title: Uterine allotransplantation in ewes using an aortocava patch.
abstract: BACKGROUND
  We investigated a novel allotransplantation model using an aortocava patch in ewes.
  
  
  RESULTS
  We carried out 10 uterine orthotopic allotransplantations in ewes with end-to-side anastomosis of the aortocava donor patch on the left external iliac vessel recipient. The immunosuppressive protocol was a combination of cyclosporine (10 mg/kg/day) and mycophenolic acid (3 g/day). An estimation of the immunosuppressive therapy exposure was performed by measuring the area under the curve (AUC) of immunosuppressive plasma concentrations. The graft was assessed by vaginoscopy, magnetic resonance imaging (MRI) and second look laparotomy at 6, 8 and 10 weeks, respectively. The median (range) times for cold and warm ischemia were 95 min (75-130) and 91 min (55-165), respectively. All the vascular anastomoses were patent at the end of the surgery. The median AUC of cyclosporine and mycophenolic acid were 1.24 mg h/l (0.34-3.85) and 18.40 mg h/l (3.76-42.35), respectively. Of the 10 ewes receiving a transplant, 6 could be assessed. Cervical biopsies showed signs of necrosis in all six ewes. The MRI results correlated with the macroscopic observations of the 'second look' laparotomy. The aortocava vascular pedicles were thrombosed, adding to the peripheral neovascularization. Graft histology showed endometrial tissue in two out of six ewes.
  
  
  CONCLUSIONS
  Mobility of the transplant within the pelvis, the length of the vascular pedicle and rejection can explain the high rate of transplant necrosis. The particular digestive anatomy and physiology of ruminants makes it difficult to administer an optimal immunosuppressive treatment. MRI appears to be a good non-invasive examination for graft estimation.
authors: Obstetrics and Gynecology Department, Hôpital Mère-Enfant, CHU Dupuytren, av Larrey, Limoges 87000, France. gauthiertristan@yahoo.fr
authors: T
authors: T
authors: Gauthier
authors: F
authors: F
authors: Bertin
authors: L
authors: L
authors: Fourcade
authors: A
authors: A
authors: Maubon
authors: F
authors: F
authors: Saint Marcoux
authors: P
authors: P
authors: Piver
authors: P
authors: P
authors: Marquet
authors: I
authors: I
authors: Pommepuy
authors: X
authors: X
authors: Plainard
authors: C
authors: C
authors: Couquet
authors: M J
authors: MJ
authors: Cornuejols
authors: M
authors: M
authors: Essig
authors: Y
authors: Y
authors: Aubard
mesh_terms: D000818:Animals; D001011:Aorta / Q000473:pathology*; D019540:Area Under Curve; D016572:Cyclosporine / Q000494:pharmacology; D004717:Endometrium / Q000473:pathology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007511:Ischemia; D008279:Magnetic Resonance Imaging / Q000379:methods; D009173:Mycophenolic Acid / Q000627:therapeutic use; D012756:Sheep; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods; D014599:Uterus / Q000637:transplantation*; D014621:Vagina / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid