25.0%; Figure VCA 15). In terms of race and ethnicity, White candidates constituted the majority (71.4%), while candidates in the Black, Hispanic, and Other categories represented 10.7%, 16.1%, and 1.8%, respectively (Figure VCA 16). Since 2014, male candidates have consistently outnumbered female candidates among nonuterus VCA recipients (39 of 56 [69.6%] and 17 of 56 [30.4%], respectively) (Figure VCA 17). The distribution of blood types among nonuterus VCA candidates since 2014 reveals most having blood type O (46.4%), followed by type A (33.9%), type B (16.1%), and type AB (3.6%) (Figure VCA 18). The median waiting time for organ-specific transplant among patients who had undergone transplant since 2014 was notably the longest for scalp transplant (355 days), followed by face (342 days), penis (262 days), Other/multiple (238 days), upper limb (186 days), and abdominal wall (102 days) (Figure VCA 19).

3.2 Donors

Since the regulation of VCA transplant in 2014, donor data for nonuterus VCA transplant have been limited. Similar to in previous years,⁴ most donors in 2014-2022 were aged 18-34 years (50.0%), with the remainder 35-49 years (35.2%), younger than 18 years (11.8%), and 50-64 years (2.9%) (Figure VCA 27).

3.3 Recipients

Of the total 56 listed nonuterus VCA candidates, 34 individuals (60.7%) underwent transplant in 2014-2022. There has been no substantial change in the number of nonuterus VCA transplants performed. Upper limb transplant was the most frequently performed (44.1%), followed by face (32.4%), abdominal wall (11.8%), penis (5.9%), scalp (2.9%), and Other/multiple (2.9%) (Figure VCA 21).

The demographic profile of the 34 patients who underwent nonuterus VCA transplant in 2014-2022 can be summarized as follows: the primary causes leading to transplant were trauma (41.2%), infection (23.5%), and burn/explosion (5.9%). However, a portion of etiologic data was missing (17.6%) (Figure VCA 26), which is consistent with the findings of the previous year’s report.⁴ The age distribution of nonuterus VCA transplant recipients during this period was as follows: the most prevalent age group was 18-34 years (41.1%), followed by 50-64 years (26.5%), 35-49 years (20.6%), 65 years or older (8.8%), and younger than 18 years (2.9%) (Figure VCA 22). These recipients were stratified into two distinct categories for race and ethnicity data collection: White (27 of 34 [79.4%]) and non-White (7 of 34 [20.6%]) (Figure VCA 23). Among nonuterus VCA recipients during this period, males continued to make up the largest portion, accounting for 70.6% (24 of 34), while females were the remaining 29.4% (10 of 34) (Figure VCA 24). When analyzing the distribution of blood types among nonuterus VCA transplant recipients since 2014, it is evident that type O blood is the most prevalent (50.0%), followed by type A (29.4%) and type B (20.6%). Note that no transplants were performed in individuals with type AB blood (Figure VCA 25).

3.4 Access and Outcomes

Currently, 21 programs in 11 states have performed nonuterus VCA transplant (Figure VCA 28, Table VCA 3). When assessing the distribution of programs according to organ type, upper limb transplant emerges as the most prevalent procedure, with nine programs having performed it from 2014 through 2022. Face transplant has been carried out at five programs, and abdominal wall transplant has been done at three programs. Transplants in the Other/multiple category were performed at one program; penis and scalp transplant were conducted at two programs and one program, respectively (Figure VCA 28). Compared with the previous year’s report,⁴ there was an increase in the number of programs providing abdominal wall transplant from two to three.

The examination of patient outcomes in nonuterus VCA transplant involved the classification of results into “functioning graft” and “failed graft.” Over the recorded timeframe of 2014-2022, there was one occurrence of upper limb VCA failure reported (1 of 15 [6.7%]), while abdominal wall, face, Other/multiple, penis, and scalp VCA transplants were reported with a 100% functioning graft rate, similar to earlier observations (Table VCA 2).