Department of Clinical Pathology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Am J Transplant. 2021 Feb;21(2):798-808. doi: 10.1111/ajt.16213. Epub 2020 Aug 11.
Uterus transplantation has enabled women with absolute uterine factor infertility to carry a pregnancy. The first human uterus transplantation trial was initiated in 2013 in Gothenburg, Sweden. It was completed with 7 transplantations with long-term allograft survival and 9 children born from 6 women. In the present study we describe the histopathology of these 7 allografts, which were removed at 22-83 months after transplantation, and compare findings to control cases. Morphological findings in a subset of explants included linear subepithelial inflammation and perivascular stromal inflammation in the cervix, small inflammatory foci in the myometrium, and intimal inflammation in larger arteries. The average number of T cells, B cells, and macrophages was higher in transplants compared to normal controls, but variability was high among transplants. Chronic-active vascular rejection was seen in 2 of 7 transplants, both showed also inflammation in the cervix. Further, the inflammation seen in the cervix reflected the inflammation in the myometrium, suggesting that cervical biopsies are suitable to monitor rejection. However, the degree of inflammation and signs of rejection in explants did not reflect on the possibility to become pregnant in this limited series.
子宫移植使患有绝对子宫因素不孕的女性能够怀孕。首例人类子宫移植试验于 2013 年在瑞典哥德堡启动。该试验共进行了 7 次移植，长期异体移植物存活，6 名女性中有 9 名儿童出生。在本研究中，我们描述了 7 例这些同种异体移植物的组织病理学，这些移植物在移植后 22-83 个月被取出，并与对照病例进行了比较。一组标本的形态学发现包括宫颈的上皮下线性炎症和血管周围间质炎症、子宫肌层的小炎症灶以及较大动脉的内膜炎症。与正常对照组相比，移植组的 T 细胞、B 细胞和巨噬细胞数量平均更高，但移植组之间的差异很大。7 例移植中有 2 例出现慢性活动性血管排斥反应，这 2 例均表现为宫颈炎症。此外，宫颈的炎症反映了子宫肌层的炎症，表明宫颈活检适合监测排斥反应。然而，在这个有限的系列中，标本中的炎症程度和排斥反应的迹象并没有反映出怀孕的可能性。
