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Review
. 2019 May 29;8(6):760.
doi: 10.3390/jcm8060760.

The Key Role of Warm and Cold Ischemia in Uterus Transplantation: A Review

Antoine Tardieu  1   2 , Ludivine Dion  3   4 , Vincent Lavoué  5   6 , Pauline Chazelas  7   8 , Pierre Marquet  9 , Pascal Piver  10   11 , Camille Sallée  12 , Yves Aubard  13   14 , Chantal Barin-Le Guellec  15   16 , Frederic Favreau  17   18 , Tristan Gauthier  19   20
Affiliations
Review

The Key Role of Warm and Cold Ischemia in Uterus Transplantation: A Review

Antoine Tardieu et al. J Clin Med. .

Abstract

Introduction: Uterus transplantation (UTx) is a promising treatment for uterine infertility that has resulted in several births since 2014. Ischemia is a key step in organ transplantation because it may lead to changes jeopardizing graft viability. Method: We performed a systematic review of animal and human studies relating to uterine ischemia. Results: We retained 64 studies published since 2000. There were 35 studies in animals, 24 in humans, and five literature reviews. Modest preliminary results in large animals and humans are limited but encouraging. In small animals, pregnancies have been reported to occur after 24 h of cold ischemia (CI). In ewes, uterine contractions have been detected after 24 h of CI. Furthermore, it has been shown in animals that uterine tolerance to CI and to warm ischemia (WI) can be increased by pharmacological products. In women, mean CI time in studies of births from uteri obtained from live donors was between 2 h 47 min and 6 h 20 min from a deceased donor; with only one birth in this case. Muscle contractions have also been demonstrated in myometrial samples from women, after six or more hours of CI. Conclusion: The uterus seems to be able to tolerate a prolonged period of CI, of at least six hours. Studies of the ischemia tolerance of the uterus and ways to improve it are essential for the development of UTx, particularly for procedures using grafts from deceased donors.

Keywords: deceased donor; ischemia; transplantation; uterus.

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Conflict of interest statement

The authors declare no conflict of interest.

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