The concept of machine perfusion in uterus transplatation

Uterus transplantation represents the only opportunity for women affected by absolute uterine factor infertility to become pregnant. One of the major challenges in uterus transplantation is represented by the high rate of thrombotic complications, often resulting in graft loss and poor outcomes. Although the exact etiology remains unknown, it is possible that post-implantation thrombosis of the uterine vessels could be the expression of microcirculation failure resulting from ischemia and reperfusion injury (IRI). Uterus machine perfusion could offer a way to ameliorate IRI and protect the graft from vascular complications. Thanks to the experience gained in solid organ ex-situ perfusion, it can be speculated that the uterus graft could benefit from different perfusion techniques: hypothermic oxygenated perfusion would reduce the ischemia reperfusion injury, with an impact on graft, recipient and offspring outcomes that is currently unknown; normothermic machine perfusion would allow graft reconditioning, flow measurements and graft testing in a near-physiological environment, helping the physician to understand the relationship between flow, pressure and myometrial function. Lastly, machine perfusion could play a major role in improving the logistics of uterus transplantation, resulting in a safe expansion of the preservation time.