title: Long-term function of parathyroid subcutaneous autoimplantation after presumed total parathyroidectomy in the treatment of secondary hyperparathyroidism. A clinical retrospective study.
abstract: BACKGROUND
  Parathyroidectomy (PTx) is recommended in patients affected by secondary hyperparathyroidism (2HPT) of chronic kidney disease-mineral bone disorders (CKD-MBD), resistant to medical treatment. Analyzing total parathyroidectomy with muscular or subcutaneous autoimplantation (TPai) outcomes in hemodialysis (HD) 2HPT patients, and monitoring intact parathyroid hormone (iPTH) levels, we evaluated long-term functional results of subcutaneous parathyroid glandular tissue autoimplantation.
  
  
  METHODS
  40 HD 2HPT patients, resistant to medical treatment, and awaiting for renal transplantation, underwent total parathyroidectomy with subcutaneous autoimplantation of 9-12 fragments of not nodular hyperplasia parathyroid tissue in not dominant forearm. iPTH were analyzed 24 h, and 3-6-12-24 months after surgery. The 1.08-6.99 pmol/L range was taken as reference of normal iPTH level based on which eu- (1.08-6.99), hypo- (<1.08), aparathyroidism (0) and persistence or relapse (>6.99) of disease were determined.
  
  
  RESULTS
  In every case PTai determined an extraordinary improvement of quality of life, associated with a notable reduction of iPTH serum level. Immediate normalization of iPTH was achieved in 50% of cases; hypoparathyroidism in 25% of cases and persistence of disease in 25% were observed. Long term follow-up showed a reduction of hypoparathyroidism and an increase of relapse rate up to 20%. Grafting resection was never performed.
  
  
  CONCLUSIONS
  Subcutaneous autotrasplantation is a very simple and fast surgical technique. Nevertheless, similar success and recurrence rates were reported following muscular or subcutaneous grafting, as confirmed in our experience.
  
  
  CONCLUSIONS
  Subcutaneous grafting was effective as muscular implantation, with comparable functional results, but avoiding its potential complications.
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: giovanni.conzo@unina2.it.
authors.forename: G
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: c.della.pietra@alice.it.
authors.forename: C
authors.initials: C
authors.lastname: Della Pietra
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: ernestart@msn.com.
authors.forename: E
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: claudiog86@tin.it.
authors.forename: C
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: claudio.mauriello@live.it.
authors.forename: C
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: antonietta.palazzo@unina2.it.
authors.forename: A
authors.initials: A
authors.lastname: Palazzo
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: luigi.santini@unina2.it.
authors.forename: L
authors.initials: L
authors.lastname: Santini
authors.affiliation: Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: landino.fei@unina2.it.
authors.forename: L
authors.initials: L
authors.lastname: Fei
authors.affiliation: Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: gianluca.rossetti@unina2.it.
authors.forename: G
authors.initials: G
authors.lastname: Rossetti
authors.affiliation: Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: giovanni.docimo@unina2.it.
authors.forename: G
authors.initials: G
authors.lastname: Docimo
authors.affiliation: Department of Cardio-thoracic and Respiratory Sciences First Division of Nephrology, Second University of Naples, Italy. Electronic address: alessandra.perna@unina2.it.
authors.forename: A
authors.initials: A
authors.lastname: Perna
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone
keywords: Autotransplantation; Chronic kidney disease; Muscular implantation; Parathyroidectomy; Secondary hyperparathyroidism; Subcutaneous implantation