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Nordberg RC, Magalhaes RS, Cervelló I, Williams JK, Atala A, Loboa EG. A biomechanical assessment of tissue-engineered polymer neo-uteri after orthotopic implantation. F&S SCIENCE 2024; 5:58-68. [PMID: 38145868 PMCID: PMC10923056 DOI: 10.1016/j.xfss.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To assess the in vivo biomechanical maturation of tissue-engineered neo-uteri that have previously supported live births in a rabbit model. DESIGN Nonclinical animal study. SETTING University-based research laboratory. ANIMALS Eighteen adult female rabbits. INTERVENTION Biodegradable poly-DL-lactide-co-glycolide-coated polyglycolic acid scaffolds seeded with autologous uterine-derived endometrial and myometrial cells. Nonseeded scaffolds and seeded, tissue-engineered neo-uteri were implanted into one uterine horn of rabbits for 1, 3, or 6 months, excised, and biomechanically assessed in comparison to native uterine tissue. MAIN OUTCOME MEASURES Tensile stress-relaxation testing, strain-to-failure testing, and viscoelastic modeling. RESULTS By evaluating the biomechanical data with several viscoelastic models, it was revealed that tissue-engineered uteri were more mechanically robust than nonseeded scaffolds. For example, the 10% instantaneous stress of the tissue-engineered neo-uteri was 2.1 times higher than the nonseeded scaffolds at the 1-month time point, 1.6 times higher at the 3-month time point, and 1.5 times higher at the 6-month time point. Additionally, as the duration of implantation increased, the engineered constructs became more mechanically robust (e.g., 10% instantaneous stress of the tissue-engineered neo-uteri increased from 22 kPa at 1 month to 42 kPa at 6 months). Compared with native tissue values, tissue-engineered neo-uteri achieved or surpassed native tissue values by the 6-month time point. CONCLUSION The present study evaluated the mechanical characteristics of novel tissue-engineered neo-uteri that have previously been reported to support live births in the rabbit model. We demonstrate that the biomechanics of these implants closely resemble those of native tissue, giving further credence to their development as a clinical solution to uterine factor infertility.
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Affiliation(s)
- Rachel C Nordberg
- Joint Department of Biomedical Engineering at University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina
| | - Renata S Magalhaes
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Irene Cervelló
- IVI Foundation Research Department, Health Research Institute La Fe, Valencia, Spain
| | - J Koudy Williams
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Elizabeth G Loboa
- Office of the Provost, Southern Methodist University, Dallas, Texas.
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Veroux M, Scollo P, Giambra MM, Roscitano G, Giaquinta A, Setacci F, Veroux P. Living-Donor Uterus Transplantation: A Clinical Review. J Clin Med 2024; 13:775. [PMID: 38337468 PMCID: PMC10856556 DOI: 10.3390/jcm13030775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother's sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer-Rokitansky-Küster-Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.
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Affiliation(s)
- Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, 95123 Catania, Italy; (M.M.G.); (G.R.); (A.G.); (F.S.); (P.V.)
| | - Paolo Scollo
- Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95123 Catania, Italy;
| | - Martina Maria Giambra
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, 95123 Catania, Italy; (M.M.G.); (G.R.); (A.G.); (F.S.); (P.V.)
| | - Giuseppe Roscitano
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, 95123 Catania, Italy; (M.M.G.); (G.R.); (A.G.); (F.S.); (P.V.)
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, 95123 Catania, Italy; (M.M.G.); (G.R.); (A.G.); (F.S.); (P.V.)
| | - Francesco Setacci
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, 95123 Catania, Italy; (M.M.G.); (G.R.); (A.G.); (F.S.); (P.V.)
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, 95123 Catania, Italy; (M.M.G.); (G.R.); (A.G.); (F.S.); (P.V.)
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Warren AM, da Graca B, Wall A, Powers MB, Saracino G, Testa G, Johannesson L. Psychosocial Outcomes in Nondirected Uterus Donors 1 Y After Donation. Transplantation 2023; 107:e355-e362. [PMID: 37653586 DOI: 10.1097/tp.0000000000004799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND As uterus transplantation transitions to a clinical procedure for women with absolute uterine-factor infertility, transplant centers performing uterus transplantation need information about the experience of living donors. This study examined the psychosocial impact on 17 nondirected uterus donors in the Dallas UtErus Transplant Study 1 y following donation. METHODS A prospective longitudinal study was conducted to measure psychosocial outcomes of depression, anxiety, posttraumatic stress, quality of life, and resilience [measured using the Hospital Anxiety and Depression Scale or Patient Health Questionnaire 9-Item, Generalized Anxiety Disorder 7-Item, Posttraumatic Stress Disorder Checklist for the DSM-5, health-related quality of life Short Form-36, and Connor-Davidson Resilience Scale 10-Item, respectively) assessed at baseline, at 6-mo and 1-y follow-up. Differences among baseline, 6-mo, and 1-y postdonation were analyzed. RESULTS The median age was 38.0 y, 16 were married, 15 were of non-Hispanic/Latino ethnicity. Most donors did not report psychosocial distress; however, 1 donor reported decline on the role limitations because of Emotional Problems Scale and also showed an increase in depression symptoms at the 6 mo, but at 1 y was below the clinical cutoff for depression. A second donor showed modest decline in emotional well-being. Improvements were seen in other donors on the Physical Functioning Scale and posttraumatic stress symptoms. CONCLUSIONS Although most nondirected donors appeared to remain stable, both positive and negative changes were observed over the first year. Larger studies are needed to determine psychosocial risks and benefit and what additional resources might be needed to ensure optimal psychosocial outcomes.
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Affiliation(s)
- Ann Marie Warren
- Baylor University Medical Center, Dallas, TX
- Baylor Scott & White Research Institute, Dallas, TX
| | | | - Anji Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | | | - Giovanna Saracino
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
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Lee JY. Who should provide the uterus? The ethics of live donor recruitment for uterus transplantation. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109227. [PMID: 37640534 DOI: 10.1136/jme-2023-109227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children - often the mothers of recipients - tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus - such as transgender men, or cisgender women who do not wish to gestate or to have children - tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups.
