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Polenz D, Sauer IM, Martin F, Reutzel-Selke A, Ashraf MI, Schirmeier A, Lippert S, Führer K, Pratschke J, Tullius SG, Moosburner S. A new bicornuate model of rat uterus transplantation. Acta Obstet Gynecol Scand 2024. [PMID: 38693698 DOI: 10.1111/aogs.14857] [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: 02/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Uterus transplantation has revolutionized reproductive medicine for women with absolute uterine factor infertility, resulting in more than 40 reported successful live births worldwide to date. Small animal models are pivotal to refine this surgical and immunological challenging procedure aiming to enhance safety for both the mother and the child. MATERIAL AND METHODS We established a syngeneic bicornuate uterus transplantation model in young female Lewis rats. All surgical procedures were conducted by an experienced and skilled microsurgeon who organized the learning process into multiple structured steps. Animals underwent meticulous preoperative preparation and postoperative care. Transplant success was monitored by sequential biopsies, monitoring graft viability and documenting histological changes long-term. RESULTS Bicornuate uterus transplantation were successfully established achieving an over 70% graft survival rate with the passage of time. The bicornuate model demonstrated safety and feasibility, yielding outcomes comparable to the unicornuate model in terms of ischemia times and complications. Longitudinal biopsies were well-tolerated, enabling comprehensive monitoring throughout the study. CONCLUSIONS Our novel bicornuate rat uterus transplantation model provides a distinctive opportunity for sequential biopsies at various intervals after transplantation and, therefore, comprehensive monitoring of graft health, viability, and identification of potential signs of rejection. Furthermore, this model allows for different interventions in each horn for comparative studies without interobserver differences contrary to the established unicornuate model. By closely replicating the clinical setting, this model stands as a valuable tool for ongoing research in the field of uterus transplantation, promoting further innovation and deeper insights into the intricacies of the uterus transplant procedure.
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Affiliation(s)
- Dietrich Polenz
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Igor Maximilian Sauer
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Martin
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anja Reutzel-Selke
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Muhammad Imtiaz Ashraf
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja Schirmeier
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Steffen Lippert
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Führer
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan Günther Tullius
- Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Einstein Berlin Institute of Health Visiting Fellow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Moosburner
- Department of Surgery, Experimental Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- BIH Academy, Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Do XH, Tong TH, Nguyen TC, Ngo TA, Tran MTT. Anatomic characteristics and novel transplantation model of the canine uterus. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:109-117. [PMID: 37435146 PMCID: PMC10332280 DOI: 10.4285/kjt.23.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background In Vietnam, the rate of absolute uterine factor infertility is increasing, but no study has been published on uterine transplantation. The present study was designed to comprehensively observe the canine uterine anatomy and to examine the possibility of using a living canine donor for uterine transplantation training and further research. Methods Ten female Vietnamese mixed-breed dogs were sacrificed for anatomical research, and 15 additional pairs were used to evaluate the novel uterine transplant model. Results The anatomic features of the canine uterus differed considerably from those of the human uterus, with the uterine vessels originating from branches of the pudendal vessels (also known as the vaginal vessels). The uterine vascular pedicle had a small diameter (1 to 1.5 mm for arteries and 1.2 to 2.0 mm for veins) and required manipulation under a microscope. To perform uterine transplantation, the donor specimen's artery and vein lengths were successfully reconstructed by anastomosis between both sides of the vasculature using autologous Y-shaped subcutaneous veins. The living-donor uterine transplantation model constructed in this study was feasible, with the transplanted uterus surviving in 86.7% of cases (13/15). Conclusions Uterine transplantation was successfully performed in a Vietnamese canine living donor model. This model could be helpful in uterine transplantation training and improve the transplantation success rate in humans.
