Introduction: Uterus transplantation (UTx) is a promising treatment for uterine infertility that has resulted in several births since 2014. Ischemia is a key step in organ transplantation because it may lead to changes jeopardizing graft viability. Method: We performed a systematic review of animal and human studies relating to uterine ischemia. Results: We retained 64 studies published since 2000. There were 35 studies in animals, 24 in humans, and five literature reviews. Modest preliminary results in large animals and humans are limited but encouraging. In small animals, pregnancies have been reported to occur after 24 h of cold ischemia (CI). In ewes, uterine contractions have been detected after 24 h of CI. Furthermore, it has been shown in animals that uterine tolerance to CI and to warm ischemia (WI) can be increased by pharmacological products. In women, mean CI time in studies of births from uteri obtained from live donors was between 2 h 47 min and 6 h 20 min from a deceased donor; with only one birth in this case. Muscle contractions have also been demonstrated in myometrial samples from women, after six or more hours of CI. Conclusion: The uterus seems to be able to tolerate a prolonged period of CI, of at least six hours. Studies of the ischemia tolerance of the uterus and ways to improve it are essential for the development of UTx, particularly for procedures using grafts from deceased donors.

Aim: 18 F-Fluorodeoxyglucose positron-emission tomography integrated with computed tomography ( 18 FDG PET-CT) is a non-invasive examination that could be helpful for the management of endometrial cancer. This study investigated the performance of 18 FDG PET-CT in assessing para-aortic (PA) lymph-node involvement in high-risk endometrial cancer. Materials and Methods: This was a retrospective, single-center study carried out between 2009 and 2018. The inclusion criteria were high-risk and locally advanced type 1 or 2 endometrial cancer with 18 FDG PET-CT before PA lymphadenectomy. Results: During the study period, among 142 patients with high-risk endometrial cancer, 35 patients (24.6%) underwent 18 FDG PET-CT followed by PA lymphadenectomy. In 25% of cases, PA lymphadenectomy was not performed due to the discovery of metastasis. 18 FDG PET-CT had a sensitivity of 50%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 75%, accuracy of 80% and an area under the curve of 0.75 for the evaluation of PA involvement. Conclusion: According to its high specificity in PA lymph-node evaluation, a positive PET scan might allow PA lymphadenectomy to be avoided.Endometrial cancer is the fourth most frequent cancer in women, with more than 8,000 cases per year in France (1). A knowledge of lymph-node status and International Federation of Gynecology and Obstetrics (FIGO) stage is necessary to establish the most appropriate treatment strategy. The risk of lymph-node involvement is strongly correlated with the characteristics of the tumor, and depends on its histological type, grade, the degree of local extension (myometrium and cervical stroma), and the presence of lymphovascular space invasion (2). Since the European Society for Medical Oncology (ESMO) congress of 2009 (3) and the publication of the French National Institute of Cancer (INCA) recommendations in 2010 (4), para-aortic lymphadenectomy (PAL) has been recommended for stage I tumors of histological type 1 (endometrioid adenocarcinoma) with a high risk of recurrence (stage IB and grade 3, or with the presence of lymphovascular space invasion, regardless of grade), for tumors of stage II and above, and for histological type 2 tumors (clear-cell carcinoma, papillary serous carcinoma, and carcinosarcoma) of all stages.PAL is a surgical procedure associated with non-negligible morbidity, particularly in elderly patients with associated comorbid conditions (5). Its therapeutic impact on survival is a matter of debate (6). Knowledge of pelvic and paraaortic (PA) lymph-node status guides therapeutic decisions, determining whether there are indications for more or less extensive radiotherapy and systemic treatment (7). The PORTEC-3 study showed that adjuvant chemotherapy, in addition to radiotherapy, was beneficial in stage III high-risk endometrial cancer (8).18 F-Fluorodeoxyglucose positron-emission tomography integrated with computed tomography ( 18 FDG PET-CT) is a non-invasive examination that can modify the management of endometr...

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). ConclusionThe 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.

Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.

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