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Affiliation(s)
- J Y Lee
- Department of Public Health, University of Copenhagen, Kobenhavn 1172, Denmark
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5
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Uterus Transplantation: From a Deceased Donor or Living Donor? J Clin Med 2022; 11:jcm11164840. [PMID: 36013080 PMCID: PMC9409724 DOI: 10.3390/jcm11164840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/07/2023] Open
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Jakubauskiene L, Jakubauskas M, Razanskiene G, Leber B, Weber J, Rohrhofer L, Ramasauskaite D, Strupas K, Stiegler P, Schemmer P. Relaxin and Erythropoietin Significantly Reduce Uterine Tissue Damage during Experimental Ischemia–Reperfusion Injury. Int J Mol Sci 2022; 23:ijms23137120. [PMID: 35806125 PMCID: PMC9266669 DOI: 10.3390/ijms23137120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/07/2022] Open
Abstract
Successful uterus transplantation, a potential treatment method for women suffering from absolute uterine infertility, is negatively affected by ischemia–reperfusion injury (IRI). The aim of this study is to investigate the protective effect of relaxin (RLX) or/and erythropoietin (EPO) on experimental uterus IRI. Eighty rats, randomly assigned into eight groups (n = 10/group), were pretreated with either saline, 5 μg/kg human relaxin-2, 4000 IU/kg recombinant human erythropoietin or their combination. Ischemia was achieved by clamping the aorta and ovarian arteries for 60 min, following 120 min of reperfusion and tissue sampling. For sham animals, clamping was omitted during surgery. There were no differences in tissue histological score, malondialdehyde (MDA) and superoxide dismutase (SOD) levels, myeloperoxidase (MPO) and TUNEL-positive cell count between all sham-operated rats. Pretreatment with RLX preserved normal tissue morphology, reduced MDA levels, MPO and TUNEL-positive cell count, preserved SOD activity and upregulated NICD and HES1 gene expression when compared to the control group. Pretreatment with EPO reduced MDA levels. In conclusion, pretreatment with RLX, EPO or a combination of both EPO and RLX significantly alleviates uterine tissue damage caused by IRI.
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Affiliation(s)
- Lina Jakubauskiene
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Matas Jakubauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Gintare Razanskiene
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
- National Centre of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406 Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| | - Jennifer Weber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| | - Lisa Rohrhofer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| | - Diana Ramasauskaite
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
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da Graca B, Johannesson L, Testa G, Wall AE. The Ethical Evolution of Uterus Transplantation From Concept to Clinical Procedure. Clin Obstet Gynecol 2022; 65:24-36. [PMID: 35045022 DOI: 10.1097/grf.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Uterus transplantation (UTx) offers women with absolute uterine factor infertility a path to motherhood that enables them to carry their own pregnancy. Debates about the ethics of UTx have evolved in tandem with its clinical evolution: clinical trials have provided evidence regarding risks and benefits to donors and recipients that were initially uncertain; technical advances have altered the balance between risks and benefits; and the experiences of donors and recipients has revealed questions that were not anticipated. As UTx transitions to a clinical procedure, questions remain about long-term risks and benefits, applications beyond carrying a pregnancy, and cost and access.
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Affiliation(s)
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center
| | - Anji E Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center
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8
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Abstract
Uterus transplantation (UTx) is now a potential option to allow women with uterine factor infertility to give birth. However, UTx is still at an experimental stage, and basic animal studies, including in non-human primates, are needed for the accumulation of data prior to clinical application. Considering that UTx may provide new hope to Japanese women, we launched UTx research in 2009 and have since accumulated a large archive of results in the UTx research field. Furthermore, we have carried out various activities aimed at the implementation of clinical applications of UTx in Japan while clarifying the ethical and social issues involved. Currently, the clinical application of UTx in Japan is just around the corner, and it is expected that UTx research will develop further in the future. Herein, we summarize our basic experiences using non-human primates and our activities with the goal of future clinical applications.
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da Graca B, Johannesson L, Testa G, Wall A. Uterus transplantation: ethical considerations. Curr Opin Organ Transplant 2021; 26:664-668. [PMID: 34636768 DOI: 10.1097/mot.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Uterus transplantation (Utx) offers women with absolute uterine factor infertility the opportunity to carry their own pregnancies. As Utx transitions from an experimental to standard clinical procedure, we review the status of the ethical issues applicable to the stakeholders involved. RECENT FINDINGS With more than 65 Utx procedures reported to date, evidence is accruing that enables the chance of success - a live birth - for the recipient to be weighed against the risks the recipient incurs through the Utx process, as well as risks to living donors undergoing surgery, to children exposed in utero to immunosuppressants and the uterine graft environment, and to third parties related to uterus procurement from multiorgan deceased donors. Experience has also informed aspects of recipient and donor autonomy that must be safeguarded. SUMMARY Clinical trial results provides a basis for weighing the interests of the stakeholders implicated in Utx, and so can inform transplant centers' and regulatory bodies' development of policies and protocols that will determine access to Utx and allocation of organs, together with other considerations of justice. Additional evidence, particularly on long-term outcomes, is needed, and new questions can be expected to arise as access to and indications for Utx broaden.
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Affiliation(s)
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Anji Wall
- Annette C. and Harold C. Simmons Transplant Institute
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Guntram L. May I have your uterus? The contribution of considering complexities preceding live uterus transplantation. MEDICAL HUMANITIES 2021; 47:425-437. [PMID: 33627444 PMCID: PMC8639951 DOI: 10.1136/medhum-2020-011864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 06/12/2023]
Abstract
Uterus transplantation combined with in vitro fertilisation (IVF) (henceforth called UTx-IVF) as a treatment for infertility caused by an absence or malfunction of the uterus is advancing. About 50 transplantations have been conducted worldwide and at least 14 children have been born-9 of them by women taking part in a Swedish research project on UTx-IVF. The Swedish research protocol initially stated that the potential recipient must 'have her own donor' who is preferably related to the recipient. But what does it mean to ask someone for a uterus? What challenges does this question instigate? And what norms may it enact? In this article, I explore how 10 women-who have considered, and sometimes pursued, UTx-IVF-describe their experiences of searching for a donor. I aim to show how an analysis of such accounts can help us unpack some of the specific relational and gendered dimensions of UTx-IVF and by doing so enrich discussions of risks, benefits, care and support in UTx-IVF. Drawing on research in social sciences and medical humanities that has demonstrated how assisted reproductive technologies and organ donation can provoke social and familial conundrums, with respect to such topics as embodiment and identity, I present three patterns that describe different dimensions of the interviewees' quest for a uterus donor. I discuss the negotiations that took place, how expectations unfolded and how entanglements were managed as the interviewees considered asking someone for a donation. Such an examination, I suggest, contributes to make care and support more attuned to the experiences and entanglements that UTx-IVF entails for those pursuing it. This will become increasingly important if (or when) UTx-IVF becomes part of general healthcare. To conclude, I problematise responsibilities and relational challenges in medical innovation, and in this way provide insights into how the ethical debate over UTx-IVF can broaden its scope.
