Background
The functional results of cryopreserved heterotopic parathyroid autotransplantation
(CHPA) are not well defined. The authors evaluated the outcomes of delayed CHPA for
the treatment of surgically induced hypoparathyroidism.
Methods
Since November 1991, 448 parathyroid samples from 436 patients were cryopreserved
at our institution. Of these, 29 patients underwent 34 CHPA procedures, with placement
of 20 to 25 pieces of parathyroid tissue (approximately 50 to 75 mg) into the forearm.
Outcomes were determined based on peripheral parathyroid hormone (PTH) levels and,
where available, PTH gradients between grafted and nongrafted arms. Graft function
results were defined as completely functional (patients with normal PTH and calcium
levels off all calcium/vitamin D supplementation), partially functional (normal PTH
levels and mild hypocalcemia on calcium supplementation), or nonfunctional (low PTH
levels and dependent on calcium/vitamin D supplementation).
Results
Of the 29 patients with CHPA, prospective data were available for 26 patients undergoing
30 CHPA procedures (9 patients with MEN 1, 4 with MEN 2A, 1 with MEN 2B, and 12 with
sporadic hyperparathyroidism). The mean follow-up interval was 2 years. Twelve of
26 patients (46%) had completely functional grafts, 6 patients (23%) had partially
functional grafts, and the remaining 8 patients (31%) had nonfunctional grafts. No
patient with CHPA had graft-dependent recurrent hyperparathyroidism. Of the 14 patients
(15 autografts) with MEN, 7 patients (50%) had fully functional grafts, and 2 patients
(14%) had partially functional grafts. The mean cryopreservation period was 7.9 months
(range, 1 week to 22 months) for functional autografts and 15.3 months (range, 2 weeks
to 106 months) for nonfunctional autografts (P < .01).
Conclusions
Based on these data and those in previous studies, approximately 60% of delayed, cryopreserved
parathyroid autografts are functional. In this study 40% autografts (46% of patients)
achieved full competency off supplements. Some patients have evidence of graft function
with normal PTH levels but are not normocalcemic. Results were similar for patients
with MEN and nonhereditary hyperparathyroidism. The duration of cryopreservation was
a significant indicator of graft failure, and no functional autograft was observed
beyond 22 months of preservation. CHPA is a useful treatment modality for patients
with postoperative hypocalcemia after thyroid or parathyroid surgery, who do not respond
to immediate parathyroid autotransplantation.
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Article info
Publication history
Accepted:
September 22,
2005
St. Louis, Mo, Durham, NC, Stanford, Calif, and Ann Arbor, MichIdentification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
