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Uterus and Ovarian Transplantation
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Uterus and Ovarian Transplantation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 10163

Special Issue Editors

Dr. Iori Kisu

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
Interests: uterus transplantation; gynecological cancer; Mayer–Rokitansky–Küster–Hauser syndrome; uterine factor infertility; nonhuman primates
Special Issues, Collections and Topics in MDPI journals
Dr. Seido Takae

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
Interests: primary ovarian insufficiency; infertility treatment; in vitro activation; Akt stimulation; ovarian tissue vitrification; fertility preservation; ovarian follicle; ovary; ovulation induction; ovarian tissue cryopreservation; ovarian tissue transplantation

Special Issue Information

Dear Colleagues,

Uterus transplantation (UTx) is now a possible approach for women with absolute uterine factor infertility to deliver a child, following the first successful delivery by Brännström et al. in Sweden in September 2014. This remarkable achievement attracted major attention worldwide and caused many countries to prepare for UTx.

Also, ovarian tissue transplantation (OTT) following cryopreservation is considered to be an important procedure of fertility preservation, and these have already been reported that there are around 200 live birth cases. However, the procedure is still in the unestablished procedures and there is still room for development.

This Special Issue will be beneficial to understanding the current situation of UTx and OTT, discussing unresolved issues, and sharing progress and knowledge, for the future development of gynecological organs transplantation.  

You may choose our Joint Special Issue in Transplantology.

Dr. Iori Kisu
Dr. Seido Takae
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Uterus transplantation
  • Mayer–Rokitansky–Küster–Hauser syndrome
  • uterine factor infertility
  • surrogacy
  • ovarian tissue transplantation
  • ovarian tissue cryopreservation
  • fertility preservation
  • child cancer patients

Related Special Issue

Published Papers (5 papers)