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Affiliation(s)
- Lisa Guntram
- TEMA-Department of Thematic Studies, Linkopings universitet Institutionen for Tema, Linkoping, Sweden
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Aljerian K. Uterine transplant: an ethical framework analysis from a Middle Eastern perspective. Curr Med Res Opin 2021; 37:1049-1060. [PMID: 33705236 DOI: 10.1080/03007995.2021.1902296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Significant advances in infertility treatment have been achieved over the past several decades, but women with uterine dysfunction, anomaly, or agenesis still need support to carry a pregnancy to term. Recently, advancements in surgical, anesthetic and immunosuppressive therapy have brought the idea of successful uterine transplant closer to reality, but many challenges must be overcome before uterine transplant can become more common, including ethical challenges related to the study and the conduct of this procedure. METHODS This was an updated ethical analysis of uterine transplant from a Middle Eastern perspective, using an established ethical framework that has been adapted for the analysis of research in non-Western cultures and developing countries. RESULTS Using the ethical framework, this analysis explored research developments in uterine transplant to date, using the following categories: collaborative partnership, social value, scientific validity, a fair selection of study population, favorable risk-benefit ratio, independent review, informed consent, and respect for recruited participants. The analysis revealed a significant need for region- and religion-specific ethical guidelines for uterine transplant procedures. CONCLUSIONS The horizons of research need to expand by addressing and researching the ethical issues related to uterine transplant trials and clinical procedures. LIMITATIONS Limitations included the challenges related to applying ethical analyses to work in developing countries, and the fact that this analysis was based on the views and interpretations of a single researcher.
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Affiliation(s)
- Khaldoon Aljerian
- Forensic and Legal Medicine Unit, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Uterus transplantation (UTx) offers women with absolute uterine factor infertility the option to gestate and birth their own biologically related child. The first birth following living donation UTx happened in 2014. The first birth following deceased donation happened in December 2017, with further successes since. Interest in deceased donation UTx is increasing. The authors established a database to track UTx clinical trials and outcomes. Utilising this database and existing literature, this article reviews the first reported cases of deceased donation UTx and outcomes, and drawing upon comparisons with living donor UTx, comments upon the future for this area of reproductive transplantation research. This is the first article to bring together the literature on deceased donation UTx procedures and outcomes.
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Carbonnel M, Revaux A, Menzhulina E, Karpel L, Snanoudj R, Le Guen M, De Ziegler D, Ayoubi JM. Uterus Transplantation with Live Donors: Screening Candidates in One French Center. J Clin Med 2020; 9:E2001. [PMID: 32630524 PMCID: PMC7356518 DOI: 10.3390/jcm9062001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
We report our experience regarding the profile and screening process of potential recipients (R) and their live donors (D) in our Uterus transplantation (UTx) trial from 2014 to 2020. The initial screening was performed using medical questionnaires and consultations. The second step of the screening consisted of two individual interviews with an independent multidisciplinary committee. Then, a complete medical, biological and imaging assessment of the directed living D, the R, and her partner was performed over a two-day hospitalization. A total of 239 women contacted our department: 165 potentials R and 74 potentials D. During the first step of screening, 141 R and 45 D were excluded. Only 12 R/D pairs were pursued. During inclusion, 10 R/D pairs were excluded. One R/D pair is still under evaluation. Finally, only 1 R/D pair was definitively included (0.6%), which led us to perform the first French UTx in March 2019 with a successful graft. The primary limiting factors of inclusion were due to very strict criteria and difficulty of having a suitable directed living D. The International Society of UTx (ISUTx) guidelines based on worldwide results of trials can help ease our inclusion criteria in the future while remaining safe for patients.
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Affiliation(s)
- Marie Carbonnel
- Department of Obstetrics and Gynecology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France; (A.R.); (E.M.); (L.K.); (D.D.Z.); (J.M.A.)
| | - Aurelie Revaux
- Department of Obstetrics and Gynecology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France; (A.R.); (E.M.); (L.K.); (D.D.Z.); (J.M.A.)
| | - Elena Menzhulina
- Department of Obstetrics and Gynecology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France; (A.R.); (E.M.); (L.K.); (D.D.Z.); (J.M.A.)
| | - Lea Karpel
- Department of Obstetrics and Gynecology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France; (A.R.); (E.M.); (L.K.); (D.D.Z.); (J.M.A.)
| | - Renaud Snanoudj
- Department of Nephrology and Transplantation, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France;
| | - Morgan Le Guen
- Department of Anesthesiology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France;
| | - Dominique De Ziegler
- Department of Obstetrics and Gynecology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France; (A.R.); (E.M.); (L.K.); (D.D.Z.); (J.M.A.)
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology, Hospital Foch, University of Versailles, Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78000 Versailles, France; (A.R.); (E.M.); (L.K.); (D.D.Z.); (J.M.A.)
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Abstract
Absolute uterine factor infertility is the final hurdle for assisted reproductive treatments. Uterus transplant trials are happening worldwide; to advance the debate around uterine transplantation (UTx), this article considers selection criteria for clinical trials from a UK perspective and makes recommendations for future selection criteria for UTx treatment. Recommendations advanced include the use of donor eggs, access for single women and women in same-sex relationships, prohibiting participation of women who are already mothers, and a preference for deceased donors and bioengineered uteri. With UTx treatment on the horizon, it is important to proactively consider future selection criteria. TWEETABLE ABSTRACT: Review of UK selection criteria for clinical trials for uterus transplantation; recommendations for the future.
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Daryabari SS, Kajbafzadeh AM, Fendereski K, Ghorbani F, Dehnavi M, Rostami M, Garajegayeh BA, Tavangar SM. Development of an efficient perfusion-based protocol for whole-organ decellularization of the ovine uterus as a human-sized model and in vivo application of the bioscaffolds. J Assist Reprod Genet 2019; 36:1211-1223. [PMID: 31093867 PMCID: PMC6603122 DOI: 10.1007/s10815-019-01463-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/26/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The main purpose of this investigation was to determine an efficient whole-organ decellularization protocol of a human-sized uterus and evaluate the in vivo properties of the bioscaffold. METHODS Twenty-four ovine uteri were included in this investigation and were decellularized by three different protocols (n 6). We performed histopathological and immunohistochemical evaluations, 4,6-diamidino-2-phenylindole (DAPI) staining, DNA quantification, MTT assay, scanning electron microscopy, biomechanical studies, and CT angiography to characterize the scaffolds. The optimized protocol was determined, and patches were grafted into the uterine horns of eight female Wistar rats. The grafts were extracted after 10 days; the opposite horns were harvested to be evaluated as controls. RESULTS Protocol III (perfusion with 0.25% and 0.5% SDS solution and preservation in 10% formalin) was determined as the optimized method with efficient removal of the cellular components while preserving the extracellular matrix. Also, the bioscaffolds demonstrated native-like biomechanical, structural, and vascular properties. Histological and immunohistochemical evaluations of the harvested grafts confirmed the biocompatibility and recellularization potential of bioscaffolds. Also, the grafts demonstrated higher positive reaction for CD31 and Ki67 markers compared with the control samples which indicated eminent angiogenesis properties and proliferative capacity of the implanted tissues. CONCLUSIONS This investigation introduces an optimized protocol for whole-organ decellularization of the human-sized uterus with native-like characteristics and a prominent potential for regeneration and angiogenesis which could be employed in in vitro and in vivo studies. To the best of our knowledge, this is the first study to report biomechanical properties and angiographic evaluations of a large animal uterine scaffold.
