Saso Srdjan, Hurst Simon, Chatterjee Jayanta, Kuzmin Eugene, Thum Yau, David Anna L, Hakim Nadey, Corless David J, Boyd Michael, Noakes David E, Lindsay Iain, Ghaem-Maghami Sadaf, Del Priore Giuseppe, Smith J Richard
Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, London, UK.
J Obstet Gynaecol Res. 2014 Mar;40(3):754-62. doi: 10.1111/jog.12256. Epub 2013 Dec 10.
To see if: (i) a large vessel aortocaval vascular patch technique may bring about long-term graft survival after allogeneic uterine transplantation (UTn) in a rabbit model; and (ii) fertility can be achieved following natural mating post-allogeneic UTn.
Allogeneic uterine cross transplantations were performed in New Zealand white rabbits using an aortocaval macrovascular patch harvested as part of the uterine allograft. Five rabbit recipients received a uterine graft from five unrelated donor rabbits. All female rabbits were unrelated and were of proven fertility with at least one previous litter each. Tacrolimus was administrated for immunosuppression post-transplant. Natural mating was attempted if long-term survival had been achieved. The main outcome measures were: (i) long-term recipient survival; (ii) long-term adequate uterine perfusion; and (iii) successful pregnancy post-UTn.
All five recipient animals survived the surgery with satisfactory immediate postoperative recovery. Recipients 1, 2 and 4 died within the first 4 postoperative days. Both long-term survivors failed to conceive following introduction of a proven male breeder despite evidence of mating. Necropsy at 9 and 11 months showed a lack of patency of uterine cornua at the point of anastomosis, albeit a small uterus in recipient 3 and a reddish brown amorphous material at the site of the transplanted uterus in recipient 5.
We have demonstrated the feasibility of uterine allotransplantation using a macrovascular patch technique, but could not demonstrate conception because of blocked cornua. To address this, we propose using embryo transfer techniques in order to achieve conception.
探讨：（i）在兔模型中，大血管主动脉腔静脉血管补片技术是否能实现同种异体子宫移植（UTn）后的移植物长期存活；以及（ii）同种异体UTn后自然交配能否实现生育。
在新西兰白兔中进行同种异体子宫交叉移植，使用作为子宫同种异体移植物一部分获取的主动脉腔静脉大血管补片。五只兔受体接受了来自五只无关供体兔的子宫移植物。所有雌性兔均无亲缘关系，且均已证实具有生育能力，每只至少有过一窝仔。移植后给予他克莫司进行免疫抑制。若实现长期存活，则尝试自然交配。主要观察指标为：（i）受体长期存活情况；（ii）子宫长期充分灌注情况；以及（iii）UTn后成功妊娠情况。
所有五只受体动物均在手术中存活，术后即刻恢复良好。受体1、2和4在术后第1个4天内死亡。尽管有交配迹象，但两名长期存活者在引入经证实的雄性种兔后均未能受孕。术后9个月和11个月的尸检显示，吻合部位子宫角不通畅，尽管受体3的子宫较小，受体5移植子宫部位有红棕色无定形物质。
我们已证明使用大血管补片技术进行子宫同种异体移植的可行性，但由于子宫角堵塞未能证明受孕情况。为解决这一问题，我们建议使用胚胎移植技术以实现受孕。