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Research

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9 pages, 515 KiB  
Article
Transgender Males as Potential Donors for Uterus Transplantation: A Survey
by Marie Carbonnel, Léa Karpel, Ninon Corruble, Sophie Legendri, Lucile Pencole, Bernard Cordier, Catherine Racowsky and Jean-Marc Ayoubi
J. Clin. Med. 2022, 11(20), 6081; https://doi.org/10.3390/jcm11206081 - 14 Oct 2022
Cited by 2 | Viewed by 1950
Abstract
Uterus transplantation is a new treatment for patients with absolute uterine infertility that is conducted in order to enable them to carry their own pregnancy. One of the limitations for its development is donor availability. Some transgender males undergo a hysterectomy in the [...] Read more.
Uterus transplantation is a new treatment for patients with absolute uterine infertility that is conducted in order to enable them to carry their own pregnancy. One of the limitations for its development is donor availability. Some transgender males undergo a hysterectomy in the gender-affirming surgery process, and might be interested in donating their uterus for transplantation. In this manuscript, we report the results of a survey designed to determine the attitudes of such individuals regarding donation of their uterus for this purpose. Over 32 years (January 1989–January 2021), 348 biological women underwent hysterectomy at our hospital as part of gender-affirming surgery. The survey was sent to 212 of the 348 prospective participants (for 136, we lacked postal or email addresses). Among the 212 surveys sent, we obtained responses from 94 individuals (44%): 83 (88.3%) stated they would agree to donate, of whom 44 would do so for altruism, 23 for the usefulness of the gesture and 16 out of understanding of the desire to have a child; 63 (75.5%) wanted to know the recipient and 45 (54.2%) wanted to know the result of the donation. According to this survey, a high proportion of transgender males surveyed would be interested in donating their uterus for uterus transplantation. Full article
(This article belongs to the Special Issue Uterus and Ovarian Transplantation)
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10 pages, 620 KiB  
Article
Radiologic Evaluation of Uterine Vasculature of Uterus Transplant Living Donor Candidates: DUETS Classification
by Jakub Kristek, Liza Johannesson, Matthew Paul Clemons, Dana Kautznerova, Jaroslav Chlupac, Jiri Fronek, Giuliano Testa and Gregory dePrisco
J. Clin. Med. 2022, 11(15), 4626; https://doi.org/10.3390/jcm11154626 - 8 Aug 2022
Cited by 4 | Viewed by 1592
Abstract
Uterus transplantation is a treatment solution for women suffering from absolute uterine factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality uterine vasculature is paramount. We retrospectively evaluated and [...] Read more.
Uterus transplantation is a treatment solution for women suffering from absolute uterine factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality uterine vasculature is paramount. We retrospectively evaluated and compared the imaging results with actual vascular findings from the back table. In this article, we present a novel radiologic grading scale (DUETS classification) for evaluating both uterine arteries and veins concerning their suitability for uterus procurement and transplantation. This classification defines several criteria for arteries (caliber, tapering, atherosclerosis, tortuosity, segment, take-off, and course) and veins (caliber, tapering, plethora, fenestrations, duplication/multiplicity, dominant route of venous drainage, radiologist’s confidence with imaging and assessment). In conclusion, magnetic resonance angiography can provide reliable information on uterine venous characteristics if performed consistently according to a well-established protocol and assessed by a dedicated radiologist. The caliber of uterine arteries seems to be inversely related to the time passed since the last delivery. We recommend that the radiologist comments on the reliability and confidence of the imaging study. It cannot be over-emphasized that the most crucial aspect of surgical imaging is the necessity of high-quality communication between a surgeon and a radiologist. Full article
(This article belongs to the Special Issue Uterus and Ovarian Transplantation)
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9 pages, 615 KiB  
Article
Procurement of Uterus in a Deceased Donor Multi-Organ Donation National Program in France: A Scarce Resource for Uterus Transplantation?
by Ludivine Dion, Gaëlle Santin, Krystel Nyangoh Timoh, Karim Boudjema, Louise Jacquot Thierry, Tristan Gauthier, Marie Carbonnel, Jean Marc Ayoubi, François Kerbaul and Vincent Lavoue
J. Clin. Med. 2022, 11(3), 730; https://doi.org/10.3390/jcm11030730 - 29 Jan 2022
Cited by 10 | Viewed by 1720
Abstract
Uterus transplantation is a new possibility for women suffering from absolute uterine infertility to become pregnant and have children. In the case of a deceased donor, a list of exclusion criteria is defined to ensure the high quality of the uterus graft. This [...] Read more.
Uterus transplantation is a new possibility for women suffering from absolute uterine infertility to become pregnant and have children. In the case of a deceased donor, a list of exclusion criteria is defined to ensure the high quality of the uterus graft. This study evaluates the number of potentially available uterus grafts based on the pre-defined exclusion criteria in a national deceased donor multi-organ donation program in France. We analyzed the data reported in the CRISTAL database regarding all women aged 18 to 60 on whom organ procurement was performed between 2014 and 2019. Potential deceased women donors were classified into three categories: very ideal donor, ideal donor, and expanded criteria donor. Between 2014 and 2019, 4544 women underwent organ procurement. Using the very ideal donor, ideal donor, and expanded criteria donor classification, we found that, respectively, only 124, 264, and 936 donors were potentially eligible for UTx. This represents 2.8 per million people (PMP) very ideal donors, 3.8 PMP ideal donors, 8.6 PMP expanded criteria donors (ECDs). The restricted number of grafts requires a complementary strategy of living and deceased donors to meet the demand of all women with AUI. Full article
(This article belongs to the Special Issue Uterus and Ovarian Transplantation)
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Review

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14 pages, 8702 KiB  
Review
The Ozkan Technique in Current Use in Uterus Transplantation: From the First Ever Successful Attempt to Clinical Reality
by Omer Ozkan, Ozlenen Ozkan and Nasuh Utku Dogan
J. Clin. Med. 2023, 12(8), 2812; https://doi.org/10.3390/jcm12082812 - 11 Apr 2023
Cited by 3 | Viewed by 1863
Abstract
Uterus-related infertility affects 3–5% of all young women, including Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, hysterectomy, or severe Asherman syndrome. For these women with uterus-related infertility, uterus transplantation is now a viable option. We performed the first surgically successful uterus transplant in September 2011. The Donor [...] Read more.
Uterus-related infertility affects 3–5% of all young women, including Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, hysterectomy, or severe Asherman syndrome. For these women with uterus-related infertility, uterus transplantation is now a viable option. We performed the first surgically successful uterus transplant in September 2011. The Donor was a 22-year-old nulliparous woman. After five failed pregnancy attempts (pregnancy losses), ET attempts were discontinued in the first case, and a search for underlying etiology was performed, including static and dynamic imaging studies. Perfusion computed tomography revealed an obstructed blood outflow, particularly in the left anterolateral part of the uterus. In order to correct blood flow obstruction, a revision surgery was planned. By laparotomy, a saphenous vein graft was anastomosed between the left utero-ovarian and left ovarian vein. Perfusion computed tomography performed after the revision surgery confirmed the resolution of venous congestion and a decrease in uterine volume as well. Following surgical intervention, the patient was able to conceive after the first embryo transfer attempt. The baby was delivered with cesarean section at 28 weeks’ gestation due to intrauterine growth restriction and abnormal Doppler ultrasonography findings. Following this case, our team performed the second uterus transplantation in July 2021. The recipient was a 32-year-old female with MRKH syndrome, and the donor was a 37-year-old multiparous braindead woman due to intracranial bleeding. After the transplant surgery, the second patient experienced menstrual bleeding six weeks after the operation. Seven months after the transplant, in the first ET attempt, pregnancy was achieved, and she delivered a healthy baby at 29 weeks of pregnancy. Uterus transplantation from a deceased donor is a feasible option for treating uterus-related infertility. When confronted with recurrent pregnancy losses, vascular revision surgery via arterial or venous supercharging could be an option in order to deal with focal underperfused areas defined by imaging studies. Full article
(This article belongs to the Special Issue Uterus and Ovarian Transplantation)
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11 pages, 4066 KiB  
Review
Operative and Clinical Outcomes of Minimally Invasive Living-Donor Surgery on Uterus Transplantation: A Literature Review
by Yusuke Matoba, Iori Kisu, Kouji Banno and Daisuke Aoki
J. Clin. Med. 2021, 10(2), 349; https://doi.org/10.3390/jcm10020349 - 18 Jan 2021
Cited by 11 | Viewed by 1925
Abstract
Background: The surgical approach and choice of drainage veins for uterus transplantation living-donor surgery have been investigated to reduce invasiveness. Methods: A thorough search of the PubMed database was conducted. The search was not limited by language or date of publication. The data [...] Read more.
Background: The surgical approach and choice of drainage veins for uterus transplantation living-donor surgery have been investigated to reduce invasiveness. Methods: A thorough search of the PubMed database was conducted. The search was not limited by language or date of publication. The data were collected on 13 October 2020. Two reviewers independently assessed each article and determined eligibility for inclusion in the review article. Inclusion criteria were English peer-reviewed articles reporting surgical information or postoperative course, articles regarding animal research on UTx, UTx on deceased donors, or not original articles. Results: Of the 51 operations within 26 articles reviewed, the mean operative time was shortest in the laparoscopic approach, and longest in the robot-assisted approach. The mean blood loss was less in the laparoscopic and robot-assisted approaches than in the open approach. In cases where the uterine veins were not preserved, the mean operative time was shortened by each approach and the mean blood loss decreased with the laparoscopic and robot-assisted approaches. Conclusions: These procedures may contribute to less invasive living-donor surgery. Full article
(This article belongs to the Special Issue Uterus and Ovarian Transplantation)
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