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Affiliation(s)
- Seyedeh Sima Daryabari
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharibs Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharibs Street, Keshavarz Boulevard, Tehran, 1419733151, Iran.
| | - Kiarad Fendereski
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharibs Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Fariba Ghorbani
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharibs Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Mehrshad Dehnavi
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharibs Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Minoo Rostami
- Section of Tissue Engineering and Stem Cell Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Gharibs Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | | | - Seyed Mohammad Tavangar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Tardieu A, Chazelas P, Faye PA, Favreau F, Nadal-Desbarats L, Sallée C, Margueritte F, Couquet CY, Marquet P, Guellec CBL, Gauthier T. Changes in the metabolic composition of storage solution with prolonged cold ischemia of the uterus. J Assist Reprod Genet 2019; 36:1169-1178. [PMID: 31079269 DOI: 10.1007/s10815-019-01477-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/03/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The development of uterine transplantation (UTx) from deceased donors requires knowledge of the tolerance of the uterus to prolonged cold ischemia (CI). This can be evaluated through the use of biological parameters to assess degradation of the organ between its procurement and transplantation. The objective of this study was to analyze changes in the metabolic composition of the storage solution in cases of prolonged CI in uteri from ewes. METHODS Eighteen uterine auto-transplantations were performed in ewes. CI time was 1 h (T1) or 24 h (T24). Samples of Celsior® were taken when the explanted uterus was flushed (T0) and at the end of CI. A dual approach to metabolic analyses was followed: targeted biochemical analyses targeting several predefined metabolites and non-targeted metabolomics analyses based on nuclear magnetic resonance (NMR). RESULTS Metabolic analyses were performed on 16 explanted uteri. Metabolomic profiles differed significantly between T1 and T24 (p = 0.003). Hypoxia-associated degradation of the organ was demonstrated by the significantly higher lactate levels at T24 than at T1 (p < 0.05), accompanied by cell lysis, and significantly higher levels of creatine kinase activity in T24 than in T1 uteri (p < 0.05). Oxidative stress increased over time, with a significantly higher oxidized glutathione/glutathione ratio for T24 than for T1 uteri (p < 0.05). CONCLUSION The metabolic results indicate a significant degradation of the uterus during 24 h of CI. Metabolic analysis of the storage solution could be used as a non-invasive tool for evaluating uterine degradation during CI before transplantation.
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Affiliation(s)
- Antoine Tardieu
- INSERM, Inserm Unit U1248, 87000, Limoges, France. .,Department of Gynecologic and Obstetric, Hospital of Limoges, 87000, Limoges, France.
| | - P Chazelas
- Faculty of Medicine, EA 6309 "Maintenance Myélinique et Neuropathies Périphériques", University of Limoges, 87000, Limoges, France.,Laboratory of Biochemistry and Molecular genetics, Hospital of Limoges, 87000, Limoges, France
| | - P-A Faye
- Faculty of Medicine, EA 6309 "Maintenance Myélinique et Neuropathies Périphériques", University of Limoges, 87000, Limoges, France.,Laboratory of Biochemistry and Molecular genetics, Hospital of Limoges, 87000, Limoges, France
| | - F Favreau
- Faculty of Medicine, EA 6309 "Maintenance Myélinique et Neuropathies Périphériques", University of Limoges, 87000, Limoges, France.,Laboratory of Biochemistry and Molecular genetics, Hospital of Limoges, 87000, Limoges, France
| | | | - C Sallée
- Department of Gynecologic and Obstetric, Hospital of Limoges, 87000, Limoges, France
| | - F Margueritte
- Department of Gynecologic and Obstetric, Hospital of Limoges, 87000, Limoges, France
| | - C-Y Couquet
- Platform of Medicine, Imagery and experimental surgery (MICE), Hospital of Limoges, 87000, Limoges, France
| | - P Marquet
- INSERM, Inserm Unit U1248, 87000, Limoges, France
| | - C Barin-Le Guellec
- INSERM, Inserm Unit U1248, 87000, Limoges, France.,Faculty of Medicine, University of Tours, 37000, Tours, France
| | - T Gauthier
- INSERM, Inserm Unit U1248, 87000, Limoges, France.,Department of Gynecologic and Obstetric, Hospital of Limoges, 87000, Limoges, France
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18
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Puntambekar S, Puntambekar S, Telang M, Kulkarni P, Date S, Panse M, Sathe R, Agarkhedkar N, Warty N, Kade S, Manchekar M, Chitale M, Parekh H, Parikh K, Mehta M, Kinholkar B, Jana JS, Pare A, Kanade S, Sadre A, Hardikar S, Jathar A, Bakre T, Chate M, Tiruke R. Novel Anastomotic Technique for Uterine Transplant Using Utero-ovarian Veins for Venous Drainage and Internal Iliac Arteries for Perfusion in Two Laparoscopically Harvested Uteri. J Minim Invasive Gynecol 2018; 26:628-635. [PMID: 30599196 DOI: 10.1016/j.jmig.2018.11.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically. DESIGN Case study (Canadian Task Force Classification III). SETTING An urban, private, tertiary care hospital. PATIENTS Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses. INTERVENTIONS Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins. MEASUREMENTS AND MAIN RESULTS Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery. CONCLUSION By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results.
