Intra- and Postoperative Blood Flow Monitoring in a Sheep Model of Uterus Transplantation

Kengelbach‐Weigand, Annika; Lotz, Laura; Schmid, Rafael; Lang, Werner; Beckmann, Matthias W.; Hoffmann, Inge; Horch, Raymund E.; Renner, S.; Dittrich, Ralf; Boos, Anja M.; Hildebrandt, Thomas

doi:10.21873/invivo.11478

Cited by 7 publications

(10 citation statements)

References 52 publications

(80 reference statements)

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“…The modern era of human UTx studies was preceded by a thorough translational research program on laboratory animals 2,30,32–35 . The animal UTx trials used mice, 36–38 rats, 39–44 rabbits, 45–47 pigs, 48–52 sheeps, 53–62 baboons 63–67 and cynomolgus monkeys 68–74 . Most of the UTx experiments on nonhuman primates were performed with autologous grafts.…”

Section: Resultsmentioning

confidence: 99%

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Křístek

Johannesson

Novotný

et al. 2020

J of Obstet and Gynaecol

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Due to the novelty of uterus transplantation, data on preferable inflow and outflow of the graft are limited. This paper reviews the technique, type of vessels and the outcome. A systematic search of the PubMed database was conducted. We extracted and analyzed data on the arteries and veins utilized, types of anastomosis, types of donors, complications and the outcome. Thirty eight sources reported 51 human uterine transplantations, 10 graft thromboses and 25 live births. Inflow was established with two uterine arteries (UA) with/without the anterior division of the internal iliac artery in 62% (n = 31) of cases, two UA arteries with a segment/patch of the internal iliac artery in 34% (n = 17) of cases or two UA with a conduit in 4% of cases (n = 2). Both cases with a conduit developed thrombosis (n = 2). Arterial thrombosis/ischemia developed in 8 of the 51 cases. In 50% of cases with arterial thrombosis, atherosclerosis was identified as a possible cause. Outflow was established by two internal iliac veins with patches/segments in 27.5% of cases (n = 14) followed by two utero-ovarian veins in 25.5% (n = 13). Venous thrombosis occurred in 3 of the 51 cases. Uterine arteries with/without anterior division of the internal iliac artery were the most frequent arteries used for inflow and produced the highest patency rate. The presence of atherosclerosis and complex arterial reconstruction was associated with a high rate of arterial thrombosis. None of the veins utilized in the procedures appeared to be superior. There are insufficient data to draw a definite conclusion.

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Section: Resultsmentioning

confidence: 99%

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Křístek

Johannesson

Novotný

et al. 2020

J of Obstet and Gynaecol

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“…The ratio of pro-apoptotic to anti-apoptotic proteins is the determinant of cell survival or death [ 50 ]. BAX/BCL2 ratio has been studied in liver and kidney transplantation [ 44 , 51 ] and recently in UTx [ 52 ]. Based on TUNEL assay caspase-3 immunolocalization [ 39 , 53 ] and PCR quantification of BCL2 and BAX transcript levels, no apoptosis was detected in the ovine uterus 1 day after auto-transplantation in the ewe [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…BAX/BCL2 ratio has been studied in liver and kidney transplantation [ 44 , 51 ] and recently in UTx [ 52 ]. Based on TUNEL assay caspase-3 immunolocalization [ 39 , 53 ] and PCR quantification of BCL2 and BAX transcript levels, no apoptosis was detected in the ovine uterus 1 day after auto-transplantation in the ewe [ 52 ]. Our results are consistent with these data since no sign of apoptosis was detected in the uterine tissue using histological assessment or gene quantification of BAX and BLC2 .…”

Section: Discussionmentioning

confidence: 99%

“…The ICAR areas, the localization of endometrial glands, therefore appear to be more sensitive to ischemia-reperfusion. To our knowledge, the difference between CAR and ICAR areas has not been taken into account in previous UTx studies in Sheep [ 39 , 52 ]. By investigating the endometrial glandular areas, our study underlines that ICAR areas appear more sensitive to ischemia-reperfusion.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of blood parameters and molecular endometrial markers during early reperfusion in two ovine models of uterus transplantation

et al. 2021

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The dissection of the veins is the trickiest step of Uterine transplantation (UTx). Performing the anastomosis of a single uterine vein could bring a therapeutic benefit and simplification of surgery and serve for managing unilateral venous thromboses. The objectives of this project were to evaluate the expression of early markers of ischemia-reperfusion and to compare findings following one or two vein anastomoses. Orthotopic uterine auto-transplantations were performed on an ovine model with anastomosis of either two (group 1) or one utero-ovarian veins (group 2). Blood gases, histology and ischemia- reperfusion markers transcripts (PTGS2, IL6, IL8, SOD2, C3, BAX/BCL2 and TLR4) were analyzed as well as PTGS2 protein expression using Western Blot and fluorescence immunolocalization on endometrial biopsies after 3h of reperfusion. Ten ewes were included in the experimentation, 4 were in group1, 3 in group 2, the others being sham operated controls. No significant differences were observed between the two phenotypes. Based on these results, the anastomosis of one single uterine vein appears to be an approach consistent with short-term graft survival. Further experiments will be needed to confirm the reliability of this approach, especially the long-term follow-up of the uterine graft including its ability to support gestation to term.

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“…From a surgical standpoint, the key to successful uterus transplantation is the quality of vascular anastomoses. An occlusion of anastomoses is complex and might be associated with inadequate anticoagulation, poor graft fixation, low immunosuppression, inadequate surgical technique, patient’s age, and mutations associated with venous thromboembolism [ 60 ]. Kengelbach et al used different techniques in a sheep model for intraoperative and postoperative blood flow measurements using ICG, as well as Doppler flowmetry [ 60 ].…”

Section: Fluorescent Angiographymentioning

confidence: 99%

Comprehensive Review of Fluorescence Applications in Gynecology

Połom

Kalinowski

Diana

et al. 2021

JCM

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Since the introduction of indocyanine green (ICG) as a fluorophore in near-infrared imaging, fluorescence visualization has become an essential tool in many fields of surgery. In the field of gynecology, recent new applications have been proposed and found their place in clinical practice. Different applications in gynecology were investigated, subcategorized, and overviewed concerning surgical applications and available dyes. Specific applications in which fluorescence-guided surgery was implemented in gynecology are described in this manuscript—namely, sentinel node biopsy, mesometrium visualization, angiography of different organs, safety issues in pregnant women, ureters visualization, detection of peritoneal metastases, targeted fluorophores for cancer detection, fluorescent contamination hysterectomy, lymphography for lower limb lymphedema prevention, tumor margin detection, endometriosis, and metastases mapping. With evolving technology, further innovative research on the new applications of fluorescence visualization in cancer surgery may help to establish these techniques as standards of high-quality surgery in gynecology. However, more investigations are necessary in order to assess if these innovative tools can also be effective to improve patient outcomes and quality of life in different gynecologic malignancies.

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Intra- and Postoperative Blood Flow Monitoring in a Sheep Model of Uterus Transplantation

Cited by 7 publications

References 52 publications

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Analysis of blood parameters and molecular endometrial markers during early reperfusion in two ovine models of uterus transplantation

Comprehensive Review of Fluorescence Applications in Gynecology

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