Immunology of Uterine Transplantation: A Review

Abstract

The idea of using organ transplantation to solve quality-of-life issues was first introduced a century ago, with cornea transplants and thrusted before the world again in 1998, following a controversial hand transplant. Uterus transplantation (UTn) has been proposed as another quality-of-life transplant for the cure of permanent uterine factor infertility. In order to proceed in humans, a greater appreciation of the immunological mechanisms that underlie UTn is desirable. Allogeneic UTn (animal model) was first described by 2 studies in 1969. The first and only human UTn, performed in 2000, was an early attempt with limited use of animal model experiments prior to moving onto the human setting. Since then, work using rat, mouse, ovine, goat, and nonhuman primate models has demonstrated that the uterus is a very different but manageable organ immunologically compared to other transplanted organs. Therefore, specifically exploring immunological issues relating to UTn is a valuable and necessary part of the inevitable scientific process leading to successful human UTn.

Modified human uterus transplantation using ovarian veins for venous drainage: the first report of surgically successful robotic-assisted uterus procurement and follow-up for 12 months

“…At present, >15,000 infants have been born to transplanted and immunosuppressed mothers during the past 50 years (37). The clinical data on immunosuppressive drugs during pregnancy suggest a significant impact on the population and activity of immune cells during pregnancy (43), which are essential at the fetal-maternal interface, especially during the remodeling of spiral arteries. Interference with this process likely compromises endovascular trophoblast invasion and transformation of the spiral arteries in the myometrial junctional zone.…”

Uterus transplantation: Toward clinical application in Japan

“…[53][54][55][56][57][58][59] However, the significance of basic research using animals might be attenuated because the case number of human UTx is increasing steadily in the world and clinical knowledge has been accumulating. [60][61][62][63][64][65][66][67][68][69][70] Although the animal experiments might be useful for developing adequate surgical techniques that are associated with UTx, the implementation limits from the viewpoint of animal welfare should be considered further.…”