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Affiliation(s)
- Shailesh Puntambekar
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar).
| | - Seema Puntambekar
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Milind Telang
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Pankaj Kulkarni
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | | | - Mangesh Panse
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Ravindra Sathe
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | | | - Neeta Warty
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Sandesh Kade
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Manoj Manchekar
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Mihir Chitale
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Hirav Parekh
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Kajal Parikh
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Mehul Mehta
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | | | | | | | | | | | - Shirish Hardikar
- Radiology (Dr. Hardikar), Galaxy CARE Laparoscopy Institute, Pune, India
| | - Advait Jathar
- Departments of General Surgery (Drs. Puntambekar, Panse, Sathe, Manchekar, Chitale, Parekh, Mehta, and Jathar)
| | - Tejashree Bakre
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Meenakshi Chate
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
| | - Raviraj Tiruke
- Obstetrics and Gynaecology (Drs. Puntambekar, Telang, Kulkarni, Warty, Kade, Parikh, Bakre, Chate, and Tiruke)
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19
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Kisu I, Banno K, Matoba Y, Adachi M, Aoki D. Current Status of Uterus Transplantation and Approaches for Future Clinical Application in Japan. Transplant Proc 2018; 50:2783-2788. [DOI: 10.1016/j.transproceed.2018.02.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/26/2018] [Indexed: 01/28/2023]
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20
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Chmel R, Novackova M, Pastor Z, Fronek J. The Interest of Women with Mayer-Rokitansky-Küster-Hauser Syndrome and Laparoscopic Vecchietti Neovagina in Uterus Transplantation. J Pediatr Adolesc Gynecol 2018; 31:480-484. [PMID: 29751094 DOI: 10.1016/j.jpag.2018.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/21/2018] [Accepted: 04/30/2018] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE The goal of this study was to assess a group of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with surgically created neovaginas in the interest of uterus transplantation (UTx) and to recruit the first group of applicants for a UTx trial. DESIGN AND SETTING This was an original prospective study using semistructured interviews. PARTICIPANTS A study group of 50 women with MRKH syndrome with Vecchietti neovaginas was recruited via letter of invitation. INTERVENTIONS AND MAIN OUTCOME MEASURES Interest of MRKH women in obtaining experimental UTx for the treatment of absolute uterine factor infertility. RESULTS A total of 50 women responded via e-mail and 31 (62% [31 of 50] of the study group) expressed serious interest in UTx after complete information about its risks and benefits was provided during the first semistructured interview. They subsequently agreed to participate in additional interviews and further examinations. Because of various reasons, only 9 women were prepared to enter our UTx trial (18% [9 of 50] of the study group). Three recipients/donors were accepted into the living donor arm and 6 into the deceased brain donor arm of the trial. CONCLUSION Nearly two-thirds of our MRKH syndrome study group women with surgically created neovaginas were interested in UTx and motivated to undergo this method of absolute uterine factor infertility treatment. Therefore, this group of women might be approached to participate in ongoing and future UTx trials. Future studies of women with MRKH syndrome might confirm or disprove the results of our survey.
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Affiliation(s)
- Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Marta Novackova
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zlatko Pastor
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jiri Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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21
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Bruno B, Arora KS. Uterus Transplantation: The Ethics of Using Deceased Versus Living Donors. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:6-15. [PMID: 30040550 PMCID: PMC6296249 DOI: 10.1080/15265161.2018.1478018] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward.
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Affiliation(s)
- Bethany Bruno
- a Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
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22
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Favre-Inhofer A, Rafii A, Carbonnel M, Revaux A, Ayoubi JM. Uterine transplantation: Review in human research. J Gynecol Obstet Hum Reprod 2018; 47:213-221. [PMID: 29574054 DOI: 10.1016/j.jogoh.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Uterine transplantation is the solution to treat absolute uterine fertility. In this review, we present the historical, medical, technical, psychological and ethical perspectives in human uterine transplantation research. We reviewed the PubMed database following PRISMA guidelines and added data presented by several research teams during the first international congress on uterine transplantation.
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Affiliation(s)
- A Favre-Inhofer
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - A Rafii
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - M Carbonnel
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - A Revaux
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France
| | - J M Ayoubi
- Department of Gynecology and Obstetrics, Hospital Foch, Suresnes, France.
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23
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Suganuma N, Hayashi A, Kisu I, Banno K, Hara H, Mihara M. Uterus transplantation: Toward clinical application in Japan. Reprod Med Biol 2017; 16:305-313. [PMID: 29259482 PMCID: PMC5715890 DOI: 10.1002/rmb2.12048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/03/2017] [Indexed: 12/27/2022] Open
Abstract
Background In recent years, uterus transplantation (UTx) has been applied as the treatment for patients with uterine factor infertility worldwide. Thus, the clinical application of UTx in Japan should be considered through both the history of UTx technology development in the world and future prospects. Methods Recent information on UTx was collected via a literature survey and the Internet. Results Basic research using various animals has been done mainly since 2000. In 2014, the world's first UTx baby was born in Sweden. In total, 24 UTx procedures have been performed at 10 institutes in nine countries and five births were obtained (as of May, 2017). In Japan, the "Project Team for Uterus Transplantation" initiated UTx experiments in 2008 and the "Japan Society for Uterus Transplantation" was organized in March, 2014. In the rest of the world, the "International Society for Uterus Transplantation" was established in January, 2016. Conclusion Uterus transplantation is still under development as a reproductive medicine tool and organ transplant procedure. A collaborative system that is not limited by facilities and specialties should strive to build an "all-Japan" team.
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Affiliation(s)
- Nobuhiko Suganuma
- Project Team for Uterus TransplantationJapan
- Department of Human Health SciencesKyoto University Graduate School of MedicineKyotoJapan
| | - Ayako Hayashi
- Project Team for Uterus TransplantationJapan
- Department of Human Health SciencesKyoto University Graduate School of MedicineKyotoJapan
| | - Iori Kisu
- Project Team for Uterus TransplantationJapan
- Department of Obstetrics and GynecologyKeio Gijuku University School of MedicineTokyoJapan
| | - Kouji Banno
- Project Team for Uterus TransplantationJapan
- Department of Obstetrics and GynecologyKeio Gijuku University School of MedicineTokyoJapan
| | - Hisako Hara
- Project Team for Uterus TransplantationJapan
- Department of Lymphatic and Reconstructive SurgerySaiseikai Kawaguchi General HospitalKawaguchiJapan
| | - Makoto Mihara
- Project Team for Uterus TransplantationJapan
- Department of Lymphatic and Reconstructive SurgerySaiseikai Kawaguchi General HospitalKawaguchiJapan
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Testa G, Koon EC, Johannesson L. Living Donor Uterus Transplant and Surrogacy: Ethical Analysis According to the Principle of Equipoise. Am J Transplant 2017; 17:912-916. [PMID: 27754594 DOI: 10.1111/ajt.14086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/30/2016] [Accepted: 10/08/2016] [Indexed: 01/25/2023]
Abstract
The uterus is the most recent addition to the list of organs that can be successfully transplanted in humans. This article analyzes living donor uterus transplantation according to the ethical principle of equipoise. A comparison is made between living donor uterus transplantation and gestational surrogate motherhood. Both are solutions to absolute uterine infertility that allow the transfer of genetic material from intended parents to a child. The analysis concludes that living donor uterus transplantation does not violate the ethical principle of equipoise and should be considered an ethically acceptable solution to absolute uterine infertility.
