Graft Survival Effect of Hla-A Allele Matching Parathyroid Allotransplantation

Abstract

Permanent hypoparathyroidism is an endocrine disease that is mostly associated with the disruption of the parathyroid glands during surgery. Allotransplantation is the most promising approach for treatment particularly for its cost-effective and exact curative potential. Herein our aim was to evaluate human leukocyte antigen (HLA)-A allele matching effect on clinical improvement and graft survival after parathyroid transplantation. We performed parathyroid transplantation between ABO/Rh compatible recipient and an unrelated donor who has chronic kidney disease. Preoperative immunological tests include panel reactive antibody, T-flow cytometry crossmatch, B-flow cytometry crossmatch, autoflow cytometry crossmatch, and complement-dependent cytotoxicity crossmatch tests were performed. After histopathological evaluation, half of the resected parathyroid gland cells were isolated and transplanted to the omentum surface by laparoscopy. The transplantation outcome was followed up throughout 382 days. The recipient discharged 2 days after transplantation without any complication. During follow-up, calcium and vitamin D supplementation reduced to a one-third dose; even the intact PTH levels remained low. However, clinical improvement was observed by serum calcium levels. The recipient still continues with low-dose supplementation after 382 days of post-transplantation. Parathyroid cell transplantation to the omental tissue is the most promising option even with only one allele matching for patients with using lifelong high-dose supplementation. Clinical improvements and long-term effect of HLA-A allele matching should be evaluated with more studies and in larger cohorts as well.

Introductory Chapter: A Brief Statement about Parathyroid Glands

“…Reckoning the diseases associated with the parathyroid tissue, the treatment options are somewhat more limited. In the development of biomedical technology, two promising treatment options come forward, particularly in the treatment of hypoparathyroidism patients: the first is hormone replacement therapy [20,21], and the second is parathyroid transplantation [22].…”

“…Since the early 1990s, many research projects have been added to the literature about cell isolation, graft delivery location, and follow-up parameters from the same group [29][30][31][32][33]. During the last five years of the parathyroid transplantation, advanced immunological transplantation criteria, including pre-op and post-follow-up processes after parathyroid transplantation, were brought to the literature by the same group from Bezmialem Vakif University in Turkiye [22,[34][35][36][37][38][39][40][41][42][43] Parathyroid transplantation is the most effective and targeted hypoparathyroidism treatment in the literature due to limited access to hormone replacement therapy and ongoing phase studies. Long-term studies on research and parathyroid…”