Uterine allotranspiantation in the rabbit model using a macrovascular patch technique.

The uterus and its blood supply en bloc were successfully harvested with an aortic-caval macrovascular patch in animal and human cadaveric models. The objective of this study was to assess the technical feasibility of uterine allotransplantation in the rabbit. Six uterine allotransplants were performed. This involved harvesting the uterine allograft with an aortic-caval vascular patch en bloc in the donor. After 1 hour of cold ischemic storage, the uterine allograft was transplanted to the recipient using an aortic-aortal cava-caval end to side anastomosis. Our 6 rabbit recipients surgically survived the procedure. After postmortem and histological analyses in the short term, all of the uteri appeared viable with no evidence of graft vessel thromboses. Postoperative complications included limb paraplegia, pulmonary emboli, and intraperitoneal hemorrhage. The feasibility of uterine allotransplantation using a macrovascular patch, in anatomical and surgical terms, has been proven. Further research will lead to a successful program of fertility restoration.

Cold ischaemic preservation of human uterine tissue.

Uterine transplantation may be a possible treatment option in the future for absolute uterine infertility. The tolerance of human uterine tissue to cold ischemic preservation is one of the issues that need to be resolved. The objective of this study was to assess the morphological changes in human uterine tissue after cold ischemic preservation in a transplant solution. Small tissue samples of human uteri were subjected to cold ischemia (2-8 degrees C for up to 48 hours) in Celsior transplant solution. Histological analysis by light and electron microscopy was used to assess evidence of cold ischemic injury. Histological examination did not show any major changes of the uterine tissue after 48-hour cold preservation; whereas, electron microscopy after 24 hours confirmed unchanged structural integrity of the uterine myoendometrium. The human uterus is morphologically resistant toward cold ischemia in Celsior preservation solution for up to 24 hours and may be suitable for transplantation purposes.

Human uterus retrieval from a multi-organ donor.

OBJECTIVE: To determine if a uterus can be retrieved for reproductive organ transplantation and to describe the surgical technique. METHODS: We participated in a local organ donor network retrieval team for over 6 months. Heart-beating, brain-dead multi-organ donors were identified through an existing donor network following routine protocols. RESULTS: After institutional review board and organ donor network approval of the uterus transplantation project, approximately 1,800 eligible organ donors were identified as required by legislation. Multi-organ procurement surgery took place in approximate 150 of these, with nine specifically consented for the uterus retrieval. Regularly performed multi-organ transplantation retrievals included the uterus without complications in eight donors. Pedicles used included the ovarian, uterine, or internal iliac vessels. After retrieval, serial histology sections throughout the period of cold ischemia, taken every 15-30 minutes, showed no signs of change over 12 hours of cold ischemia. CONCLUSION: The human uterus can be obtained from local organ donor networks using existing protocols. LEVEL OF EVIDENCE: III.

Pelvic vascular prospects for uterine transplantation.

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. This was a prelude to study the possibility of uterine transplantation where initial concerns were about how uterine artery anastomosis might be achieved and the subsequent function of these vessels in pregnancy. In experiment 1, the uterine arteries in two sows were divided and reanastomosed. At 6 weeks, all sows including control were inseminated. After weaning 3 months after delivery, the sows were killed, and postmortem studies were undertaken. Successful reanastomoses of the uterine arteries were accomplished in both study sows. After insemination, pregnancy proceeded uneventfully, and both sows farrowed normally with average litter sizes. Histopathology of the uterine arteries revealed minimal intimal fibrosis across all anastomotic sites. Uterine artery anastomosis in the porcine model is feasible with subsequent normal vascular function in pregnancy of the anastomosed vessels.

Pulse oximetry and perfusion index measurement to assess uterine perfusion and viability.

This study was designed to establish if pulse oximetry (O2Sat) and perfusion index (PI) could be used to assess the contribution that uterine and ovarian vessels make to the overall perfusion of the uterus. During routine hysterectomies, the O2Sat and PI were measured over the right and left uterine cornu. These measurements were taken before any vessels were ligated (baseline), after only the ovarian vessels were clamped and then after the uterine vessels were clamped. Clamping the ovarian vessels alone decreased the uterine O2Sat and PI by a statistically significant amount. Subsequent clamping of the uterine vessels produced further significant decreases in O2Sat and PI. We concluded that both pairs of vessels contribute almost equally to uterine perfusion and that there may be a role, particularly for O2Sat and possibly for PI variables, in determining the success of uterine and ovarian vessel reanastomosis in uterine transplantation.

Possibilities for fertility restoration: a new surgical technique.

Previously published work concluded that uterine artery microvascular anastomosis in the porcine model was feasible with subsequent normal vascular function in pregnancy. of the anastomosed vessels. The objective of this study was to assess the feasibility of uterine autotransplantation in a porcine model using microvascular anastomoses. Eight large white/landrace sows of proven fertility were used. A supracervical hysterectomy with or without bilateral salpingo-oophorectomy (BSO) was performed. After 1 hour of cold storage in a transplant solution, the specimen was reintroduced and followed by stepwise vascular reanastomosis. Objective perfusion index measurements suggested adequate uterine perfusion after transplantation. Postoperatively, sow 1 survived to 3 months with no signs of oestrus, and sows 2, 6, and 8 were killed on days 6, 33, and 54, respectively, for pelvic infection. Histopathology of the uterine grafts revealed gradual vessel thromboses. Microvascular reanastomosis is feasible, however, unsuccessful in uterine autotransplantation because of gradual vessel thromboses. The porcine model is highly susceptible to postoperative infection.

Is it feasible to use a large vessel patch with a uterine allograft en bloc for uterine transplantation?

Uterine auto-transplantation in the porcine model using a microvascular anastomotic technique failed because of gradual vessel thromboses. A macrovascular patch harvest with the uterus en bloc is probably less likely to undergo vessel thrombosis. The objective of this study was to assess the feasibility of an aortic/inferior vena caval vascular patch harvest with the uterus en bloc for uterine cross-transplantation purposes. A preserved human cadaver and freshly killed porcine and rabbit cadaveric models were used. The infrarenal aorta, inferior vena cava, common and internal iliac vessels and the uterine arterial and venous tree together with the uterus en bloc were successfully harvested intact as a large vessel patch and graft in both animal and human models. A macrovascular patch for uterine cross-transplantation is technically easy and feasible to harvest en bloc with the uterus in fresh cadaveric donors. This technique precludes live donors and makes cadaveric organ donation essential.