Macedo Arantes Rubens, Ejzenberg Dani, Tanigawa Ryan Yukimatsu, da Silva Neto Amadeu Batista, de Martino Rodrigo Bronze, Galvão Flávio Henrique, Waisberg Daniel Reis, Ducatti Liliana, Rocha Santos Vinicius, Pinheiro Rafael Nunes, Haddad Luciana Bertocco, Lee André Dong, Soares-Junior José Maria, Baracat Edmund Chada, Carneiro D'Albuquerque Luiz Augusto, Andraus Wellington
Department of Gastroenterology, Transplantation Unit, Hospital das Clínicas da Faculadade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculadade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Acta Obstet Gynecol Scand. 2025 Mar;104(3):474-482. doi: 10.1111/aogs.14979. Epub 2024 Oct 14.
Uterine transplantation was developed for the treatment of absolute uterine factor infertility. As it is a new modality of transplantation, there is still room for technical improvement. A factor that impacts graft survival in organ transplantation is the warm ischemia time. In uterine transplantation specifically, at least two vascular anastomoses are performed on each side of the uterus, and the graft revascularization takes place when the vascular clamps of the arteries and veins are released on both sides simultaneously. For this reason, the warm ischemia time in uterine transplant is expected to be considerably long. The purpose of this study was to compare the sequential technique of uterine graft revascularization, which aims to reduce the warm ischemia time of the procedure, with the simultaneous revascularization technique.
For the procedure, the uterine auto-transplantation technique was performed using 10 non-pregnant adult ewes weighing about 45 kg, divided into two groups: simultaneous revascularization group (5 animals) and sequential revascularization group (5 animals). To evaluate the groups, we analyzed the procedure and warm ischemia times, graft macroscopy, hemodynamic, laboratory, and histological parameters of the uterus.
The sequential revascularization technique group had similar surgical procedure times, and the warm ischemia time was significantly shorter with medians of 32 min in the sequential group vs 72 min in the simultaneous group (p < 0.008). The graft macroscopy and hemodynamic, laboratory, and histological parameters evaluated were similar between the groups.
The sequential revascularization technique proved to reduce the warm ischemia time in the sheep uterine auto-transplantation model without compromising graft viability.
子宫移植是为治疗绝对子宫因素不孕症而开发的。由于它是一种新的移植方式，技术仍有改进空间。影响器官移植中移植物存活的一个因素是热缺血时间。在子宫移植中，特别是在子宫两侧至少要进行两次血管吻合，当两侧的动静脉血管夹同时松开时移植物开始重新血管化。因此，子宫移植中的热缺血时间预计会相当长。本研究的目的是比较旨在减少手术热缺血时间的子宫移植物顺序性血管重建技术与同时性血管重建技术。
在该手术中，使用10只体重约45千克的非妊娠成年母羊进行子宫自体移植技术，分为两组：同时性血管重建组（5只动物）和顺序性血管重建组（5只动物）。为评估这两组，我们分析了手术过程和热缺血时间、移植物大体检查、子宫的血流动力学、实验室及组织学参数。
顺序性血管重建技术组的手术时间相似，热缺血时间明显更短，顺序组中位数为32分钟，同时组为72分钟（p < 0.008）。两组间评估的移植物大体检查、血流动力学、实验室及组织学参数相似。
在绵羊子宫自体移植模型中，顺序性血管重建技术被证明可减少热缺血时间且不影响移植物活力。
