Uterine viability in the baboon after ligation of uterine vasculature: a pilot study to assess alternative perfusion and venous return for uterine transplantation

Shockley, Marie E.; Arnolds, Katrin; Beran, Benjamin; Rivas, K.; Escobar, Pedro F.; Tzakis, Andreas G.; Falcone, Tommaso; Sprague, M.L.; Zimberg, Stephen

doi:10.1016/j.fertnstert.2017.01.014

Cited by 20 publications

(12 citation statements)

References 9 publications

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“…In ewe # 3, we used the utero‐ovarian veins to facilitate the dissection. The use of the ovarian veins was described in baboons, which have a similar reproductive system to humans, and therefore separate uterine and ovarian veins, with a system of anastomoses between them . It was proven in baboons that the uterus was well drained through the ovarian veins when the uterine veins were ligated .…”

Section: Discussionmentioning

confidence: 99%

“…The use of the ovarian veins was described in baboons, which have a similar reproductive system to humans, and therefore separate uterine and ovarian veins, with a system of anastomoses between them . It was proven in baboons that the uterus was well drained through the ovarian veins when the uterine veins were ligated . Using the ovarian veins instead of the uterine veins in human transplantation can be done only when the donor is menopausal and willing to remove her ovaries, or with a premenopausal donor, if the ovarian tissue auto‐transplantation technique is used …”

Section: Discussionmentioning

confidence: 99%

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Team preparation for human uterus transplantation: Autologous transplantation in sheep model

Solomonov

Braun

Siman-Tov

et al. 2017

Clinical Transplantation

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We performed autologous uterus transplantation using the living-sheep donor model for team preparation before human uterine transplantation. Five sequential operations (in 3 ewes) were prospectively conducted. Surgical technique included uterus retrieval, graft preparation, and uterus transplantation. Anastomoses were performed at the level of the external iliac. At 3-week follow-up, the uterus and anastomoses were checked for strictures and thrombosis. Two successful auto-transplantations were made, and one failed because of undeveloped uterine arteries (< 1 mm in diameter). In the first two ewes, we identified and used a deep, separate uterine vein, which was not described in other publications. In the third ewe, we used the utero-ovarian vein. The team was able to perform safe dissection and auto-transplantation, with no signs of strictures or thrombosis after 3 weeks. Cold ischemic time was 60 minutes, and warm ischemic time was between 40 and 60 minutes, with no need for re-anastomoses. We noticed that using the deep uterine vein in the sheep model can anatomically simulate better the human uterine vein and the difficulty to approach it. To avoid using unsuitable vessels for anastomoses, the uterine transplantation protocol in humans should include imaging of the donor's uterine vessels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Team preparation for human uterus transplantation: Autologous transplantation in sheep model

Solomonov

Braun

Siman-Tov

et al. 2017

Clinical Transplantation

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“…Further data on uterine blood flow in nonhuman primates was obtained in a study of uterine perfusion in baboons by an American team . In the baboon models, ligation of uterine veins or uterine arteries and veins did not affect uterine and ovarian viability and cyclical sex skin turgescence and menstruation were observed in all animals .…”

Section: Uterine Blood Flowmentioning

confidence: 99%

“…The UTx studies have been performed in mice, rats, rabbits, dogs, pigs, sheep and nonhuman primates . However, there are only a few reports on UTx in nonhuman primates, and delivery after allogeneic UTx in these species has yet to be attained because of specific problems and limitations, although delivery after allogeneic UTx has been achieved in rats and sheep .…”

Section: Introductionmentioning

confidence: 99%

Basic research on uterus transplantation in nonhuman primates in Japan

Kisu

Banno

Matoba

et al. 2018

J of Obstet and Gynaecol

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Uterus transplantation (UTx) is now a potential option for women with uterine factor infertility to have a child. However, UTx is still in an experimental stage and basic animal studies including in nonhuman primates are needed for accumulation of data that will provide important information for establishment of UTx in humans. Herein, we summarized our experiences using cynomolgus macaques, with the goal of promoting further development of UTx studies in nonhuman primates. Our basic studies using cynomolgus macaques were summarized, including the results of other teams in nonhuman primates. Our team in Japan launched UTx research in 2009 using cynomolgus macaques and has accumulated a large archive of results in the UTx research field, including examination of uterine blood flow, surgical procedures of autologous and allogeneic UTx, organ perfusion methods in deceased donor models, immunological response and rejection and ischemia/reperfusion injury. We achieved the first delivery after autologous UTx in primates and the first periodic recovery of menstruation after allogeneic UTx in nonhuman primate models. Results from animal studies, including those in nonhuman primates, provide the basis for clinical application of UTx. Therefore, our accumulated data since 2009 and our basic experience in cynomolgus macaque are meaningful for future UTx trials in Japan. In addition, more validation in nonhuman primate models is needed for resolution of medical issues and further development of UTx in humans, despite clinical application of UTx in several countries.

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“…Indeed, in this report, the authors describe that robotically, the uterine veins could not be isolated, and therefore the utero-ovarian vessels were used for venous drainage instead. Proof of concept preclinical studies using the utero-ovarian veins for venous drainage of a transplanted uterus have been successfully performed in baboons (5). Further in the recent series of five human living donor transplants from Texas, short segments of the utero-ovarian vessels obtained via laparotomy were successfully used (1).…”

mentioning

confidence: 99%

The future of human uterine transplantation: can minimally invasive techniques provide a uterus suitable for transplant?

Falcone

Farrell

Flyckt

2017

Fertility and Sterility

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Uterine viability in the baboon after ligation of uterine vasculature: a pilot study to assess alternative perfusion and venous return for uterine transplantation

Abstract: Disruption of bilateral uterine vessels does not affect uterine or ovarian viability in the baboon. Bilateral uterine artery and vein ligation furthers development of a minimally invasive approach to donor hysterectomy.

Cited by 20 publications

References 9 publications

Team preparation for human uterus transplantation: Autologous transplantation in sheep model

Team preparation for human uterus transplantation: Autologous transplantation in sheep model

Basic research on uterus transplantation in nonhuman primates in Japan

The future of human uterine transplantation: can minimally invasive techniques provide a uterus suitable for transplant?

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