Successful orthotopic uterine allotransplantation in a rabbit model using aorta and cava anastomoses: a short-term viability study

  • Yu Liu
  • Ying Zhang
  • Yan Ding
  • Junwei Li
  • Qunye Tang
  • Xuyin Zhang
  • Keqin HuaEmail author
General Gynecology



We aim to develop a rabbit model system for studies on uterus transplantation.


Six sexually mature female New Zealand white rabbits of proven fertility were used for harvesting the uterine allograft with an aortic-caval macrovascular patch (including the aorta, inferior vena cava, common and internal iliacs, and uterine arterial and venous tree). The patches were transplanted in the six recipients orthotopically using aorta and cava anastomoses. Tacrolimus (0.5 mg twice daily, p.o.) was administered postoperatively for immunosuppression.


Surgical survival was 100% (n = 6), and the graft survival rate was 83.3% (n = 5). No rabbits died intraoperatively, but only one achieved short-term survival (for 8 days). Four rabbits (#1, #2, #3 and #4) died within the first 24 h as a result of veno-vena anastomosis breakdown, bradycardia, intestinal necrosis, and respiratory failure, respectively. Rabbits #5 (30 h) and #6 (8 days) died from intestinal obstruction and pneumonia, respectively. Uterine morphology was normal in rabbit #6, and rejection was not observed in the grafted uterus, which was further verified by H&E and immunohistochemistry.


Aorta and cava anastomoses can be used to ensure a viable transplanted uterus by reconstructing an adequate blood supply to the transplanted uterine graft in a rabbit model. We have demonstrated the feasibility of tacrolimus monotherapy in suppressing the rejection of an allotransplanted uterus in a rabbit model. However, UTx in a rabbit model seems difficult to achieve long-term survival.


Orthotopic uterine allotransplantation Aorto-caval anastomosis Rabbit model Immunosuppression Short term 



Abdominal aorta


Acrylonitrile butadiene styrene


Animal research: reporting in vivo experiments


Absolute uterine factor infertility


The International Federation of Gynecology and Obstetrics


Hematoxylin and eosin


Inferior vena cave


The National Centre for the 3Rs


Polyglycolic acid absorbable sutures


Uterus transplantation



The authors would like to thank the staff at Sapphire Veterinary Hospital and the veterinarians at the Institute of Neuroscience of Shanghai Institutes for Biological Sciences, CAS (Shanghai, China), who worked tirelessly at helping us to carry out our transplant work.

Author contributions

YL participated in the conception of the work and the performance of the surgery and the writing of the paper; YZ participated in the performance of the surgery and revising the manuscript; YD participated in the performance of the surgery; JL participated in the performance of the surgery; QT contributed new reagents and helped in data analysis; XZ helped in surgery design and revising the manuscript; KH participated in design of the work and revised it critically for important intellectual content and gave the final approval of the version to be published.


There is no research funding for this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants; informed consent statement is not applicable.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of GynecologyThe Obstetrics and Gynecology Hospital of Fudan UniversityShanghaiChina
  2. 2.Department of UrologyZhongshan Hospital, Fudan UniversityShanghaiChina
  3. 3.Shanghai Key Laboratory of Organ TransplantationShanghaiChina

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