Alotrasplante de paratiroides: seguimiento a 2 años

Hermosillo-Sandoval, José Manuel; Leonher-Ruezga, Karla Lisseth; Jiménez-Gómez, José Alfredo; González-Ojeda, Alejandro; Ramírez-González, Luis Ricardo

doi:10.1016/j.circir.2015.05.002

Cited by 10 publications

(4 citation statements)

References 11 publications

(4 reference statements)

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“…On the other hand, advances in the management of immunosuppression in solid organ transplants (for example, in kidney and liver transplants) have enabled good safety with fewer adverse effects. 24 Some studies on parathyroid allotransplantation report the safety of immunosuppression, whether used in the short [11][12][13]18,21 or long term. [15][16][17]19,20 The protocol used in our case followed steps already described in other studies, both about the choice of the donor and the surgical technique and graft implantation site.…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, it corrects the PTH production deficiency and as a real possibility of cure through the drastic reduction or even suspension of calcium and calcitriol replacement. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] In addition, it is a procedure with considerably lower costs than rhPTH, 19 which can be interesting in countries with difficulty in financing more expensive therapies.…”

Section: Introductionmentioning

confidence: 99%

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Living-donor fresh parathyroid tissue allotransplantation as treatment for permanent hypoparathyroidism: case report

et al. 2021

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Introduction: the standard hypoparathyroidism treatment consists of replacing calcium and active vitamin D (calcitriol), but it does not correct the underlying abnormality, parathyroid hormone (PTH) deficiency. Both the disease and its treatment are responsible for many morbidities that affect multiple organs and systems. Therefore, parathyroid allotransplantation has been described as an alternative treatment option, especially in refractory cases. Objectives: to verify if parathyroid allotransplantation is effective as a treatment for permanent hypoparathyroidism. Methodology: fresh parathyroid tissue was obtained from a 36-year-old male with a past medical history of hyperparathyroidism secondary to end-stage renal disease and immediately implanted in the recipient’s non-dominant forearm, a 57-year-old female with refractory hypoparathyroidism, despite high doses of calcium and calcitriol replacement. Corticosteroid immunosuppression was performed for 10 days. Results: the allograft showed no evidence of functionality eleven months after transplant. The procedure was considered safe. Conclusion: more studies are required to validate this technique and improve its results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Living-donor fresh parathyroid tissue allotransplantation as treatment for permanent hypoparathyroidism: case report

et al. 2021

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“…However, for successful and potentially definitive treatment of debilitating hypocalcemia that is otherwise not controllable parathyroid gland allotransplantion might as well be a reasonable option for patients without immunosuppression because of previous transplantation of another organ. In this context Hermosillo-Sandoval et al recently performed five parathyroid allografts in patients with iatrogenic hypoparathyroidism [ 31 ]. The living donors were patients with primary or secondary hyperparathyroidism requiring surgical excision.…”

Section: Discussionmentioning

confidence: 99%

Living-donor parathyroid allotransplantation for therapy-refractory postsurgical persistent hypoparathyroidism in a nontransplant recipient – three year results: a case report

et al. 2016

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BackgroundTherapy-refractory persistent hypoparathyroidism after extensive neck surgery is a rare but severe complication. Parathyroid allotransplantation may represent a definitive treatment option.Case presentationA 32-year old female was referred to our hospital with intractable persistent hypocalcemia after neck surgery for papillary thyroid cancer. Despite optimal medical treatment including calcium and vitamin D supplementation and even hormonal replacement therapy hypocalcemic symptoms failed to improve. The quality of life was considered very low. In light of the unsuccessful medical therapy and the young age of the patient parathyroid allotransplantation seemed an attractive treatment option to restore normal calcium homeostasis despite of the need for immunosuppressive therapy after the procedure. Therefore, we performed living-donor allotransplantation of two healthy parathyroid glands to the recipient’s left forearm. The surgical intervention was successful. Neither the donor nor the recipient showed any complications. In the postoperative course clinical symptoms of hypocalcemia significantly improved whereas serum calcium and parathyroid hormone (PTH) levels progressively increased into the normal range. Former intense replacement therapy could be discontinued completely in a stepwise fashion. To date, nearly three years after transplantation, the patient remains asymptomatic with normal serum levels of calcium and PTH.ConclusionSuccessful living-donor parathyroid allotransplantation for postsurgical hypoparathyroidism represents an innovative therapeutic strategy that could provide the definitive treatment in those patients in which the disease is therapy-refractory. The procedure can be justified even in nontransplant recipients. Retrieval of parathyroid glands from healthy donors is feasible and safe.

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“…Serum PTH and calcium levels normalized, and calcium/calcitriol replacement was stopped after three years of follow-up. Other successful cases of Pt-a have been reported in non-transplant patients with unrelated donors [11,[22][23][24][25][26].…”

Section: Casementioning

confidence: 99%

Parathyroid allotransplantation for severe post-surgical hypoparathyroidism: a Brazilian experience

Gadelha

Filho

d’Alva

et al. 2023

Preprint

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Purpose Parathyroid allotransplantation is an alternative therapy for refractory permanent hypoparathyroidism (PH). Herein, we present the cases of two women who developed severe PH after neck surgery for papillary thyroid cancer and underwent parathyroid allotransplantation. Despite taking high doses of calcium and calcitriol supplements, the patients experienced persistent and severe hypocalcemic symptoms. Methods Fresh parathyroid tissue was removed and prepared from two patients with hyperparathyroidism secondary to end-stage kidney disease, and implanted in the non-dominant forearm of the recipients. Donors and recipients were ABO-compatible, and immunological screening was performed only in Case 2 (HLA typing, Panel Reactive Antibody, and crossmatch tests). A short-term immunosuppressive regimen was adopted, which consists of three days of methylprednisolone followed by seven days of prednisone. Results In Case 1, oral supplementation decreased to half of the initial dose one month after transplantation and to one-fifth at the end of a 12-month follow-up period. In Case 2, intravenous calcium could be discontinued one week post-transplantation, and it was not required until six months after transplantation. Serum parathyroid hormone levels did not increase and remained mostly undetectable in both cases. In contrast, serum calcium levels increased significantly, and both patients experienced relief from hypocalcemic symptoms. Conclusion Parathyroid allotransplantation can be an effective and safe treatment for permanent PH, and should be considered in severe cases. Nevertheless, formal recommendations depend on additional studies and validated protocols.

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Alotrasplante de paratiroides: seguimiento a 2 años

Cited by 10 publications

References 11 publications

Living-donor fresh parathyroid tissue allotransplantation as treatment for permanent hypoparathyroidism: case report

Living-donor fresh parathyroid tissue allotransplantation as treatment for permanent hypoparathyroidism: case report

Living-donor parathyroid allotransplantation for therapy-refractory postsurgical persistent hypoparathyroidism in a nontransplant recipient – three year results: a case report

Parathyroid allotransplantation for severe post-surgical hypoparathyroidism: a Brazilian experience

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