Vagina transplantation: fantasy or reality?

The aim of this thesis is to assess current vaginoplasty outcomes for potential technique-related complications and complaints (part 1), and to resolve these issues with help of a tissue-engineered alternative (part 2). To that end, we developed a decellularized vaginal matrix (DVM) from healthy, human vagina wall tissue and investigated its viability as treatment option for women with amongst others Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS) and gender incongruency (GI). Our sterile human DVM of orthotopic origin was found to contain ideal tissue properties to resolve current complications seen for nonvaginal grafts. Moreover, in comparison to current tissue-engineered alternations, our matrix carries no risk of immune rejection or necessity for life-long immunosuppression therapy. Functionalization of our matrix by seeding with autologous endothelial cells and smooth muscle cells, resulted in a vaginal replacement with native resembling extracellular matrix structure, biocompatibility, biomechanical properties, matrix constituent proteins and preserved vasculature. Although the road towards clinical implementation is long, this thesis demonstrates the great potential of this approach. Human DVMs are a promising solution to overcome today’s obstacles for vagina transplantation. With confidence, we are looking forward to the future role of tissue engineering in vagina reconstruction and support.