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Presenter: Liza, Johannesson, Gothenburg, Sweden
Authors: Liza Johannesson, Anders Enskog, Michael Olausson, Andreas Tzakis, Mats Brännström
Liza Johannesson1, Anders Enskog2, Michael Olausson3, Andreas Tzakis4, Mats Brännström1.
1Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Sweden; 2Department of Anesthesia, Sahlgrenska Academy, University of Gothenburg, Sweden; 3Transplantation Institute, Sahlgrenska Academy, University of Gothenburg, Sweden; 4Division of Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Infertility affects 10% of the population. Improvements in reproductive medicine have overcome most causes of infertility, with the exception of uterine factor infertility, due either to absence of, or presence of a non-functional uterus. Uterus transplantation (UTx) may become a treatment for this group of permanently infertile women.
Aiming to develop techniques of UTx in the baboon and asses long-term function, 16 female baboons underwent autologous UTx, including ovaries, enabling assessment of resumed menstrual cyclicity (indication of successful transplantation). The animals were divided in 2 groups (n=6/10) where surgery techniques and flushing were developed further in Group 2. Arterial ends (internal iliac artery) and venous ends (Group 2 including patches of caval/left kidney vein) were joined forming one artery and one vein of the specimen. Anastomoses were done end-to-side to the left external iliac artery (Group 1)/end-to-end to the left internal iliac artery (Group 2) with venous anastomosis end-to-side to the left external iliac vein. Short time animal survival was 88%, and 75% of these animals showed cyclicity (ovarian function). Menstruation (ovarian and uterine function) was demonstrated in 6 out of 10 animals (Group 2). These were exposed to timed mating but no pregnancy occurred.
Our current research is towards allogenic UTx in the baboon and so far six transplantation attempts including retrieval surgery from living donor and transplantation of the uterus alone has been done. Immunosuppressive treatment consisted of tacrolimus, mycophenolic mofetil, antithymoglobulin and corticosteroids for 10 weeks when the study was terminated. Survival rate was 67% (two animals died <7 days postoperatively of anemia/infection). Three of the four remaining animals showed vascular thrombosis and uterine changes. One animal had a normal-sized, well-vascularized uterus.
In conclusion, UTx in baboon is feasible but further studies will be needed to improve the surgical method so that vascular thrombosis can be avoided.
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