Favre-Inhofer Angeline, Carbonnel Marie, Domert Johanna, Cornet Nathalie, Chastant Sylvie, Coscas Raphaël, Vialard François, Gelin Valérie, Galio Laurent, Richard Christophe, Trabelsi Héla, Sandra Olivier, de Ziegler Dominique, Chavatte-Palmer Pascale, Ayoubi Jean-Marc
Department of Gynaecology and Obstetrics, Foch Hospital, Suresnes, France.
Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France.
Front Surg. 2022 Feb 23;9:830826. doi: 10.3389/fsurg.2022.830826. eCollection 2022.
Absolute uterine factor infertility affects 0. 2% women of childbearing age around the world. Uterine transplantation (UTx) is a promising solution for many of them since the first birth from UTx was described by the Swedish team in 2014. The success of Utx in humans has become possible after a systematic and meticulous approach involving years of research on animal models. To date, more than 80 UTx procedures have been performed worldwide and 30 children were born.
This review summarizes the research preparation conducted in animals before beginning UTx in humans. It focuses on the advantages and limits of each animal model, their place in surgical training, and current contribution in research to improve UTx successes in humans. The different steps in the process of UTx have been analyzed, such as imaging, surgery, ischemia-reperfusion effects, rejection markers, immunosuppressive treatment, and pregnancy.
Animal models have played an essential role in the implementation of UTx, which is a highly complex procedure. While respecting the 3R requirements (replacement, refinement, and reduction), the surgical training using large animal models, such as notably ewes remain irreplaceable for teams wishing to initiate a UTx program. Furthermore, animal models are still mandatory in current research to improve the success rates of UTx in humans as well as to reduce the morbidity associated with this experimental infertility treatment.
绝对子宫因素不孕症影响着全球0.2%的育龄妇女。自2014年瑞典团队报道首例子宫移植（UTx）分娩以来，子宫移植对其中许多人来说是一个有前景的解决方案。在对动物模型进行了多年系统而细致的研究后，子宫移植在人类身上取得成功成为可能。迄今为止，全球已进行了80多例子宫移植手术，并有30名婴儿出生。
本综述总结了在人类开展子宫移植之前在动物身上进行的研究准备工作。它重点关注每种动物模型的优缺点、在手术训练中的地位以及目前在提高人类子宫移植成功率的研究中的贡献。对子宫移植过程中的不同步骤进行了分析，如成像、手术、缺血再灌注效应、排斥标志物、免疫抑制治疗和妊娠。
动物模型在子宫移植的实施中发挥了重要作用，子宫移植是一个高度复杂的过程。在遵循3R原则（替代、优化和减少）的同时，对于希望启动子宫移植项目的团队来说，使用大型动物模型（如母羊）进行手术训练仍然是不可替代的。此外，在当前研究中，动物模型对于提高人类子宫移植成功率以及降低这种实验性不孕治疗相关的发病率仍然必不可少。
