Abstract
Experience in autotransplantation of fresh and cryopreserved parathyroid tissue is reported. In 100 patients autografting of fresh tissue was combined with total parathyroidectomy (TPX + AT). Cryopreserved parathyroid glands were grafted after reoperation for primary (p) and secondary (s) hyperparathyroidism (HPT) in 4 patients (3p and 1s), and in 3 with TPX + AT for sHPT after the fresh tissue grafted during initial surgery failed to function.
One to seven years after TPX + AT, nearly 90% of 65 patients presented with normal graft function, 7.7% were hypocalcemic, and 3% exhibited graft-dependent hypercalcemia. In only 31% of all patients could a PTH-gradient—grafted versus non-grafted arm—be demonstrated. All 3 patients with pHPT who received cryopreserved autologous tissue showed normal function 6–34 months later. In 2 of 4 patients with sHPT the autografted cryopreserved tissue secretes enough PTH to maintain a normal calcium level. The results of autotransplantation of cryopreserved tissue do not depend on the length of cryopreservation but on accurate freezing and thawing technique.
Résumé
Les auteurs rapportent leur expérience d'autotransplantation de tissu parathyroïdien frais et conservé par le froid. Chez 100 sujets l'autogreffe de tissus frais fut associée à la parathyroïdectomie totale. Les parathyroïdes conservées par le froid furent greffées après réintervention pour hyperparathyroïdisme primaire ou secondaire chez quatre malades, et pour hyperparathyroïdisme secondaire chez trois opérés qui avaient subi sans succès une parathyroïdectomie totale combinée avec une autotransplantation de tissu frais.
Un an à sept ans après la parathyroïdectomie totale associée avec l'autotransplantation, près de 90% d'une série de 65 malades présentent une fonction normale, 7,7% une hypocalcémie, 3% une hypercalcémie. Chez 31%, un gradient de PTH entre sujet greffé et non greffé a pu être démontré.
Les trois opérés qui présentaient un hyperparathyroïdisme primaire et qui avaient subi une implantation de tissu parathyroïdien autologue conservé par le froid accusent une fonction normale 6–34 mois après l'opération. Chez deux des quatre sujets qui présentaient un hyperparathyroïdisme secondaire, le tissu conservé a permis de maintenir le taux normal de la calcémie.
Les résultats de l'autotransplantation de tissu parathyroïdien conservé par le froid ne dépendent pas de la durée de la conservation mais de sa qualité et de la technique de décongélation.
Resumen
Se informa la experiencia con el autotransplante de tejido paratiroideo fresco y criopreservado. En 100 pacientes se combinó el autotransplante de tejido fresco con paratiroidectomía total (TPX + AT). Glándulas paratiroides criopreservadas fueron transplantadas en el momento de la reoperación para hiperparatiroidismo (HPT) primario y secundario en cuatro pacientes, y en tres después de TPX + AT para HPT secundario, cuando el tejido fresco transplantado en el curso de la cirugía inicial dejó de funcionar. Uno a siete años después de TPX + AT casi el 90% de 65 pacientes presentaba funcionamiento normal de transplante, 7,7% apareció hipocalcémico y 3% exhibió hipercalcemia dependiente del transplante. Apenas en el 31%, de todos los pacientes se pudo demostrar un gradiente de PTH entre el brazo con el transplante y el brazo normal. Todos los tres pacientes con HPT primario que recibieron tejido autólogo criopreservado exhibieron función normal 6–34 meses más tarde. En dos de cuatro pacientes con sHPT el tejido criopreservado autotransplantado secreta suficiente PTH para mantener un nivel de calcio normal. Los resultados del autotransplante de tejido crioprecipitado no depende del tiempo de la criopreservación, sino de una técnica certera de congelación y descongelación.
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Supported by Deutsche Forschungsgemeinschaft Ro 519/2.
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Rothmund, M., Wagner, P.K. Assessment of parathyroid graft function after autotransplantation of fresh and cryopreserved tissue. World J. Surg. 8, 527–533 (1984). https://doi.org/10.1007/BF01654930
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DOI: https://doi.org/10.1007/BF01654930