Uterus transplantation

27 08 2013

To the Editor:

We read with great interest the paper “Current status of uterus transplantation in primates and issues for clinical application” by Kisu et al. (1). In that paper, the authors address the present status of experimental and clinical uterus transplantation research and potential medical, social, and ethical issues related to it.

Uterine factor infertility (UFI), congenital or acquired, affects 3% to 5% of the general population (1, 2). At present, UFI patients have no option for having a genetically linked child other than with gestational surrogacy, which is illegal in many countries (1). Experimental studies carried out in the last decades have shown pregnancy and delivery in some allograft animal models (1). End to site anastomoses of two arteries and two veins in appropriate length and thickness to the recipients’ relevant external iliac vessels are defined as the best technique for vascular anastomoses based on experimental and clinical data (1-3). Warm ischemia time (WIT) both involves the ischemia during organ retrieval, from the time of cross clamping until cold perfusion is sustained, and the ischemia time starting with removal of the organ from ice until reperfusion (4) (35 minutes in our case). Cold ischemia time (CIT) starts when the organ is put in ice and cooled with a cold perfusion solution after organ procurement surgery, and ends after the tissue reaches physiological temperature during the transplantation procedure. Decreasing the length of CIT as well as WIT are important factors in improving graft survival in transplantation (4, 5). Read the rest of this entry »





Reply of the authors: Uterus transplantation in nonhuman primates

8 04 2013

To the Editor:

It was encouraging to see that our article on uterine transplantation in nonhuman primates was discussed on the editorial page. We believe that it is important for attainment of clinical application to validate uterine transplantation in primate models. We agree with many of the comments made by Dr. Tzakis (1). These comments accurately identify challenges specific to the background of uterine transplantation experiments in primates.

First, uterine transplantation is conducted for improved quality of life, which differs from transplantation of organs for life support. Organ transplantation started decades ago; however, studies of the uterus were rare because uterus dysfunction is not life-threatening. However, the bioethical view has changed over time and with technology development, the number of uterine cancer survivors has increased, with a corresponding need for improved postoperative quality of life. Consequently, uterine transplantation with the goal of delivery in patients with uterine factor infertility is of increasing importance. It is clear that such patients cannot deliver a child without intervention, and many also lose female identity or may experience marital problems, resulting in psychological and social distress. Uterine transplantation has the potential to improve quality of life by providing the potential for pregnancy and delivery with assisted reproductive technology (ART). Read the rest of this entry »





“Reply of the authors: Uterus transplantation in nonhuman primates”

8 04 2013

To the Editor:

It was encouraging to see that our article on uterine transplantation in nonhuman primates was discussed on the editorial page. We believe that it is important for attainment of clinical application to validate uterine transplantation in primate models. We agree with many of the comments made by Dr. Tzakis (1). These comments accurately identify challenges specific to the background of uterine transplantation experiments in primates.

First, uterine transplantation is conducted for improved quality of life, which differs from transplantation of organs for life support. Organ transplantation started decades ago; however, studies of the uterus were rare because uterus dysfunction is not life-threatening. However, the bioethical view has changed over time and with technology development, the number of uterine cancer survivors has increased, with a corresponding need for improved postoperative quality of life. Consequently, uterine transplantation with the goal of delivery in patients with uterine factor infertility is of increasing importance. It is clear that such patients cannot deliver a child without intervention, and many also lose female identity or may experience marital problems, resulting in psychological and social distress. Uterine transplantation has the potential to improve quality of life by providing the potential for pregnancy and delivery with assisted reproductive technology (ART). Read the rest of this entry »