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Affiliation(s)
- G Testa
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX
| | - E C Koon
- Department of Obstetrics and Gynecology, Baylor University Medical Center at Dallas, Dallas, TX
| | - L Johannesson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Petropanagos A. Pronatalism, Geneticism, and ART. INTERNATIONAL JOURNAL OF FEMINIST APPROACHES TO BIOETHICS 2017. [DOI: 10.3138/ijfab.10.1.119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this essay, I argue that pronatalism—a social bias in favor of gestational motherhood—and geneticism—a social bias in favor of genetic motherhood—are conceptually and operationally distinct social forces that influence some women's reproductive decision making. Each of these social forces shapes the reproductive landscape, relates differently to women's identities, and causes different social stigmatization and harm. Pronatalism and geneticism warrant feminist concern because they can compromise some women's reproductive autonomy and well-being. I suggest that combating pronatalism and geneticism will require different sets of media, policy, education, and health care practice strategies.
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26
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Obara H, Kisu I, Kato Y, Yamada Y, Matsubara K, Emoto K, Adachi M, Matoba Y, Umene K, Nogami Y, Banno K, Tsuchiya H, Itagaki I, Kawamoto I, Nakagawa T, Ishigaki H, Itoh Y, Ogasawara K, Saiki Y, Sato SI, Nakagawa K, Shiina T, Aoki D, Kitagawa Y. Surgical technique for allogeneic uterus transplantation in macaques. Sci Rep 2016; 6:35989. [PMID: 27786258 PMCID: PMC5081522 DOI: 10.1038/srep35989] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/10/2016] [Indexed: 12/16/2022] Open
Abstract
No study has reported an animal model of uterus transplantation (UTx) using cynomolgus macaques. We aimed to establish a surgical technique of allogeneic UTx assuming the recovery of a uterus from a deceased donor in cynomolgus macaques. Four allogeneic UTxs were performed in female cynomolgus macaques. Donor surgeries comprised en bloc recovery of organs with iliac vessels on both sides, and/or abdominal aorta/vena cava after sufficient perfusion from one femoral artery or external iliac artery. Before perfusion, 150 mL of whole blood was obtained from the donor for subsequent blood transfusion to the recipient. Four uterine grafts were orthotopically transplanted to recipients. End-to-side anastomosis was performed to the iliac vessels on one side in case 1 and iliac vessels on both sides in case 2; aorto-aorto/cavo-caval anastomosis was performed in cases 3 and 4. Arterial blood flow of the uterine grafts was determined by intraoperative indocyanine green (ICG) angiography. ICG angiography results showed sufficient blood flow to all uterine grafts, and anaemia did not progress. Under appropriate immune suppression, all recipients survived for more than 90 days post-transplantation, without any surgical complications. We describe a surgical technique for allogeneic UTx in cynomolgus macaques.
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Affiliation(s)
- Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yojiro Kato
- Department of Transplant Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Katsura Emoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Adachi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kiyoko Umene
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yuya Nogami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Tsuchiya
- Research Center for Animal Life Science, Shiga University of Medical Science, Shiga, Japan
| | - Iori Itagaki
- Research Center for Animal Life Science, Shiga University of Medical Science, Shiga, Japan
| | - Ikuo Kawamoto
- Research Center for Animal Life Science, Shiga University of Medical Science, Shiga, Japan
| | - Takahiro Nakagawa
- Research Center for Animal Life Science, Shiga University of Medical Science, Shiga, Japan
| | - Hirohito Ishigaki
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Yasushi Itoh
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Kazumasa Ogasawara
- Research Center for Animal Life Science, Shiga University of Medical Science, Shiga, Japan.,Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Yoko Saiki
- Department of Anesthesiology, Saiseikai Kanagawaken Hospital, Kanagawa, Japan
| | - Shin-Ichi Sato
- Safety Research Center, Ina Research Inc., Nagano, Japan
| | | | - Takashi Shiina
- Department of Molecular Life Science, Division of Basic Medical Science and Molecular Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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27
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Adachi M, Kisu I, Nagai T, Emoto K, Banno K, Umene K, Nogami Y, Tsuchiya H, Itagaki I, Kawamoto I, Nakagawa T, Ogasawara K, Aoki D. Evaluation of allowable time and histopathological changes in warm ischemia of the uterus in cynomolgus monkey as a model for uterus transplantation. Acta Obstet Gynecol Scand 2016; 95:991-8. [DOI: 10.1111/aogs.12943] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Masataka Adachi
- Department of Obstetrics and Gynecology; Keio University School of Medicine; Tokyo Japan
| | - Iori Kisu
- Department of Obstetrics and Gynecology; Keio University School of Medicine; Tokyo Japan
| | - Toshihiro Nagai
- Electron Microscope Laboratory; Keio University School of Medicine; Tokyo Japan
| | - Katsura Emoto
- Department of Pathology; Keio University School of Medicine; Tokyo Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology; Keio University School of Medicine; Tokyo Japan
| | - Kiyoko Umene
- Department of Obstetrics and Gynecology; Keio University School of Medicine; Tokyo Japan
| | - Yuya Nogami
- Department of Obstetrics and Gynecology; Keio University School of Medicine; Tokyo Japan
| | - Hideaki Tsuchiya
- Research Center for Animal Life Science; Shiga University of Medical Science; Shiga Japan
| | - Iori Itagaki
- Research Center for Animal Life Science; Shiga University of Medical Science; Shiga Japan
- The Corporation for Production and Research of Laboratory Primates; Ibaraki Japan
| | - Ikuo Kawamoto
- Research Center for Animal Life Science; Shiga University of Medical Science; Shiga Japan
| | - Takahiro Nakagawa
- Research Center for Animal Life Science; Shiga University of Medical Science; Shiga Japan
| | - Kazumasa Ogasawara
- Research Center for Animal Life Science; Shiga University of Medical Science; Shiga Japan
- Department of Pathology; Division of Pathology and Disease Regulation; Shiga University of Medical Science; Shiga Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology; Keio University School of Medicine; Tokyo Japan
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Kisu I, Kato Y, Yamada Y, Matsubara K, Obara H, Emoto K, Adachi M, Umene K, Nogami Y, Banno K, Kitagawa Y, Aoki D. Organ Perfusion for Uterus Transplantation in Non-Human Primates With Assumed Procurement of a Uterus From a Brain-Dead Donor. Transplant Proc 2016; 48:1266-9. [DOI: 10.1016/j.transproceed.2015.12.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/30/2015] [Indexed: 01/08/2023]
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Kumnig M, Jowsey-Gregoire SG. Key psychosocial challenges in vascularized composite allotransplantation. World J Transplant 2016; 6:91-102. [PMID: 27011907 PMCID: PMC4801807 DOI: 10.5500/wjt.v6.i1.91] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 02/05/2023] Open
Abstract
Psychosocial factors are important elements in the assessment and follow-up care for vascularized composite allotransplantation (VCA) and require multidisciplinary evaluation protocols. This review will highlight differences between VCA with solid organ transplantation (SOT), provide information on the psychosocial selection of VCA candidates, ethical issues, psychological outcomes, and on the need for multicenter research. VCA is primarily a life-enhancing procedure to improve recipients' quality of life and psychological well-being and it represents a potential option to provide reproduction in case of penile or uterine transplantation. The risk benefit ratio is distinctly different than SOT with candidates desiring life enhancing outcomes including improved body image, return to occupations, restored touch, and for uterine transplant, pregnancy. The Chauvet Workgroup has been convened with membership from a number of transplant centers to address these issues and to call for multicenter research. A multicenter research network would share similar evaluation approaches so that meaningful research on psychosocial variables could inform the transplant community and patients about factors that increase risk of non-adherence and other adverse psychosocial and medical outcomes.
