Composite Tissue Transplantation and Uterine Factor Infertility
Summary
Composite tissue transplantation combines multiple tissue types into a single graft, restoring form and function in complex reconstructive scenarios such as limb, facial or uterine restoration. Such procedures demand advanced microsurgical techniques to anastomose vessels and nerves, robust immunosuppressive regimens to prevent rejection and rigorous methods to assess graft viability. Uterine factor infertility arises when a woman lacks a functional uterus due to congenital absence, surgical removal or uterine malformations. Absolute uterine factor infertility can be addressed only by transplantation of a uterus from a living or deceased donor, followed by assisted reproduction. Uterus transplantation bridges transplantation science with reproductive medicine, requiring coordination between surgical teams and in vitro fertilisation protocols. These life-giving procedures are distinct from life-saving organ transplants in their ethical complexity, the necessity of temporary graft residence and the imperative to balance maternal, foetal and donor welfare. Progress in vascularised composite allotransplantation and uterine transplantation holds global significance, offering alternatives to surrogacy and prosthetic solutions, while raising challenges in donor selection, immunomodulation, long-term outcomes and equitable access.
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Composite Tissue Transplantation and Uterine Factor Infertility publication trend
The graph below shows the total number of articles in composite tissue transplantation and uterine factor infertility across all publications each year (not limited to Nature Index journals).
Technical terms
Vascularised Composite Allograft (VCA): A transplant comprising multiple tissue types—such as skin, muscle and bone—perfused by a shared vascular supply.
Absolute Uterine Factor Infertility (AUFI): A form of infertility due to the absence or non-function of the uterus, addressable only by uterine transplantation or surrogacy.
Immunosuppression: Medical regimens used to dampen the recipient’s immune response and prevent rejection of transplanted grafts.
Graft Rejection: The immune-mediated process by which a recipient’s immune system recognises and attacks transplanted tissue.
References
- Uterus transplantation: from research, through human trials and into the future. Human Reproduction Update (2023).
- Methods of ex vivo analysis of tissue status in vascularized composite allografts. Journal of Translational Medicine (2023).
- Evolution of surgical steps in robotics-assisted donor surgery for uterus transplantation: results of the eight cases in the Swedish trial. Fertility and Sterility (2020).
- Uterine transplantation and IVF for congenital or acquired uterine factor infertility: A systematic review of safety and efficacy outcomes in the first 52 recipients. PLOS ONE (2020).
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