Fazekas Gabor, Farkas Balint, Lorinczy Denes
Department of Vascular Surgery, Clinical Center and Medical School, University of Pecs, H-7624 Pecs, Hungary.
National Laboratory of Human Reproduction, University of Pecs, H-7624 Pecs, Hungary.
Biomedicines. 2025 Sep 29;13(10):2388. doi: 10.3390/biomedicines13102388.
: A novel treatment of absolute uterine factor infertility is uterus transplantation. In preparation for human surgery, autotransplantation was performed in a sheep model to assess ischemia-reperfusion injury of the uterine wall. : Seven multiparous ewes underwent live-donor uterus autotransplantation; in six, the procedure was completed successfully. Tissue blocks of complete uterine wall, endometrium, and myometrium were obtained at four predefined time points: native (baseline), after 1 h of cold ischemia, after 30 min of warm ischemia, and after 30 min of reperfusion. Samples were analyzed by differential scanning calorimetry and routine hematoxylin-eosin histology. : Histology demonstrated preserved epithelial, glandular, and stromal structures, with only minimal, reversible changes that increased with the ischemic duration. Differential scanning calorimetry confirmed alterations in thermal stability: in the uterine wall and myometrium, the calorimetric enthalpy decreased from baseline (3.40 ± 0.53 J/g) to reperfusion (2.62 ± 0.22 J/g), indicating structural loosening; in contrast, the endometrium calorimetric enthalpy slightly increased, suggesting greater flexibility and less susceptibility to ischemia-reperfusion injury. : In this preliminary study, differential scanning calorimetry proved to be an effective and sensitive method for detecting early structural alterations in the uterine wall that could negatively impact post-transplant function. Cold and warm ischemia did not cause irreversible damage within a two-hour time frame, supporting the feasibility of short-term preservation in uterus transplantation. The myometrium demonstrated more significant vulnerability than the endometrium, which highlights the necessity of protective strategies to preserve smooth muscle integrity during transplantation.
一种治疗绝对子宫因素不孕症的新方法是子宫移植。在准备人类手术时，在绵羊模型中进行了自体移植，以评估子宫壁的缺血再灌注损伤。七只经产母羊接受了活体供体子宫自体移植；其中六只手术成功完成。在四个预定义时间点获取完整子宫壁、子宫内膜和肌层的组织块：原位（基线）、冷缺血1小时后、温缺血30分钟后和再灌注30分钟后。通过差示扫描量热法和常规苏木精-伊红组织学对样本进行分析。组织学显示上皮、腺体和基质结构得以保留，仅有轻微的、可逆的变化，且随着缺血时间的延长而增加。差示扫描量热法证实了热稳定性的改变：在子宫壁和肌层中，量热焓从基线（3.40±0.53焦耳/克）降至再灌注时（2.62±0.22焦耳/克），表明结构松弛；相比之下，子宫内膜量热焓略有增加，表明其具有更大的柔韧性且对缺血再灌注损伤的敏感性较低。在这项初步研究中，差示扫描量热法被证明是一种有效且灵敏的方法，可用于检测子宫壁中可能对移植后功能产生负面影响的早期结构改变。冷缺血和温缺血在两小时时间范围内未造成不可逆损伤，这支持了子宫移植短期保存的可行性。肌层比子宫内膜表现出更显著的脆弱性，这突出了在移植过程中采取保护策略以保持平滑肌完整性的必要性。
