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Title: Uterine transplantation : the move from the animal model into the human setting : surgical, reproductive and clinical aspects
Author: Saso, Srdjan
ISNI:       0000 0004 5920 5983
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2014
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Women with absolute uterine factor infertility (AUFI) are considered as being 'unconditionally infertile'. Uterine transplantation (UTx) may be a possible treatment option in the future for such women. This thesis describes a number of key areas of research that are important in order to move closer to a successful and crucially, safe transplant in the human setting. Nine allogeneic transplants were carried out in a rabbit model to investigate anatomical and surgical aspects necessary for a successful UTx. An attempt to characterise and quantify the immunological mechanisms involved in allogeneic UTx (rejection patterns) was made. Out of the nine recipients, one was a long-term survivor. Embryo transfer was performed in this one doe with the aim of establishing pregnancy. Performing UTx in a large-animal model is necessary as the pelvis resembles a woman's reproductive system more closely. In addition, the anastomotic technique is similar. Five sheep autotransplants were performed to further define surgical techniques. The anastomotic model was internal to external iliac vessel. Out of the five transplants, three sheep demonstrated adequate perfusion in the immediate post-operative period. Furthermore, the suitability of two different imaging modalities, pulse oximetry and multispectral imaging, for assessing uterine perfusion and extent of ischaemia were been studied in both the rabbit and sheep models. Biophotonics was also applied in the form of Endoscopic Laser Speckle Contrast Analysis to characterize blood flow in the two models. Both Multispectral Imaging and Endoscopic Laser Speckle Contrast Analysis have never been assessed before in a gynecological context. In order to transfer the concept of UTx to the human, we carried out a retrospective study of abdominal radical trachelectomy (ART) as a potential replacement for radical hysterectomy in patients with early stage cervical cancer desiring a fertility-sparing procedure. ART forms the foundation of the original work into aspects of UTx. This original body of research revolved around the potential blood supply to a uterus. Furthermore, an attempt has been made to analyse the motivations, aims and feelings of patients diagnosed with AUFI towards UTx. Forty patients were interviewed. The final study involved the evaluation of the perceptions of health care professionals towards UTx, with 528 participants surveyed.
Supervisor: Smith, James Richard ; Ghaem-Maghami, Sadaf Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available