Uterine autotransplantation in cynomolgus macaques: the first case of pregnancy and delivery.
BACKGROUND
For women with congenital uterine infertility, or for those who have undergone hysterectomy, uterine transplantation is one of the potential treatments to regain fertility. In this study, we utilized a primate model of uterine transplantation, and evaluated the patency of our microsurgical anastomoses, and the perfusion of the transplanted uterus.


METHODS
Two female cynomolgus monkeys underwent surgery. We anastomosed two arteries and one vein in Case 1 and two arteries and two veins in Case 2. The arteries used were the uterine arteries and the anastomosis was done to the external iliac artery. We used one of the ovarian veins in both animals, but resected the ovary from the Fallopian tube. Uterine arterial blood flow and uterine size were determined by intraoperative indocyanine green (ICG) angiography and ultrasonography. The biopsy of the uterine cervix was performed after surgery.


RESULTS
ICG angiography showed that the unilateral uterine artery perfused the bilateral uterine bodies and cervix. In Case 1, ICG angiography showed the occlusion of one of the anastomosed arteries during the operation and the uterus appeared atrophied 2 months after operation. In Case 2, the transplanted uterus survived and normal menstruation occurred. The animal achieved a natural pregnancy and was delivered by the Caeserean section due to early separation of the placenta. The newborn suffered fetal distress.


CONCLUSIONS
These results show the anastomosis of at least the bilateral uterine arteries and the unilateral ovarian vein is required for uterus transplantation. This is the first report of a natural pregnancy in a primate following uterine autotransplantation.
Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan. mihara@keiseigeka.name
Makoto
M
Mihara
Iori
I
Kisu
Hisako
H
Hara
Takuya
T
Iida
Jun
J
Araki
Timothy
T
Shim
Mitsunaga
M
Narushima
Takumi
T
Yamamoto
Hisashi
H
Moriguchi
Yojiro
Y
Kato
Makoto
M
Tonsho
Kouji
K
Banno
Daisuke
D
Aoki
Nobuhiko
N
Suganuma
Noriko
N
Kagawa
Yuji
Y
Takehara
Osamu
O
Kato
Isao
I
Koshima
D000714:Anastomosis, Surgical; D000792:Angiography / Q000379:methods; D000818:Animals; D001706:Biopsy; D001783:Blood Flow Velocity; D005260:Female; D007208:Indocyanine Green / Q000494:pharmacology; D008252:Macaca fascicularis; D014182:Transplantation, Autologous; D018608:Ultrasonography, Doppler / Q000379:methods; D014599:Uterus / Q000098:blood supply / Q000276:immunology* / Q000473:pathology / Q000637:transplantation*
D007208:Indocyanine Green