The auto-transplantation of uterus in swine: surgical techniques and long-term graft survival

Objective: Uterus transplantation (UTx) provides a available treatment for men with absolute uterus-related infertility. The aim of this study was to develop surgical techniques for UTx and to observe the long-term graft survival in the swines. Materials and Methods: Ten female swines received uterus auto-transplantation surgery after general anesthesia. The operative time, ischemic time, and vascular injury in each swine were recorded. The bicornual uterus with vaginal canal and main vessel were removed, bake-table preparation was performed with cooled at 4 degrees C, and perfused with heparin saline with continuous flushing. The uterus was placed in original pelvic position. The uterus arteries and veins were end-side anastomosed with external iliac arteries and veins in the host swines. Results: One case was randomly selected as the preliminary experiment. The remaining nine cases showed that the uterine arteries and veins were anastomosed successfully and only eight cases attained long-term survival. The host in another case died four days after surgery from suspicious embolism postoperation. The blood flow of uterus arteries was observed by Doppler ultrasonography at four days after the operation and no congestion was found. The second-look laparotomy at six months after surgical was subsequently performed mid the uterus showed a normal morphology and size. However, the pregnancy was unsuccessful due to the shorter observation time, and the severe adhesion and tubal obstruction after surgery may have affected pregnancy of those swines. Conclusion: These preliminary experiences suggest that the uterine auto-transplantation using the end-side vascular anastomosed method is feasible. The accumulation of basic data and experiences from swine experiments can provide important guidance for establishment of UTx in humans.