Ovarian transplant: a new frontier

Two cases of orthotopic ovarian transplantations were performed on patients diagnosed to have Turner's syndrome (ovarian dysgenesis) with primary amenorrhea, short stature, and absent secondary sexual characters. Chromosomal analysis showed 45XO pattern. Both transplants were living related from a sister and from a mother. In both the cases the donor and the recipient were immunologically matched by blood group, histocompatibility antigens (HLA), and lymphocyte cross-match done twice. The donor ovaries were dissected extraperitoneally to have long vascular pedicles. In the first case the donor ovarian vein was sutured end-to-side to external iliac vein and the ovarian artery was sutured to the inferior epigastric artery end-to-end using an operative microscope. The ovary was placed in the orthotopic position transperitoneally. Follow-up for 2.5 years has shown regular menstruations, documented ovulations, rise in hormonal levels, and development of secondary sexual characters. In the second case there was no large vein available for anastomosis so that an avascular orthotopic transplantation was performed. The ovarian cortex was dissected in a fan-shaped manner of 0.5-cm strips. Two grafts sutured onto surgicel were placed orthotopically in the ovarian fossa and the remaining ones were placed into the broad ligament. One month follow-up shows good take-up and follicular development on USG, power-angio, and MRI. Hormonal rise has indicated functioning graft. Immunosuppression was achieved in both cases using cyclosporine (4 mg/kg) and prednisolone (2 mg/kg).