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

Abstract

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.

Fresh tissue parathyroid allotransplantation with short‐term immunosuppression: 1‐year follow‐up

“…Medication is the first approach for these patients; however, it is only palliative and long‐term medication use has several side effects . PA may represent a definitive treatment option for PH . PA may be divided into two classes: cell type PA and tissue type PA.…”

“…PA may be divided into two classes: cell type PA and tissue type PA. There are many methods for cell type PA, for example, direct transplantation, cryopreservation and cultivation, and microencapsulation . Each method has positive and negative outcomes.…”

“…In the last decade, PA studies for both living and cadaver donors have accelerated but long‐term follow‐up has not occurred. To our knowledge, only two studies have been published that include long‐term follow‐up . Hermosillo‐Sandoval et al .…”

“…2 PA may represent a definitive treatment option for PH. 1 PA may be divided into two classes: cell type PA and tissue type PA. There are many methods for cell type PA, for example, direct transplantation, cryopreservation and cultivation, and microencapsulation.…”

“…Permanent hypoparathyroidism (PH) is a clinical condition accompanied by hypocalcemia, hyperphosphatemia, and low parathormone (PTH) levels . PH is the major complication post‐thyroidectomy . Vitamin D and oral calcium supplementation are the standard treatment options.…”