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Yeast Infection Led to Removal of Transplanted Uterus Yeast Infection Led to Removal of Transplanted Uterus
(about 7 hours later)
Just two weeks after receiving the first uterus transplant in the United States, a patient at the Cleveland Clinic suddenly developed a serious complication last month, and on March 8 the transplant had to be removed. No details were given.Just two weeks after receiving the first uterus transplant in the United States, a patient at the Cleveland Clinic suddenly developed a serious complication last month, and on March 8 the transplant had to be removed. No details were given.
On Friday, the clinic explained what went wrong: a common yeast infection.On Friday, the clinic explained what went wrong: a common yeast infection.
In a written statement, the clinic said, “Preliminary results suggest that the complication was because of 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.”In a written statement, the clinic said, “Preliminary results suggest that the complication was because of 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 infection was caused by a fungus, a type of yeast called Candida albicans, two of the doctors who performed the surgery said in an interview. It is normally found in the vagina, living in balance with bacteria and other microbes. But illness or some medications can disrupt the balance, allowing overgrowth of the yeasts, and at that point they can cause problems. The infection was caused by a fungus, a type of yeast called Candida albicans, two of the doctors who performed the surgery said in an interview. It is normally found in the vagina, living in balance with bacteria and other microbes. But illness or some medications can disrupt the balance, allowing for a problematic overgrowth of the yeasts.
The surgeons said that since yeasts normally inhabit the genital tract, they could have come from either the donor or the recipient. The transplant included some vaginal tissue from the donor, as well as the uterus.The surgeons said that since yeasts normally inhabit the genital tract, they could have come from either the donor or the recipient. The transplant included some vaginal tissue from the donor, as well as the uterus.
Vaginal yeast infections are a familiar nuisance to many women and usually not difficult to treat with over-the-counter medicines. But in transplant recipients, yeast infections can be hard to control, because the drugs that prevent rejection also prevent the immune system from fighting the infection. If a yeast infection spreads into the bloodstream, it can be extremely difficult to treat, and can be fatal.Vaginal yeast infections are a familiar nuisance to many women and usually not difficult to treat with over-the-counter medicines. But in transplant recipients, yeast infections can be hard to control, because the drugs that prevent rejection also prevent the immune system from fighting the infection. If a yeast infection spreads into the bloodstream, it can be extremely difficult to treat, and can be fatal.
The recipient, Lindsey McFarland, 26, of Lubbock, Tex., had the uterus transplant on Feb. 24, in a nine-hour operation. She seemed to be recovering well for nearly two weeks, doctors said, when she suddenly began to bleed heavily on March 7.The recipient, Lindsey McFarland, 26, of Lubbock, Tex., had the uterus transplant on Feb. 24, in a nine-hour operation. She seemed to be recovering well for nearly two weeks, doctors said, when she suddenly began to bleed heavily on March 7.
“This was a serious complication, potentially life-threatening,” said Dr. Andreas G. Tzakis, a leader of the surgical team. He is director of solid organ transplant surgery at a Cleveland Clinic hospital in Weston, Fla.“This was a serious complication, potentially life-threatening,” said Dr. Andreas G. Tzakis, a leader of the surgical team. He is director of solid organ transplant surgery at a Cleveland Clinic hospital in Weston, Fla.
Doctors rushed Ms. McFarland into surgery and discovered that an infection — they did not know then what kind — had extended into an artery they had connected to provide blood flow to the uterus. It had damaged the vessel and caused clots. The transplant had to be removed immediately. A week later, Ms. McFarland needed another operation, to treat more bleeding.Doctors rushed Ms. McFarland into surgery and discovered that an infection — they did not know then what kind — had extended into an artery they had connected to provide blood flow to the uterus. It had damaged the vessel and caused clots. The transplant had to be removed immediately. A week later, Ms. McFarland needed another operation, to treat more bleeding.
Once the cause of the infection was identified, she was treated with antifungal medicines. With the transplant removed, she was able to stop taking antirejection drugs and give her immune system a chance to recover and help control the infection.Once the cause of the infection was identified, she was treated with antifungal medicines. With the transplant removed, she was able to stop taking antirejection drugs and give her immune system a chance to recover and help control the infection.
She spent about five weeks in the hospital. Dr. Tzakis said she was still taking antifungal medicine, but was well. She declined to comment for this article.She spent about five weeks in the hospital. Dr. Tzakis said she was still taking antifungal medicine, but was well. She declined to comment for this article.
The failure of the procedure was a setback for the clinic’s plan to perform 10 uterus transplants on an experimental basis. The goal of the surgery is to make pregnancy and childbirth possible for women who were born without a uterus or lack one because of illness or injury. The transplants are meant to be temporary, left in place just long enough for a woman to have one or two babies, then removed so that she can stop taking antirejection medicines.The failure of the procedure was a setback for the clinic’s plan to perform 10 uterus transplants on an experimental basis. The goal of the surgery is to make pregnancy and childbirth possible for women who were born without a uterus or lack one because of illness or injury. The transplants are meant to be temporary, left in place just long enough for a woman to have one or two babies, then removed so that she can stop taking antirejection medicines.
