Percutaneous ethanol injection therapy in post-transplant patients with secondary hyperparathyroidism

Abstract

Summary Persistent hyperparathyroidism is frequent in postrenal transplant patients. Percutaneous ethanol injection therapy (PEIT) is an alternative for treatment of patients with secondary hyperparathyroidism but it was not described in postrenal transplant patients. We report our experience with PEIT to control hyperparathyroidism in the post‐transplant period. We performed PEIT under ultrasonographic guidance and local anesthesia in eight patients because of persistent secondary hyperparathyroidism after renal transplantation. Indications for PEIT were: high intact parathyroid hormone (iPTH) levels with hypercalcemia, hypophosphatemia, osteopenia and/or bone pain. All patients had at least one visible parathyroid nodule by ultrasonography. Biochemical assays were performed immediately before PEIT, between 1 and 7 days after last PEIT, and a mean of 8.0 ± 2.8 months after PEIT. Serum iPTH and calcium levels decreased significantly after treatment and remained unchanged until final control. Serum iPTH decreased from 286.9 ± 107.2 to 154.6 ± 42.2 pg/ml (P < 0.01) after PEIT (percentual reduction 36.5 ± 9.5%). This response was significantly correlated to total ethanol volume used (r: 0.94, P < 0.0001). Hypercalcemia disappeared in six of eight patients treated. Only minor complications were registered. There were no changes in renal function related to the treatment. Our findings show that PEIT is a useful and safe alternative for patients with persistent post‐transplant secondary hyperparathyroidism.

Radiofrequency Ablation Followed by Percutaneous Ethanol Ablation Leading to Long-Term Remission of Hyperparathyroidism

“…Percutaneous treatment of a parathyroid adenoma by absolute ethanol injection may represent an alternative therapeutic approach [ 7 ]. This procedure was first described by Solbiati et al in 1985 [ 8 ] and has been mainly used in the treatment of secondary or tertiary hyperparathyroidism [ 9 , 10 ]. Few studies suggest that parathyroid adenoma by absolute ethanol injection may also be used for the treatment of selected cases of primary hyperparathyroidism, although there are reports of incomplete inactivation of the PTH secretion.…”

Use of Percutaneous Ethanol Injection Therapy for Recurrent Secondary Hyperparathyroidism after Subtotal Parathyroidectomy

“…This technique is not only an alternative to surgical parathyroidectomy, but also an important adjunct to medical management [7]. It has proved to be useful for patients either on dialysis or after renal transplantation in circumstances in which the disease is considered to be resistant to medical treatment or when the surgical risk is high [8–10]. …”

“…In this setting, parathyroidectomy is considered too aggressive for controlling the hyperparathyroidism, and was carries out [10]. …”

Post-renal transplant calciphylaxis: treatment of hyperparathyroidism by percutaneous ethanol injection therapy and parathyroidectomy

“…When a PTX is performed, graft function may worsen [ 3 ]. PEIT may be recommended as treatment for hyperparathyroidism in renal transplant patients who require a PTX and are at a risk for graft loss [ 4 ]. In contrast, there is a report involving graft survival after a PTX, although overall graft survival was not different [ 5 ].…”