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Kisu I, Banno K, Mihara M, Hara H, Umene K, Adachi M, Nogami Y, Aoki D. A surgical technique using the ovarian vein in non-human primate models of potential living-donor surgery of uterus transplantation. Acta Obstet Gynecol Scand 2015; 94:942-8. [PMID: 26095999 DOI: 10.1111/aogs.12701] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/14/2015] [Indexed: 01/25/2023]
Abstract
AIM Living donor surgery in organ transplantation should be performed in a minimally invasive manner under conditions that are as safe as possible. The objective of this study is to examine whether the procedure for using the ovarian vein makes donor surgery less invasive in a cynomolgus monkey model of potential living-donor surgery of uterus transplantation. MATERIAL AND METHODS Twenty-two female cynomolgus monkeys aged 6-9 years and with body weights of 3.55 ± 1.28 kg were used in the study. Vessels and tissues surrounding the uterus were dissected while preserving the uterine artery/vein. The deep uterine vein was used as a venous pedicle in four monkeys (Group 1), and the ovarian vein was used instead of the deep uterine vein in 18 monkeys (Group 2). With the uterine artery/vein and deep uterine vein (Group 1) or ovarian vein (Group 2) connected to the uterus, the vaginal canal was cut. The vessels were then clamped to produce a donor surgery model. Surgical time, intraoperative organ and vascular injury were examined in each animal. RESULTS The average surgical time from laparotomy to clamping of vessels was 230 ± 112 min in all 22 cynomolgus monkeys, and significantly longer in Group 1 (n = 4) than in Group 2 (n = 18) (393 ± 71 vs. 194 ± 84 min, p < 0.05). Surgical time in Group 2 showed a tendency to decrease in animals treated later in the study, with a significantly longer time in the first 10 monkeys compared with the last 8 (253 ± 65 vs. 120 ± 26 min, p < 0.05). All monkeys had no complications, including no injuries to other organs and no unanticipated vascular injury. CONCLUSION The procedure using the ovarian vein was less invasive than that using the deep uterine vein in mimicking living-donor surgery in a cynomolgus monkey model of uterus transplantation.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Mihara
- Department of Vascular Surgery, Saiseikai General Hospital, Saitama, Japan
| | - Hisako Hara
- Department of Plastic and Reconstructive Surgery, Graduates School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoko Umene
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Adachi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yuya Nogami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Johannesson L, Dahm-Kähler P, Eklind S, Brännström M. The future of human uterus transplantation. ACTA ACUST UNITED AC 2015; 10:455-67. [PMID: 25259905 DOI: 10.2217/whe.14.22] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The only untreatable subgroup of female infertility is absolute uterine factor infertility (AUFI), which is due to congenital or surgical absence of a uterus or presence of a nonfunctional uterus. The solitary option for a woman with AUFI to become a biological mother today is through a gestational surrogate mother, a procedure that is prohibited in Sweden and large parts of the world. Uterus transplantation (UTx) is a potential future treatment of AUFI. After extensive animal research, also involving non-human primates, a small number of human UTx cases have recently been performed. Here, we summarize the primate UTx experiments that have paved the way for the human UTx cases, which are described and analyzed in more detail. We also estimate how many women of fertile age are affected by AUFI and describe the causes. The ethics around UTx is complex and is also addressed.
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Affiliation(s)
- Liza Johannesson
- Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Women's Clinic, Carlanderska Hospital, Gothenburg
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Şahin S, Selçuk S, Eroğlu M, Karateke A. Uterus transplantation: Experimental animal models and recent experience in humans. Turk J Obstet Gynecol 2015; 12:38-42. [PMID: 28913039 PMCID: PMC5558403 DOI: 10.4274/tjod.66809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/08/2014] [Indexed: 12/01/2022] Open
Abstract
Uterus transplantation has been considered as an alternative management modality in the last few years for adoption or gestational surrogacy for women with absence of uterus due to congenital or acquired reasons. Surrogacy is legal in only a few countries because of ethical, social and legal issues. Up to date, a total of 11 uterus transplantation cases have been reported in which uteri were harvested from ten live donors and one donor with brain death. After unsuccessful attempt of first uterus transplantation, many studies have been conducted in animals and these experimental models enabled our knowledge to increase on this topic. First experimental studies were performed in rodents; later uterus transplantation was accomplished in sheep, pigs and rabbits. Recently, researches in non-human primates have led the experience regarding transplantation technique and success to improve. In this review, we reviewed the experimental animal researches in the area of uterus transplantation and recent experience in humans.
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Affiliation(s)
- Sadık Şahin
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecologic and Pediatric İstanbul, Turkey
| | - Selçuk Selçuk
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecologic and Pediatric İstanbul, Turkey
| | - Mustafa Eroğlu
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecologic and Pediatric İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Training and Research Hospital, Clinic of Gynecologic and Pediatric İstanbul, Turkey
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33
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Akar ME. Might uterus transplantation be an option for uterine factor infertility? J Turk Ger Gynecol Assoc 2015; 16:45-8. [PMID: 25788850 PMCID: PMC4358312 DOI: 10.5152/jtgga.2015.15107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 01/07/2015] [Indexed: 02/02/2023] Open
Abstract
Current data on uterus allotransplantation research has been reviewed and summarized. Over the past 15 years, progress in uterus transplantation research has increased dramatically. As a consequence, the first pregnancy and delivery following uterus allotransplantation in rats have been reported. The technique has been better defined. Although clinical pregnancy and delivery following uterus allotransplantation has been reported in humans, there are still many questions to be answered before clinical application. Gestational surrogacy still remains an important option for being a genetic parent in selected cases with uterine factor infertility.
