Abstract
To see if: (i) a large vessel aortocaval vascular patch technique may bring about long-term graft survival after allogeneic uterine transplantation (UTn) in a rabbit model; and (ii) fertility can be achieved following natural mating post-allogeneic UTn. Allogeneic uterine cross transplantations were performed in New Zealand white rabbits using an aortocaval macrovascular patch harvested as part of the uterine allograft. Five rabbit recipients received a uterine graft from five unrelated donor rabbits. All female rabbits were unrelated and were of proven fertility with at least one previous litter each. Tacrolimus was administrated for immunosuppression post-transplant. Natural mating was attempted if long-term survival had been achieved. The main outcome measures were: (i) long-term recipient survival; (ii) long-term adequate uterine perfusion; and (iii) successful pregnancy post-UTn. All five recipient animals survived the surgery with satisfactory immediate postoperative recovery. Recipients 1, 2 and 4 died within the first 4 postoperative days. Both long-term survivors failed to conceive following introduction of a proven male breeder despite evidence of mating. Necropsy at 9 and 11 months showed a lack of patency of uterine cornua at the point of anastomosis, albeit a small uterus in recipient 3 and a reddish brown amorphous material at the site of the transplanted uterus in recipient 5. We have demonstrated the feasibility of uterine allotransplantation using a macrovascular patch technique, but could not demonstrate conception because of blocked cornua. To address this, we propose using embryo transfer techniques in order to achieve conception.
Highlights
Uterine transplantation (UTn) has been proposed as a treatment option for women diagnosed with absolute uterine factor infertility (AUFI) and who are willing to bear their own child.[1]
Since the first human uterine transplantation (UTn) attempt in 2000, in which the donor graft failed after 99 days because of thrombosis of the uterine vasculature leading to subsequent necrosis of the transplanted uterus, important advances have been made into several fields which define UTn
The macrovascular patch technique in this study as in our previous six allotransplants proved successful in enabling a feasible allo-UTn with respect to anatomy and vascular viability in the immediate postoperative period
Summary
Uterine transplantation (UTn) has been proposed as a treatment option for women diagnosed with absolute uterine factor infertility (AUFI) and who are willing to bear their own child.[1] AUFI renders a woman ‘unconditionally infertile’. Causes are congenital, such as Müllerian duct anomalies, or acquired (e.g. a Uterine viability post-transplantation hysterectomy performed secondary to obstetric hemorrhage, myoma, endometrial or cervical malignancy). Only the sheep model led to the birth of a healthy, term lamb
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