Parathyroid autografts—morphology and function: Six years' experience with parathyroid autotransplantation in uremic patients

Abstract

Recurrence of hyperparathyroidism (HPT) following total parathyroidectomy and autotransplantation (APTX) has been reported before. However, no data about the time interval between grafting and relapse and about morphology were given. Only 1 case of primary hyperparathyroidism with APTX has been extensively analyzed. We have performed autotransplantation in 42 patients with HPT due to chronic renal failure. Implanted parathyroid tissue showed typical chief cell hyperplasia. Within 4–33 months, 6 patients developed recurrent HPT with serum iPTH levels being highest in venous blood of the grafted arm. Grafts had to be removed. Although only 20–40 mg of parathyroid tissue had been implanted, removed grafts weighed from 0.9 to 3.1 g. Explanted grafts were examined by light and electron microscopy. The size and DNA content of nuclei were determined. In all cases the explanted material showed a distinct invasive growth into the adjacent connective tissue and muscles and in 2 cases mitotic figures were demonstrated, a finding resembling malignant neoplasia of the parathyroid. From our clinical and morphological observations we draw the following conclusions: Surgical treatment of renal hyperparathyroidism by PTX + Auto‐TX unforeseeably may result in very accelerated growth of grafted tissue. Because of invasive growth there exists the risk of uncontrolled spread of parathyroid tissue. Graft removal may turn out to be difficult and possibly necessitate repeated and extensive surgery. Before the observed phenomenon is totally understood, we no longer recommend PTX + Auto‐TX as an alternative to subtotal PTX in the surgical treatment of renal hyperparathyroidism.

Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: A retrospective cohort study

“…Although no graft reimplantation is performed after intramuscular autograftectomy, repeated autograftectomy may indicate incomplete autograftectomy because of the locally invasive behavior of the intramuscular transplanted cells and the difficulty in distinguishing the grafted parathyroid tissue from the surrounding muscle. 13 In contrast, the only repeated autograftectomy in the Subcutaneous group was caused by hyperplasia of the preserved autograft, rather than local recurrence in the cleaned pockets.…”

“…Previous studies reported the high incidence of intramuscular autograftectomy and repeated autograftectomy without comparison with subcutaneous autografts. [13][14][15] Chou et al 16 reported intramuscular autotransplantation had a greater incidence of autograftectomy than subcutaneous autotransplantation (9 of 75, 12% vs 1 of 110, 0.9%). The present study shows that intramuscular parathyroid autotransplantation led to a greater incidence of autograftectomy (15 of 65, 23% vs 14 of 823, 1.7%) and repeated autograftectomy (4 of 65, 6.4% vs 1 of 823, 0.1%) than subcutaneous parathyroid autotransplantation.…”

Prospektive Beobachtungsstudie zur operativen Therapie des renalen Hyperparathyreoidismus

“…4,5). Im Gesamtkrankengut wurden ü ber 60 % der hiervon betrof-fenen Patienten innerhalb von 4 Wochen beschwerdefrei, wä hrend sich das ossä re Syndrom lä ngerfristig zurü ckbildete.…”

“…Replantiertes nodulä r-hyperplastisches Nebenschilddrü sengewebe fü hrt in hö herem Maße zum Rezidiv als diffus-hyperplastisches Gewebe [3,13,14]. Obwohl bei 2 unserer Patienten mit Transplantatrezidiv bis zur neuerlichen Normalisierung der Transplantatfunktion je 2 Revisionen erforderlich waren, beobachteten wir keinwie von anderen Autoren beschrieben [5] -infiltratives Wachstum des transplantierten Nebenschilddrü sengewebes. Obwohl bei 2 unserer Patienten mit Transplantatrezidiv bis zur neuerlichen Normalisierung der Transplantatfunktion je 2 Revisionen erforderlich waren, beobachteten wir keinwie von anderen Autoren beschrieben [5] -infiltratives Wachstum des transplantierten Nebenschilddrü sengewebes.…”

Heterotransplantation of Human Parathyroid Glands into Nude Mice.

“…with thyroid cancer, since lymph node dissection jeopardizes the vascularity of parathyroid glands leading to postoperative hypoparathyroidism [3]. Although the results of autotransplantation are satisfactory in most cases, problems such as the recurrence of hyperparathyroidism due to graft hyperplasia or hypoparathyroidism due to failure of autotransplanted normal parathyroid gland to function does occur in a few cases [4][5][6].…”