Uterus transplantation in a non-human primate: Long-term follow-up after autologous transplantation

Liza Johannesson, Anders Enskog, Pernilla Dahm-Kähler, A Hanafy, D C Chai, J M Mwenda, C Díaz-García, Michael Olausson, Mats Brännström

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Abstract

BACKGROUND: Uterus transplantation (UTx) may provide the first available treatment for women affected by uterine infertility. The present study aimed to further develop a surgical technique for autologous UTx in a non-human primate species and to assess long-term function.

METHODS: Female baboons (n= 16) underwent autologous transplantation of the uterus with the Fallopian tubes and ovaries, performed with a previously published surgical technique (n= 6, Group 1) or using a modified technique (n= 10; Group 2). The uterine arteries were dissected to the proximal end of the anterior branch (Group 1) or the entire (Group 2) internal iliac artery, and the ovarian veins were dissected to the crossing over the ureter (Group 1) or further cranially to include greater lengths and patches of the cava/renal vein (Group 2). Back-table preparation created common venous and arterial ends with arterial anastomosis either end-to-side to the left external iliac artery (Group 1) or end-to-end to the left internal iliac artery (Group 2).

RESULTS: Overall short-time survival of the animals was 88% (66% in Group 1 and 100% in Group 2). Of all the operated animals, 75% (66% in Group 1 and 80% in Group 2) resumed ovarian cyclicity. Regular menstruation after UTx was demonstrated only in Group 2 (60%). Menstruating animals (n= 6) were each exposed to timed mating for ≥5 menstrual cycles, but pregnancy did not occur. Adhesions and tubal blockage were seen in post-mortem analysis.

CONCLUSIONS: The modified UTx model of Group 2 is a safe procedure and shows resumed long-term uterine function in a majority of the animals, although pregnancy could not be demonstrated.

Original languageEnglish
Pages (from-to)1640-8
Number of pages9
JournalHuman Reproduction
Volume27
Issue number6
DOIs
Publication statusPublished - Jun 2012
Externally publishedYes

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Autologous Transplantation
Iliac Artery
Primates
Uterus
Transplantation
Animal Pregnancy
Uterine Artery
Renal Veins
Menstruation
Fallopian Tubes
Papio
Periodicity
Ureter
Menstrual Cycle
Infertility
Ovary
Veins
Pregnancy
Therapeutics

Cite this

Johannesson, L., Enskog, A., Dahm-Kähler, P., Hanafy, A., Chai, D. C., Mwenda, J. M., ... Brännström, M. (2012). Uterus transplantation in a non-human primate: Long-term follow-up after autologous transplantation. Human Reproduction, 27(6), 1640-8. https://doi.org/10.1093/humrep/des093
Johannesson, Liza ; Enskog, Anders ; Dahm-Kähler, Pernilla ; Hanafy, A ; Chai, D C ; Mwenda, J M ; Díaz-García, C ; Olausson, Michael ; Brännström, Mats. / Uterus transplantation in a non-human primate : Long-term follow-up after autologous transplantation. In: Human Reproduction. 2012 ; Vol. 27, No. 6. pp. 1640-8.
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title = "Uterus transplantation in a non-human primate: Long-term follow-up after autologous transplantation",
abstract = "BACKGROUND: Uterus transplantation (UTx) may provide the first available treatment for women affected by uterine infertility. The present study aimed to further develop a surgical technique for autologous UTx in a non-human primate species and to assess long-term function.METHODS: Female baboons (n= 16) underwent autologous transplantation of the uterus with the Fallopian tubes and ovaries, performed with a previously published surgical technique (n= 6, Group 1) or using a modified technique (n= 10; Group 2). The uterine arteries were dissected to the proximal end of the anterior branch (Group 1) or the entire (Group 2) internal iliac artery, and the ovarian veins were dissected to the crossing over the ureter (Group 1) or further cranially to include greater lengths and patches of the cava/renal vein (Group 2). Back-table preparation created common venous and arterial ends with arterial anastomosis either end-to-side to the left external iliac artery (Group 1) or end-to-end to the left internal iliac artery (Group 2).RESULTS: Overall short-time survival of the animals was 88{\%} (66{\%} in Group 1 and 100{\%} in Group 2). Of all the operated animals, 75{\%} (66{\%} in Group 1 and 80{\%} in Group 2) resumed ovarian cyclicity. Regular menstruation after UTx was demonstrated only in Group 2 (60{\%}). Menstruating animals (n= 6) were each exposed to timed mating for ≥5 menstrual cycles, but pregnancy did not occur. Adhesions and tubal blockage were seen in post-mortem analysis.CONCLUSIONS: The modified UTx model of Group 2 is a safe procedure and shows resumed long-term uterine function in a majority of the animals, although pregnancy could not be demonstrated.",
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Johannesson, L, Enskog, A, Dahm-Kähler, P, Hanafy, A, Chai, DC, Mwenda, JM, Díaz-García, C, Olausson, M & Brännström, M 2012, 'Uterus transplantation in a non-human primate: Long-term follow-up after autologous transplantation' Human Reproduction, vol. 27, no. 6, pp. 1640-8. https://doi.org/10.1093/humrep/des093

