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The Future of Reproductive Organ Transplant – A Brief Review
spontaneous abortion.
15,16
Ovarian infertility factor is a significant and concluded that in vitro fertilisation would replace the need for
problem for young women who are diagnosed with cancer.
17
A survey fallopian tube transplant.
25
Thirty years on, in vitro fertilisation has
indicated that fertility is a major concern for young women diagnosed become one of the standard modalities for reproductive
with early-stage breast cancer. However, this concern was properly endocrinologists, and the problem of fallopian tube injury has been
addressed in only 49% of cases. Ovarian failure is a major concern overcome. In the early 1970s, Scott et al. published the results of
after chemotherapy or radiotherapy since a significant number of experimental uterine transplantion in dogs and monkeys.
26,27
In both
patients will either become ammenorrhoeic or enter premature studies, the grafts were rejected within two weeks. Since the uterus is
menopause due to depletion of primordial follicles.
18,19
This renders a non-vital organ, the animals remained healthy throughout the
the patient infertile, unless there are means to protect the ovarian rejection process. Other research groups were able to autotransplant
tissue prior to the start of cancer treatment. reproductive organs, resulting in successful pregnancies in sheep,
dogs and rabbits.
28–30
These groups demonstrated that it is possible to
Assessment of Need perform uterine transplantation in various animals, including primates.
According to the US census bureau, by 2010 there will be 62 million
women of childbearing age in the US alone,
20
and 113,000 (182 cases/ Current Practices, Current Studies and
100,000 individuals) of these women will be diagnosed with various Their Future Outlook
forms of cancer. The most prominent form is breast cancer, claiming Male
42,000 women (67 cases/100,000 individuals). An additional 18,600 Storage of semen prior to starting cancer treatment has been a routine
women (30 cases/100,000 individuals) will be diagnosed with various practice for some time. Sperm cryopreservation has produced good
female genital tract cancers, including cervical, uterine, ovarian results with a high success rate in terms of achieving pregnancy after
vaginal or vulvular cancer.
21
These statistics raise a lot of concerns, cancer treatment.
31
Successful reproductive outcomes can still be
specifically regarding preservation of fertility. With rapid advances in achieved even if sperm banking is performed after starting treatment,
the treatment of cancer, the number of women who are able to as long as azoospermia has not occurred.
32
Several problems still exist
achieve remission or cure is growing each year: it has been estimated with semen preservation. Sperm banking collects a finite number of
that by 2010, for every 250 women there will be one cancer survivor.
22
sperm, and the freezing and thawing process will contribute to the
As a result, more and more women are concerned with the issue of depletion of that finite source. Also, sperm cryopreservation does not
childbearing after chemotherapy or radiation. Many women will suffer restore the individual’s natural fertility. Finally, even though semen
from uterine infertility factors, either congenital or acquired. Nair et al. cryopreservation has been a successful means of preserving fertility, it
estimated that in the US, approximately 5,000 women in the 15–24- is reserved for individuals who have entered puberty. For pre-pubertal
year-old age group will undergo hysterectomies annually (0.2/1,000 males, alternative means must be considered.
women/year). These hysterectomies are indicated by various reasons:
genital tract malignancies, uncontrollable post-partum haemorrhage Testicular Tissue Cryopreservation
or a benign condition that has a significant impact on the individual’s Testicular tissue cryopreservation is a promising area for fertility
quality of life.
23
preservation. An individual’s testicular tissue can be collected and
cryopreserved until after cancer treatment. It can then be grafted to
Historical Context the primary site or an ectopic site.
33
Both of these modalities have
With Murray et al. demonstrating that it is possible to have a shown promising results in reintroducing spermatogenesis in the host
successful pregnancy after a solid-organ transplant, researchers are in animal studies. These may be implemented in future human trials.
working hard to find ways to improve organ transplant as a treatment Keros et al. published data demonstrating that slow programmed
option. Research into organ harvest techniques, ways of storing the freezing using dimethyl sulphoxide as the cryoprotectant in the
solid organ in transit and modifications to transplantation surgical freezing–thawing process was an effective means of protecting the
techniques has been ongoing for the past 50 years. Mastrobattista et spermatogonia, Sertoli cells and stromal architecture.
34
al. recently reviewed the number of successful pregnancies after
organ transplant.
24
According to the National Transplantation In Vitro Spermatogenesis
Pregnancy Registry (NTPR), 1,642 successful pregnancies have been Another promising area of male fertility research is in vitro
reported after a solid-organ transplant.
2
These successes have revived spermatogenesis. Orwig et al. cryopreserved testicular tissue from a
interest in research into reproductive organ transplant. An increasing monkey for several weeks. The tissue was then thawed and cleansed
number of men and women are able to overcome the life-threatening of all the cryoprotectant and grafted under the back skin of a nude
illness of cancer and, as stated above, by 2010 one in 250 women will mouse. The mouse received human chorionic gonadotropin (HCG)
be a cancer survivor. A number of these women may have become hormonal treatment for several weeks prior to the removal of the
infertile secondary to their cancer treatment, and an increasing graft. Under histological examination, it was observed that initiation of
number of these individuals will be interested in producing offspring; spermatogenesis up to the level of primary spermatoocytes had
reproductive organ transplant may offer them this possibility. begun. Orwig et al. concluded that combining cryopreservation of
testicular tissue with xenografting may be able to produce viable
The fallopian tubes were one of the first reproductive organs studied sperm from primate species.
33
as a means of using transplantation to restore fertility to women who
had become infertile after suffering an insult to their oviduct. Animal Germ Cell Transplant
studies were promising, as live birth was possible in sheep after Spermatogonial stem cell transplantation has been an ongoing area of
fallopian tube transplantation. However, transplantation in women was interest. In 1994, Brinster et al. developed a technique in which testis
not successful owing to severe host rejection towards the graft. In cells from a fertile donor were transplanted into the testes of an
1970, Cohen reviewed the possibility of fallopian tube transplantation infertile recipient; the donor cells were able to enter normal
EUROPEAN OBSTETRICS & GYNAECOLOGY 43
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