Dr. Tzakis and Dr. Tommaso Falcone, Cleveland Clinic’s chairman of obstetrics and gynecology, said the medical and surgical team would hold off on doing any more uterus transplants until it could be sure that procedures were in place to prevent problems like Ms. McFarland’s. They said they were considering various options, like using antifungal medicines preventively and washing the tissues of both the donor and recipient to reduce the risk of infection. Dr. Tzakis and Dr. Tommaso Falcone, Cleveland Clinic’s chairman of obstetrics and gynecology, said the medical and surgical team would hold off on doing any more uterus transplants until it could be sure that procedures were in place to prevent problems like Ms. McFarland’s.
They said they were considering various options, like using antifungal medicines preventively and washing the tissues of both the donor and recipient to reduce the risk of infection.
Ms. McFarland was born without a uterus, and in a previous interview said that she had long hoped to experience pregnancy and childbirth, and that she still felt the desire even after adopting three children.Ms. McFarland was born without a uterus, and in a previous interview said that she had long hoped to experience pregnancy and childbirth, and that she still felt the desire even after adopting three children.
The only successful uterus transplants have been performed in Sweden, at the University of Gothenburg. Nine women have had the transplants there, and five have given birth. Two of the nine transplants failed during the first year after the surgery and had to be removed, one because of blood clots and the other because of a bacterial infection. The only successful uterus transplants have been performed in Sweden, at the University of Gothenburg. Nine women have had the transplants there, and five have given birth.
Two of the nine transplants failed during the first year after the surgery and had to be removed, one because of blood clots and the other because of a bacterial infection.
Unlike the Cleveland team, doctors in Sweden used live uterus donors rather than cadavers for the transplants. In some cases, mothers were the uterus donors for their daughters.Unlike the Cleveland team, doctors in Sweden used live uterus donors rather than cadavers for the transplants. In some cases, mothers were the uterus donors for their daughters.
Three other medical centers in the United States are also planning to perform uterus transplants on an experimental basis: Baylor University Medical Center at Dallas, Brigham and Women’s Hospital in Boston and Nebraska Medicine in Omaha.Three other medical centers in the United States are also planning to perform uterus transplants on an experimental basis: Baylor University Medical Center at Dallas, Brigham and Women’s Hospital in Boston and Nebraska Medicine in Omaha.
Of the three, Baylor is the farthest along. Dr. Göran B.G. Klintmalm, chief of transplantation there, said his team had begun evaluating prospective patients. He also said the team would consider both living and deceased donors.Of the three, Baylor is the farthest along. Dr. Göran B.G. Klintmalm, chief of transplantation there, said his team had begun evaluating prospective patients. He also said the team would consider both living and deceased donors.
“Gothenburg, which has the only experience to date that is of value, stuck entirely with living donors,” Dr. Klintmalm said in a telephone interview in March, after the Cleveland transplant failed but before the cause was made public. “It was easy for us to accept that premise.” “Gothenburg, which has the only experience to date that is of value, stuck entirely with living donors,” Dr. Klintmalm said in a telephone interview in March, after the Cleveland transplant failed but before the cause was made public.
“It was easy for us to accept that premise.”
He added: “The deceased donor piece of it, the way we have approached this is, well, if an excellent recipient doesn’t have the potential related donor, we may have to go to the deceased donor. To have the both possibilities available makes a lot of sense.”He added: “The deceased donor piece of it, the way we have approached this is, well, if an excellent recipient doesn’t have the potential related donor, we may have to go to the deceased donor. To have the both possibilities available makes a lot of sense.”
Dr. Klintmalm said the Cleveland doctors had discussed their failed transplant with his team.Dr. Klintmalm said the Cleveland doctors had discussed their failed transplant with his team.
“What they experienced is something that helps us to fine tune our protocol and approach, to hopefully avoid having the same situation,” Dr. Klintmalm said.“What they experienced is something that helps us to fine tune our protocol and approach, to hopefully avoid having the same situation,” Dr. Klintmalm said.
He also said that the Baylor team had adjusted its screening procedures to take into account possible exposure to the Zika virus, which is linked to small heads and severe brain defects in infants whose mothers contracted the virus during pregnancy.He also said that the Baylor team had adjusted its screening procedures to take into account possible exposure to the Zika virus, which is linked to small heads and severe brain defects in infants whose mothers contracted the virus during pregnancy.
“Now we have added all the Zika virus questions,” Dr. Klintmalm said. “The recipients, the donors, have they traveled to Brazil, for example?”“Now we have added all the Zika virus questions,” Dr. Klintmalm said. “The recipients, the donors, have they traveled to Brazil, for example?”