Autotransplantation of parathyroid glands into subcutaneous forearm tissue for renal hyperparathyroidism

Chou, Fong‐Fu; Chan, Hon Man; Huang, Tiao‐Lai; Lee, Chen Hsen; Hsu, Kuo Tai

doi:10.1016/s0039-6060(98)70067-4

Cited by 51 publications

(24 citation statements)

References 10 publications

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“…A variety of modalities have been developed as surgical methods for secondary HPT. The total PTX with forearm autotransplantation we used in this study has long been proven to be an effective and safe method [23]. In the present study, despite successful surgical treatment, the nonresponders did not enjoy further increment of hemoglobin.…”

Section: Discussionmentioning

confidence: 46%

Effects of Parathyroidectomy on Iron Homeostasis and Erythropoiesis in Hemodialysis Patients with Severe Hyperparathyroidism

Lee¹,

Chou²,

Chang³

et al. 2003

Blood Purif

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Aims: Secondary hyperparathyroidism (HPT) worsens anemia and may cause hyporesponsiveness to recombinant human erythropoietin therapy (r-HuEPO). To investigate the effect of parathyroidectomy (PTX) on iron homeostasis and erythropoiesis, we conducted a prospective study in chronic hemodialysis patients who underwent PTX. Methods: Thirty-two patients were enrolled in this study. Based on the increases in hemoglobin level after PTX, patients were divided into responders and nonresponders. Iron homeostasis and erythropoiesis were assessed before and 1 and 3 months after PTX, hemoglobin and parathyroid hormone levels were monitored until 6 months after PTX. Results: In the responders, increased hemoglobin levels were observed in 15 patients at 1 and 3 months after PTX (8.0 ± 0.8 g/dl vs. 9.2 ± 1.3 and 10.1 ± 0.9 g/dl, p < 0.05). The nonresponders had higher pre-PTX hemoglobin levels than the responders (10.3 ± 1.6 g/dl vs. 8.0 ± 0.8 g/dl, p < 0.05). There was no further increase in hemoglobin at 6 months compared to 3 months after PTX in both groups. In neither group did PTX affect serum ferritin, transferrin saturation and serum erythropoietin level. Serum soluble transferrin receptor (sTfR) concentration was found to be higher in responders than in nonresponders (3.32 ± 1.28 mg/l vs. 1.70 ± 0.31 mg/l, p < 0.05). Conclusions: We conclude that PTX can improve anemia in hemodialysis patients with severe hyperparathyroidism and greater resistance to r-HuEPO therapy. The reversing of anemia does not involve altering iron mobilization. Pre-PTX hemoglobin and serum sTfR levels can predict the effect of PTX on correcting anemia.

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Section: Discussionmentioning

confidence: 46%

Effects of Parathyroidectomy on Iron Homeostasis and Erythropoiesis in Hemodialysis Patients with Severe Hyperparathyroidism

Lee¹,

Chou²,

Chang³

et al. 2003

Blood Purif

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“…2000;135:186-190 S UBCUTANEOUS grafting of parathyroid tissue after total parathyroidectomy in uremic patients has seldom been described. [1][2][3] Resection of hypertrophied grafts is easy when hyperparathyroidism recurs after this procedure, but the published series [1][2][3] are small with a rather short follow-up. The present study determines how the late results of this procedure compared with those reported for other surgical techniques used in the treatment of renal hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

Long-term Results of Subcutaneous Parathyroid Grafts in Uremic Patients

Kinnaert

Salmon²,

Decoster-Gervy³

et al. 2000

Arch Surg

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“…Ultrasound, 99m Tc-sestamibi, CT and MRI are the most commonly used modalities. Combination modalities such as CT-MIBI-SPECT are also gaining in popularity [67]. Fusion imaging combining MIBI-SPECT with contrast enhanced CT has been employed by one of the authors (PKP) with a positive predictive value of 91%, although the majority of patients in this series had primary HPT [68].…”

Section: Pre-operative Imagingmentioning

confidence: 99%

“…The sternocleidomastoid muscle, the brachioradialis muscle, or the subcutaneous fat of the forearm are all potential sites for re-implantation. In all cases, the site of re-implantation should be marked with a metallic clip or non absorbable suture material so it may be identified in the future if necessary [67,70]. Re-implantation into the forearm may obviate the need for surgical re-exploration of the neck in the event of recurrent HPT due to the graft.…”

Section: Operative Approachmentioning

confidence: 99%

The surgical management of renal hyperparathyroidism

Madorin

Owen

Fraser

et al. 2011

Eur Arch Otorhinolaryngol

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Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. Patients present with various bone disorders, cardiovascular disease, and typical laboratory abnormalities. Medical treatment consists of controlling hyperphosphatemia, vitamin D/analog and calcium administration, and calcimimetic agents. Improved medical therapies have led to a decrease in the use of parathyroidectomy (PTX). The surgical indications include parathyroid hormone (PTH) levels >800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Transplant recipients often show decreased PTH, calcium and phosphorus levels, but some will have persistent HPT. Evidence suggests that PTX may cause deterioration in renal graft function in the short-term calling into the question the indications for PTX in these patients. Pre-operative imaging is only occasionally helpful except in re-operative PTX. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages and disadvantages which are discussed. Intraoperative PTH monitoring has a high positive predictive value of cure but a poor negative predictive value and therefore is of limited utility. Hypocalcemia is the most common complication requiring aggressive calcium administration. Benefits of surgery may include improved survival, bone mineral density and alleviation of symptoms.

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Autotransplantation of parathyroid glands into subcutaneous forearm tissue for renal hyperparathyroidism

Cited by 51 publications

References 10 publications

Effects of Parathyroidectomy on Iron Homeostasis and Erythropoiesis in Hemodialysis Patients with Severe Hyperparathyroidism

Effects of Parathyroidectomy on Iron Homeostasis and Erythropoiesis in Hemodialysis Patients with Severe Hyperparathyroidism

Long-term Results of Subcutaneous Parathyroid Grafts in Uremic Patients

The surgical management of renal hyperparathyroidism

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