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Affiliation(s)
- Xuan-Hai Do
- Department of Practical and Experimental Surgery, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thanh-Hai Tong
- Plastic Surgery Center, National Burn Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Trung-Chuc Nguyen
- Department of Practical and Experimental Surgery, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tuan-Anh Ngo
- Department of Cardiovascular Surgery, 108 Military Central Hospital, Hanoi, Vietnam
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Graft Failure after Uterus Transplantation in 16 Recipients: A Review. J Clin Med 2023; 12:jcm12052032. [PMID: 36902818 PMCID: PMC10003853 DOI: 10.3390/jcm12052032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Uterus transplantation (UTx) is now an alternative to surrogacy and adoption for women with uterine factor infertility to have children; however, there are still unresolved clinical and technical issues. One of these is that the graft failure rate after transplantation is somewhat higher than that of other life-saving organ transplants, which is a critical concern. Herein, we summarize the details of 16 graft failures after UTx with living or deceased donors using the published literature in order to learn from these negative outcomes. To date, the main causes of graft failure are vascular factors (arterial and/or venous thrombosis, atherosclerosis, and poor perfusion). Many recipients with thrombosis develop graft failure within one month of surgery. Therefore, it is necessary to devise a safe and stable surgical technique with higher success rates for further development in the UTx field.
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Le Gal C, Carbonnel M, Balaya V, Richard C, Gelin V, Galio L, Sandra O, Hersant B, Bosc R, Charton J, Chavatte-Palmer P, Vialard F, Coscas R, Ayoubi JM. Analysis of Predictive Factors for Successful Vascular Anastomoses in a Sheep Uterine Transplantation Model. J Clin Med 2022; 11:jcm11185262. [PMID: 36142908 PMCID: PMC9503062 DOI: 10.3390/jcm11185262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Uterine transplantation is becoming an increasingly realistic therapeutic for uterine infertility. Surgical training on large animal models such as sheep is a prerequisite for establishing a program in humans. The objective of our study was to analyze the predictive factors for successful vascular anastomoses. We performed 40 autotransplants that involved end-to-side anastomoses from the uterine to the external iliac vessels. We analyzed vessel results in terms of success or failure; a total of 78.7% of arterial and 82.9% of venous anastomoses were successful in the immediate postoperative period. In multivariate analysis, independent factors associated with immediate successful vein anastomoses were as follows: a short warm ischemia time (<2 h, OR = 0.05; 95% CI [0.003−0.88], p = 0.04), the absence of any anastomotic complications (OR = 0.06; 95% CI [0.003−0.099], p = 0.049), and their realization by a vascular surgeon (OR = 29.3; 95% CI [1.17−731.9], p = 0.04). Secondly, we showed that an increase in lactate levels greater than 2.72 mmol/L, six hours after reperfusion was predictive of failure, with a sensibility of 85.7% and a specificity of 75.0%. In order to perfect the management of vascular anastomoses by a vascular surgeon, training on animal models and in microsurgery are mandatory in establishing a uterine transplantation program in humans.
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Affiliation(s)
- Claire Le Gal
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
| | - Marie Carbonnel
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
- Correspondence:
| | - Vincent Balaya
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
| | - Christophe Richard
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
- MIMA2 Platform, INRAE, 78350 Jouy-en-Josas, France
| | - Valerie Gelin
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
- MIMA2 Platform, INRAE, 78350 Jouy-en-Josas, France
| | - Laurent Galio
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
| | - Olivier Sandra
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
| | - Barbara Hersant
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor University Hospital, 94000 Creteil, France
| | - Romain Bosc
- Department of Maxillofacial and Plastic & Reconstructive Surgery, Henri Mondor University Hospital, 94000 Creteil, France
| | - Johanna Charton
- Department of Vascular Surgery, Amboise Pare University Hospital, AP-HP, 92100 Boulogne-Billancourt, France
| | - Pascale Chavatte-Palmer
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
| | - François Vialard
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- National Veterinary School, BREED, 94700 Maisons-Alfort, France
- Department of Genetics, Medical Biology Laboratory, Poissy-St Germain en Laye University Hospital, 78300 Poissy, France
| | - Raphael Coscas
- Department of Vascular Surgery, Amboise Pare University Hospital, AP-HP, 92100 Boulogne-Billancourt, France
- UMR 1018, Inserm-Paris11-CESP, Versailles Saint-Quentin-en-Yvelines University, 78000 Versailles, France
| | - Jean-Marc Ayoubi
- UVSQ, INRAE, BREED, Paris-Saclay University, 78350 Jouy-en-Josas, France
- Department of Gynecology and Obstetrics, Foch Hospital, 92150 Suresnes, France
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