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It is still an experimental procedure with numerous critical details remaining to be established, including tolerance to warm and cold ischemic insults. In preparation for human uterus transplantation trials, most teams use the sheep as a model system for research and team training, since the vasculature and the uterus is of similar size as in the human. We, therefore, aimed to develop an <jats:italic>ex vivo<\/jats:italic> sheep uterus reperfusion platform that mimics the reperfusion situation so that initial assessments and comparisons can be performed without the need for costly and labor\u2010intensive <jats:italic>in vivo<\/jats:italic> transplantation experiments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Isolated sheep uteri were perfused with the preservation solution <jats:styled-content style=\"fixed-case\">IGL<\/jats:styled-content>\u20101 and were then exposed to cold ischemia for either 4\u00a0(n\u00a0=\u00a06) or 48\u00a0hours (n\u00a0=\u00a07). Uteri were then reperfused for 48\u00a0hours under normothermic conditions with an oxygenated recirculating perfusate containing growth factors and synthetic oxygen carriers. Histological and biochemical analysis of the perfusate was conducted to assess reperfusion injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Quantification of cell density indicated no significant edema in the myometrium or in the endometrium of uteri exposed to 4\u00a0hours cold ischemia and then a normothermic <jats:italic>ex vivo<\/jats:italic> reperfusion for 48\u00a0hours. Only the outer serosa layer and the inner columnar luminal epithelial cells were affected by the reperfusion. However, a much faster and severe reperfusion damage of all uterine layers were evident during the reperfusion experiment following 48\u00a0hours of cold ischemia. This was indicated by major accumulation of extracellular fluid, presence of apoptotic\u2010labeled glandular epithelial layer and vascular endothelium. A significant accumulation of lactate was measured in the perfusate with a subsequent decrease in <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We developed a novel <jats:italic>ex vivo<\/jats:italic> sheep uterus model for prolonged perfusion. This model proved to be able to distinguish reperfusion injury\u2010related differences associated to organ preservation. The experimental setup is a platform that can be used to conduct further studies on uterine ischemia\u2010 and reperfusion injury that may lead to improved human uterus transplantation protocols.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13617","type":"journal-article","created":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T09:40:37Z","timestamp":1554111637000},"page":"1127-1138","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["The development of an extended normothermic <i>ex vivo<\/i> reperfusion model of the sheep uterus to evaluate organ quality after cold ischemia in relation to uterus transplantation"],"prefix":"10.1111","volume":"98","author":[{"given":"Arvind M.","family":"Padma","sequence":"first","affiliation":[{"name":"Laboratory for Transplantation and Regenerative Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynecology 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