Abstract

Uterus transplantation (UTx) is the first and only available treatment for women with absolute uterine factor infertility. However, clinical application is limited by the lack of organs, ischemia/reperfusion injury, as well as immunosuppression after UTx. Several different preservation solutions are used in experimental and clinical UTx, including Custodiol® solution. Recently, the novel Custodiol-N solution was developed with superior results in organ preservation. However, the solution was not tested yet in UTx. Therefore, the aims of this study were to evaluate the effect of Custodiol-N in uterus prolonged cold preservation time (8 and 24 h), compared to Custodiol® solution. Uterus tissue samples were obtained from adult Sprague Dawley rats (n = 10/group). Cold ischemic injury was estimated by histology, including immunohistochemistry, and biochemical tissue analyses. After 8 h of cold ischemia, higher percentage of tissue edema, necrosis signs and myeloperoxidase expression, as well as lower superoxide dismutase activity were found in Custodiol® compared to Custodiol-N (p < 0.05). These differences were more pronounced after 24 h of cold preservation time (p < 0.05). This study demonstrated that Custodiol-N protects uterus grafts from cold ischemic injury better than standard Custodiol® most likely via inhibition of oxidative stress and tissue edema. It seems that iron chelators in the composition of Custodiol-N play an important protective role against cold ischemia.

Highlights

  • Uterus transplantation (UTx) is the first and only available treatment for absolute uterine factor infertility (AUFI)

  • This study demonstrated that Custodiol-N protects uterus grafts from cold ischemic injury better than standard Custodiol® most likely via inhibition of oxidative stress and tissue edema

  • Whereas a cold ischemia time is short in living donation, longer ischemia times have to be taken into consideration when using deceased donors

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Summary

Introduction

Uterus transplantation (UTx) is the first and only available treatment for absolute uterine factor infertility (AUFI). Several births have occurred in multiple centers worldwide utilizing uterus grafts from both living and deceased donors [6]. Wider clinical application is inherently limited by an organ shortage, ischemia/reperfusion injury (IRI), since all of these factors limit success rates of UTx [2]. The use of deceased donors is indisputable advantageous because of avoiding surgical risks for the donor. The main risk for a living donor is a thromboembolic event development due to the long surgical duration together with the possibility of anesthetic complications [8]. More precise knowledge about the tolerance of the uterus to prolonged cold ischemia is required in order to increase the organ donor pool and improve the general outcomes

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