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Early Uterine Transplant Graft Loss Due to Thrombosis: Single-Center Experience With Causes, Prevention, Diagnosis, and Treatment.
Kristek, J; Sticova, E; Chlupac, J; Cermakova, H; Maluskova, J; Janousek, L; Olausson, M; Fronek, J.
Afiliação
  • Kristek J; Department of Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. jiri.fronek@ikem.cz.
Physiol Res ; 71(Suppl 1): S75-S87, 2022 Dec 27.
Article em En | MEDLINE | ID: mdl-36592443
ABSTRACT
Uterus transplantation (UTx) is a promising treatment option for women who wish to give birth but suffer from absolute uterine factor infertility. This paper presents an interim analysis of a trial focusing on the causes, prevention, diagnosis, and management of graft thrombosis. Our team analyzed 10 cases of UTx (recipients numbered 1 to 10). Early thrombosis developed in 2 of 10 (20 %) recipients, and thrombectomy and temporary viability preservation were achieved in both cases. However, re-thrombosis developed in both cases, and a graft hysterectomy was carried out. In recipient number 2, vascular changes might have contributed to graft thrombosis. The histopathological finding of the explant revealed subintimal excentric fibrosis with focal sclerotic changes. In recipient number 8, thrombosis was facilitated by external compression of the vascular pedicles by the hematoma as well as production of de novo donor-specific antibodies. Thrombosis led to graft loss in both cases despite an attempt at a thrombectomy. Therefore, the focus must be on prevention including a thorough evaluation of the donor candidate. In the postoperative course, perfusion is closely followed-up with an ultrasound, Doppler flow monitoring, and macroscopic evaluation of the cervix. In the event that findings are unclear, a relaparotomy should be promptly indicated. If thrombosis is revealed, a thrombectomy and an attempt to salvage the graft are indicated; however, the role of this strategy is questionable due to the low chance of long-term success. The indication of upfront graft removal and early re-transplantation in the treatment of uterine graft remains debatable.
Assuntos

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 Base de dados: MEDLINE Assunto principal: Trombose / Transplantes Tipo de estudo: Diagnostic_studies / Etiology_studies Limite: Female / Humans Idioma: En Revista: Physiol Res Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 Base de dados: MEDLINE Assunto principal: Trombose / Transplantes Tipo de estudo: Diagnostic_studies / Etiology_studies Limite: Female / Humans Idioma: En Revista: Physiol Res Ano de publicação: 2022 Tipo de documento: Article