Uterus transplantation in a non-human primate : Long-term follow-up after autologous transplantation. / Johannesson, Liza; Enskog, Anders; Dahm-Kähler, Pernilla; Hanafy, A; Chai, D C; Mwenda, J M; Díaz-García, C; Olausson, Michael; Brännström, Mats.

In: Human Reproduction, Vol. 27, No. 6, 06.2012, p. 1640-8.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Uterus transplantation in a non-human primate

T2 - Long-term follow-up after autologous transplantation

AU - Johannesson, Liza

AU - Enskog, Anders

AU - Dahm-Kähler, Pernilla

AU - Hanafy, A

AU - Chai, D C

AU - Mwenda, J M

AU - Díaz-García, C

AU - Olausson, Michael

AU - Brännström, Mats

PY - 2012/6

Y1 - 2012/6

N2 - BACKGROUND: Uterus transplantation (UTx) may provide the first available treatment for women affected by uterine infertility. The present study aimed to further develop a surgical technique for autologous UTx in a non-human primate species and to assess long-term function.METHODS: Female baboons (n= 16) underwent autologous transplantation of the uterus with the Fallopian tubes and ovaries, performed with a previously published surgical technique (n= 6, Group 1) or using a modified technique (n= 10; Group 2). The uterine arteries were dissected to the proximal end of the anterior branch (Group 1) or the entire (Group 2) internal iliac artery, and the ovarian veins were dissected to the crossing over the ureter (Group 1) or further cranially to include greater lengths and patches of the cava/renal vein (Group 2). Back-table preparation created common venous and arterial ends with arterial anastomosis either end-to-side to the left external iliac artery (Group 1) or end-to-end to the left internal iliac artery (Group 2).RESULTS: Overall short-time survival of the animals was 88% (66% in Group 1 and 100% in Group 2). Of all the operated animals, 75% (66% in Group 1 and 80% in Group 2) resumed ovarian cyclicity. Regular menstruation after UTx was demonstrated only in Group 2 (60%). Menstruating animals (n= 6) were each exposed to timed mating for ≥5 menstrual cycles, but pregnancy did not occur. Adhesions and tubal blockage were seen in post-mortem analysis.CONCLUSIONS: The modified UTx model of Group 2 is a safe procedure and shows resumed long-term uterine function in a majority of the animals, although pregnancy could not be demonstrated.

AB - BACKGROUND: Uterus transplantation (UTx) may provide the first available treatment for women affected by uterine infertility. The present study aimed to further develop a surgical technique for autologous UTx in a non-human primate species and to assess long-term function.METHODS: Female baboons (n= 16) underwent autologous transplantation of the uterus with the Fallopian tubes and ovaries, performed with a previously published surgical technique (n= 6, Group 1) or using a modified technique (n= 10; Group 2). The uterine arteries were dissected to the proximal end of the anterior branch (Group 1) or the entire (Group 2) internal iliac artery, and the ovarian veins were dissected to the crossing over the ureter (Group 1) or further cranially to include greater lengths and patches of the cava/renal vein (Group 2). Back-table preparation created common venous and arterial ends with arterial anastomosis either end-to-side to the left external iliac artery (Group 1) or end-to-end to the left internal iliac artery (Group 2).RESULTS: Overall short-time survival of the animals was 88% (66% in Group 1 and 100% in Group 2). Of all the operated animals, 75% (66% in Group 1 and 80% in Group 2) resumed ovarian cyclicity. Regular menstruation after UTx was demonstrated only in Group 2 (60%). Menstruating animals (n= 6) were each exposed to timed mating for ≥5 menstrual cycles, but pregnancy did not occur. Adhesions and tubal blockage were seen in post-mortem analysis.CONCLUSIONS: The modified UTx model of Group 2 is a safe procedure and shows resumed long-term uterine function in a majority of the animals, although pregnancy could not be demonstrated.

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DO - 10.1093/humrep/des093

M3 - Article

VL - 27

SP - 1640

EP - 1648

JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

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Johannesson L, Enskog A, Dahm-Kähler P, Hanafy A, Chai DC, Mwenda JM et al. Uterus transplantation in a non-human primate: Long-term follow-up after autologous transplantation. Human Reproduction. 2012 Jun;27(6):1640-8. https://doi.org/10.1093/humrep/des093