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Review
. 2022 Feb 23:9:830826.
doi: 10.3389/fsurg.2022.830826. eCollection 2022.

Involving Animal Models in Uterine Transplantation

Angeline Favre-Inhofer  1   2 , Marie Carbonnel  1   2 , Johanna Domert  3 , Nathalie Cornet  1   2 , Sylvie Chastant  3 , Raphaël Coscas  4   5 , François Vialard  2   6   7 , Valérie Gelin  2   6 , Laurent Galio  2   6 , Christophe Richard  2   6 , Héla Trabelsi  2   6 , Olivier Sandra  2   6 , Dominique de Ziegler  1   2 , Pascale Chavatte-Palmer  2   6 , Jean-Marc Ayoubi  1   2
Affiliations
Review

Involving Animal Models in Uterine Transplantation

Angeline Favre-Inhofer et al. Front Surg. .

Abstract

Background: Absolute uterine factor infertility affects 0. 2% women of childbearing age around the world. Uterine transplantation (UTx) is a promising solution for many of them since the first birth from UTx was described by the Swedish team in 2014. The success of Utx in humans has become possible after a systematic and meticulous approach involving years of research on animal models. To date, more than 80 UTx procedures have been performed worldwide and 30 children were born.

Material and method: This review summarizes the research preparation conducted in animals before beginning UTx in humans. It focuses on the advantages and limits of each animal model, their place in surgical training, and current contribution in research to improve UTx successes in humans. The different steps in the process of UTx have been analyzed, such as imaging, surgery, ischemia-reperfusion effects, rejection markers, immunosuppressive treatment, and pregnancy.

Conclusion: Animal models have played an essential role in the implementation of UTx, which is a highly complex procedure. While respecting the 3R requirements (replacement, refinement, and reduction), the surgical training using large animal models, such as notably ewes remain irreplaceable for teams wishing to initiate a UTx program. Furthermore, animal models are still mandatory in current research to improve the success rates of UTx in humans as well as to reduce the morbidity associated with this experimental infertility treatment.

Keywords: animal; animal models; sheep; surgery; transplantation; uterus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Uterus autotransplantation in sheep.
Figure 2
Figure 2
Steps of uterine transplantation (UTx) in human.
Figure 3
Figure 3
Different steps in UTx in sheep. (A) Uterine dissection, lateral view. (B) Back table. (C) Pelvic view before anastomoses. (D) Arterial and venous latero-terminal anastomoses. (1) Utero-ovarian vein; (2) uterine artery; (3) umbilical artery; (4) cervico-uterine arterial branch; (5) external iliac artery; (6) external iliac vein; (7) ureter; (8) rectum; (9) uterine horn; and (10) cervix.
Figure 4
Figure 4
Different steps of UTx and their research domains. IVF: In vitro Fertilization.
See this image and copyright information in PMC

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