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Affiliation(s)
- Münire Erman Akar
- Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Gauthier T, Piver P, Pichon N, Bibes R, Guillaudeau A, Piccardo A, Pesteil F, Tricard J, Gardet E, Laskar M, Lalloué F, Marquet P, Aubard Y. Uterus retrieval process from brain dead donors. Fertil Steril 2014; 102:476-82. [DOI: 10.1016/j.fertnstert.2014.04.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 01/22/2023]
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Application of detergents or high hydrostatic pressure as decellularization processes in uterine tissues and their subsequent effects on in vivo uterine regeneration in murine models. PLoS One 2014; 9:e103201. [PMID: 25057942 PMCID: PMC4109986 DOI: 10.1371/journal.pone.0103201] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/27/2014] [Indexed: 12/24/2022] Open
Abstract
Infertility caused by ovarian or tubal problems can be treated using In Vitro Fertilization and Embryo Transfer (IVF-ET); however, this is not possible for women with uterine loss and malformations that require uterine reconstruction for the treatment of their infertility. In this study, we are the first to report the usefulness of decellularized matrices as a scaffold for uterine reconstruction. Uterine tissues were extracted from Sprague Dawley (SD) rats and decellularized using either sodium dodecyl sulfate (SDS) or high hydrostatic pressure (HHP) at optimized conditions. Histological staining and quantitative analysis showed that both SDS and HHP methods effectively removed cells from the tissues with, specifically, a significant reduction of DNA contents for HHP constructs. HHP constructs highly retained the collagen content, the main component of extracellular matrices in uterine tissue, compared to SDS constructs and had similar content levels of collagen to the native tissue. The mechanical strength of the HHP constructs was similar to that of the native tissue, while that of the SDS constructs was significantly elevated. Transmission electron microscopy (TEM) revealed no apparent denaturation of collagen fibers in the HHP constructs compared to the SDS constructs. Transplantation of the decellularized tissues into rat uteri revealed the successful regeneration of the uterine tissues with a 3-layer structure 30 days after the transplantation. Moreover, a lot of epithelial gland tissue and Ki67 positive cells were detected. Immunohistochemical analyses showed that the regenerated tissues have a normal response to ovarian hormone for pregnancy. The subsequent pregnancy test after 30 days transplantation revealed successful pregnancy for both the SDS and HHP groups. These findings indicate that the decellularized matrix from the uterine tissue can be a potential scaffold for uterine regeneration.
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36
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Miyazaki K, Maruyama T. Partial regeneration and reconstruction of the rat uterus through recellularization of a decellularized uterine matrix. Biomaterials 2014; 35:8791-8800. [PMID: 25043501 DOI: 10.1016/j.biomaterials.2014.06.052] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
Despite dramatic progress in infertility treatments and assisted reproduction, no effective therapies exist for complete loss of uterine structure and/or function. For such patients, genetic motherhood is possible only through gestational surrogacy or uterine transplantation. However, many ethical, social, technical and safety challenges accompany such approaches. A theoretical alternative is to generate a bioartificial uterus, which requires engineering of uterine architecture and appropriate cellular constituents. Here, rat uteri decellularization by aortic perfusion with detergents produced an underlying extracellular matrix together with an acellular, perfusable vascular architecture. Uterine-like tissues were then regenerated and maintained in vitro for up to 10 d through decellularized uterine matrix (DUM) reseeding with adult and neonatal rat uterine cells and rat mesenchymal stem cells followed by aortic perfusion in a bioreactor. Furthermore, DUM placement onto a partially excised uterus yielded recellularization and regeneration of uterine tissues and achievement of pregnancy nearly comparable to the intact uterus. These results suggest that DUM could be used for uterine regeneration, and provides insights into treatments for uterine factor infertility.
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Affiliation(s)
- Kaoru Miyazaki
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo 160-8582, Japan
| | - Tetsuo Maruyama
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo 160-8582, Japan.
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Sahin S, Ozakpinar OB, Ak K, Eroglu M, Acikel M, Tetik S, Uras F, Cetinel S. The protective effects of tacrolimus on rat uteri exposed to ischemia-reperfusion injury: a biochemical and histopathologic evaluation. Fertil Steril 2014; 101:1176-82. [PMID: 24502894 DOI: 10.1016/j.fertnstert.2013.12.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/25/2013] [Accepted: 12/26/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effects of the immunosuppressant tacrolimus as an antioxidant and analyze the histopathologic changes in rat uteri exposed to experimental ischemia-reperfusion (I/R) injury. DESIGN Experimental study. SETTING Experimental surgery laboratory in a university. ANIMAL(S) Twenty-eight female rats exposed to experimentally induced uterine I/R injury. INTERVENTION(S) Group I: control group; group II: uterine I/R injury-induced group; group III: pre-ischemia tacrolimus group; group IV: post-ischemia tacrolimus group. MAIN OUTCOME MEASURE(S) Uterine tissue malondialdehyde (MDA) level as a marker of lipid peroxidation and glutathione (GSH) level and superoxide dismutase (SOD) and catalase (CAT) activities as markers of tissue antioxidant capacity; histopathologic examination of all uterine rat tissue. RESULT(S) Following aortic I/R injury, MDA levels were significantly increased whereas GSH levels and CAT and SOD activities were found to be decreased compared with control animals. MDA levels were found to recover prominently after the administration of tacrolimus in both groups III and IV. Administration of tacrolimus improved uterine GSH levels and CAT activity in the tacrolimus-treated groups. CONCLUSION(S) Our results indicate that tacrolimus reduces oxidative damage in rat uteri exposed to I/R injury induced by distal abdominal aortic occlusion. Histologic evaluation reveals that tacrolimus attenuates the inflammatory response and protects the tissue damage induced by I/R injury.
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Affiliation(s)
- Sadik Sahin
- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey.
| | | | - Koray Ak
- Department of Cardiovascular Surgery, Marmara University, Istanbul, Turkey
| | - Mustafa Eroglu
- Department of Obstetrics and Gynecology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Merve Acikel
- Department of Histology and Embryology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sermin Tetik
- Department of Biochemistry, School of Pharmacy, Marmara University, Istanbul, Turkey
| | - Fikriye Uras
- Department of Biochemistry, School of Pharmacy, Marmara University, Istanbul, Turkey
| | - Sule Cetinel
- Department of Histology and Embryology, School of Medicine, Marmara University, Istanbul, Turkey
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