Background
The functionality of cryopreserved parathyroid autotransplantation (CPAT) has been
evaluated in few studies, mostly conducted by experienced single-institution centers
that have reported different success rates ranging from 17% to 83%. In France, CPAT
are rare and their functionality has never been evaluated. Moreover, French tissue
banks are facing an accumulation of ungrafted samples. The aim of our work was to
evaluate the implantation rate of cryopreserved parathyroid samples and the functionality
of CPAT in a multicenter study.
Methods
Data from 9 French tissue banks were analyzed. CPAT functionality was defined as fully
functional (normal parathyroid hormone [PTH] and calcium levels without treatment),
partially functional (normal PTH levels but need for treatment to maintain normocalcemia),
and nonfunctional (low PTH levels and need for treatment). For dialyzed patients,
CPAT was considered nonfunctional if the PTH level in the nongrafted arm was less
than 20 pg/mL, partially functional if the PTH level was between 20 and 50 pg/mL,
and fully functional if the PTH level was between 50 and 300 pg/mL.
Results
The 9 centers had cryopreserved 1376 samples of parathyroid tissue and only 22 (1.6%)
had been autografted in 20 patients (65% renal hyperparathyroidism, 20% multiple endocrine
neoplasia type 1, 15% “other”) by 12 different surgical teams. The median duration
of storage was 11.1 months (range, 0.4–28.5). Only 2 autografts (10%) were fully functional,
2 (10%) were partially functional, and 17 (80%) were nonfunctional at 26 months median
follow-up.
Conclusion
The reimplantation rate is low, and the functionality of CPAT is less than those published
by experienced centers. Logistical and technical problems occurring in less experienced
centers are probably the main reasons for nonfunctioning implants. Considering the
results of this study, we suggest that cryopreservation of parathyroid glands should
be abandoned when not performed in very large experimented centers, that CPAT should
be used only for patients with hyperplasic parathyroid tissue, and that tissue samples
should be systematically destroyed when patients do not have hypoparathyroidism or
after 1 year of storage.
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Article info
Publication history
Published online: February 15, 2010
Accepted:
October 5,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
