Fresh Tissue Parathyroid Allotransplantation from a Cadaveric Donor without Immunosuppression: A 3-Year Follow-Up

Ayşan, Erhan; Yücesan, Emrah; Göncü, Beyza; İdiz, Ufuk Oğuz

doi:10.1177/000313482008600405

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…The donor–recipient compatibility details were often neglected in studies: ABO and HLA compatibility were reported in, respectively, 14 and 9 of the 22 total cohorts. Studies mentioning only “compatibility was searched for”, “donor and recipient were evaluated” or “noncompatible”, without specifying whether this statement meant ABO and/or HLA, were regarded as insufficient [ 26 , 32 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

Parathyroid Allotransplantation: A Systematic Review

2022

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Background: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by design is a one-time cure through its restoration of the parathyroid function and, therefore, could be the solution. A systematic literature review is conducted in the present paper, with the aim of outlining the possibilities of parathyroid allotransplantation and to calculate its efficacy. Additionally, various transplantation characteristics are linked to success. Methods: This review is carried out according to the PRISMA statement and checklist. Relevant articles were searched for in medical databases with the most recent literature search performed on 9 December 2021. Results: In total, 24 articles involving 22 unique patient cohorts were identified with 203 transplantations performed on 148 patients. Numerous types of (exploratory) interventions were carried out with virtually no protocols that were alike: there was the use of (non-) cryopreserved parathyroid tissue combined with direct transplantation or pretreatment using in vitro techniques, such as culturing cells and macro-/microencapsulation. The variability increased further when considering immunosuppression, graft histology, and donor–recipient compatibility, but this was found to be reported in its entirety by exception. As a result of the large heterogeneity among studies, we constructed our own criterium for transplantation success. With only the studies eligible for our assessment, the pooled success rate for parathyroid allotransplantation emerged to be 46% (13/28 transplantations) with a median follow-up duration of 12 months (Q1–Q3: 8–24 months). Conclusions: Manifold possibilities have been explored around parathyroid allotransplantation but are presented as a double-edged sword due to high clinical diverseness, low expertise in carrying out the procedure, and unsatisfactory study quality. Transplantations carried out with permanent immunosuppression seem to be the most promising, but, in its current state, little could be said about the treatment efficacy with a high quality of evidence. Of foremost importance in pursuing the answer whether parathyroid allotransplantation is a suitable treatment for hypoparathyroidism, a standardized definition of transplantation success must be established with a high-quality trial.

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Section: Resultsmentioning

confidence: 99%

Parathyroid Allotransplantation: A Systematic Review

2022

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“…Since the early 1990s, many research projects have been added to the literature about cell isolation, graft delivery location, and follow-up parameters from the same group [29][30][31][32][33]. During the last five years of the parathyroid transplantation, advanced immunological transplantation criteria, including pre-op and post-follow-up processes after parathyroid transplantation, were brought to the literature by the same group from Bezmialem Vakif University in Turkiye [22,[34][35][36][37][38][39][40][41][42][43] Parathyroid transplantation is the most effective and targeted hypoparathyroidism treatment in the literature due to limited access to hormone replacement therapy and ongoing phase studies. Long-term studies on research and parathyroid…”

Section: Parathyroid Transplantationmentioning

confidence: 99%

Introductory Chapter: A Brief Statement about Parathyroid Glands

Göncü¹,

Gensure²

2023

Parathyroid Glands - New Aspects

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“…11 Most recently, Aysan et al reported a deceased donor parathyroid allotransplant with methylprednisolone induction and no maintenance immunosuppression with continued allograft function out to 36 mo. 12 Because of the paucity of literature surrounding deceased donor parathyroid gland (PTG) procurement, this study's aim was to describe our group's initial learning curve with standard 4-gland exploration in situ and evolution toward en bloc cadaveric dissection ex vivo. Importantly, because of timing constraints related to concurrent recipient operations (notably heart, liver, and lung teams), the donor PTG procurement was performed after organ flushing, and all transplantable organs were procured.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Procurement of Deceased Donor Parathyroid Glands With the Aid of Near-infrared Autofluorescence Imaging

Ward

Kelly

Syed

et al. 2022

Transplantation Direct

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Background. Parathyroid allotransplantation is a burgeoning treatment for severe hypoparathyroidism. Deceased donor parathyroid gland (PTG) procurement can be technically challenging due to lack of normal intraoperative landmarks and exposure constraints in the neck of organ donors. In this study, we assessed standard 4-gland exposure in situ and en bloc surgical techniques for PTG procurement and ex vivo near-infrared autofluorescence (NIRAF) imaging for identification of PTGs during organ recovery. Methods. Research tissue consent was obtained from organ donors or donor families for PTG procurement. All donors were normocalcemic, brain-dead, solid organ donors between 18 and 65 y of age. PTGs were procured initially using a standard 4-gland exposure technique in situ and subsequently using a novel en bloc resection technique after systemic organ preservation flushing. Parathyroid tissue was stored at 4 °C in the University of Wisconsin solution up to 48 h post-procurement. Fluoptics Fluobeam NIRAF camera and Image J software were utilized for quantification of NIRAF signal. Results. Thirty-one brain-dead deceased donor PTG procurements were performed by abdominal transplant surgeons. In the initial 8 deceased donors, a mean of 1.75 glands (±1.48 glands SD) per donor were recovered using the 4-gland in situ technique. Implementation of combined en bloc resection with ex vivo NIRAF imaging in 23 consecutive donors yielded a mean of 3.60 glands (±0.4 SD) recovered per donor (P < 0.0001). Quantification of NIRAF integrated density signal demonstrated >1-fold log difference in PTG (2.13 × 105 pixels) versus surrounding anterior neck structures (1.9 × 104 pixels; P < 0.0001). PTGs maintain distinct NIRAF signal from the time of recovery (1.88 × 105 pixels) up to 48 h post-procurement (1.55 × 105 pixels) in organ preservation cold storage (P = 0.34). Conclusions. The use of an en bloc surgical technique with ex vivo NIRAF imaging significantly enhances the identification and recovery of PTG from deceased donors.

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Fresh Tissue Parathyroid Allotransplantation from a Cadaveric Donor without Immunosuppression: A 3-Year Follow-Up

Cited by 6 publications

References 17 publications

Parathyroid Allotransplantation: A Systematic Review

Parathyroid Allotransplantation: A Systematic Review

Introductory Chapter: A Brief Statement about Parathyroid Glands

Procurement of Deceased Donor Parathyroid Glands With the Aid of Near-infrared Autofluorescence Imaging

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