Subcutaneous forearm transplantation of autologous parathyroid tissue in patients with renal hyperparathyroidism.
BACKGROUND
Parathyroidectomy is required in up to 5% of patients with chronic renal failure. Intramuscular transplantation of autologous parathyroid tissue in the forearm has been the traditional method of transplantation at the time of total parathyroidectomy. The removal of an intramuscular transplantation can be technically difficult should graft-dependent hyperparathyroidism (GRH) occur. This problem resulted in our initiating a study of subcutaneous transplantation with total parathyroidectomy in patients with renal failure.


METHODS
Twenty-six patients who were receiving dialysis therapy underwent total parathyroidectomy and subcutaneous transplantation. Parathyroid tissue was diced into 1- to 2-mm pieces, and 6 pieces were grafted into 6 subcutaneous pockets of the forearm. Intact parathyroid hormone was measured within 48 hours of operation and in the bilateral antecubital veins 1 to 24 months after the operation to assess completeness of resection and graft function, respectively.


RESULTS
No major surgical complications occurred. Symptoms improved in 24 patients (85%). Graft failure rate was 4.3%. No GRH was observed. Follow-up was 4 to 55 months (mean, 27 months).


CONCLUSIONS
This study indicates that the subcutaneous transplantation function is comparable to intramuscular transplantation and suggests a decreased incidence of GRH. Subcutaneous transplantation is technically easier than intramuscular transplantation and has the additional advantage of easy removal should GRH occur.
Monchik
J M
JM
Rhode Island Hospital, Department of Endocrine Surgery, Providence, USA.
Bendinelli
C
C
Passero
M A
MA
Roggin
K K
KK
D005500:Follow-Up Studies; D005542:Forearm; D006085:Graft Survival; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology / Q000601:surgery*; D015592:Immunoradiometric Assay; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality; D016030:Kidney Transplantation; D010280:Parathyroid Glands / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D012008:Recurrence; D012189:Retrospective Studies; D012867:Skin; D014182:Transplantation, Autologous; D017211:Treatment Failure
D010281:Parathyroid Hormone