Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: A retrospective cohort study

Comparison of different parathyroid autograft project after total parathyroidectomy in patients with secondary hyperparathyroidism

“…At 5 years, the cumulative frequency of intramuscular autograftectomy was 7.5% in Tominaga's study and is 6.1% in the present study. However, there are several studies consider that intramuscular multi-point transplantation with conventional incisions has a higher recurrence rate than other transplantation methods like subcutaneous autotransplantation 10,14 .In our study, there are similar situations that the cumulative frequency of autograftectomy in syringe injection group is 2.7%,which is much better than conventional incisions group.In summary, these data suggest that the method of modi ed syringe injection is a feasible alternative with a comparable, if not greater, e cacy than implantation of conventional incision. Moreover, in response to the possible secondary removal after modi ed syringe injection, the reoperation could in a relatively shorter time(P = 0.02), simpler operation and less trauma under local anesthesia.…”

“…There is a certain amount of reports on how to perform autologous transplantation of parathyroid glands, but there are not many involved transplanting parathyroid glands into the forearm or deltoid muscle by injection, and most of them are still in the exploration stage 4,10,12 . In this study, we retrospectively analyzed perioperative management of patients with secondary hyperparathyroidism.…”

“…The follow-up of all patients after discharge from the hospital was recorded by the nephrology and Head and Neck Surgery. This study identi ed the success of the operation as postoperative PTH level < 72 ng / L(the upper limit of the reference range); postoperative persistent parathyroid gland hyperactivity was de ned as PTH level still three-fold higher than the upper limit of the reference value on the third postoperative day 10,11 . For patients match the criterion of successful operation,it is necessary to follow-up the trend of PTH level : the monthly postoperative PTH level should be recorded for patients had lower normal value when discharge from hospital.…”

“…Until the PTH level reach the normal reference range, the follow-up interval could extend to every 3-6 months. If the random PTH > 400 ng/L during follow-up, the possibility of disease recurrence caused by prosthetic graft hyperplasia should be considered 10 . Beyond that, if the clinical observation and imaging evidence suggest that the forearm graft hyperplasia is signi cant, the forearm graft should be removed.…”

Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience

“…The recurrence of secondary hyperparathyroidism with the need for autograftectomy is an event that occurs in 5–7.5% of cases according to the literature, but in recent studies, it was also shown to be higher than 9% with an increased risk for implantation of parathyroid tissue at the intramuscular site. According to previous studies, in the intramuscular AT, there is an increase in intraoperative time correlated with the greater difficulty for the intervention, and in the case of autograftectomy, it implies the sacrifice of an important motor component of the forearm, with consequent functional impairment and worsening of quality of life [ 10 – 15 , 23 , 29 , 37 , 40 , 41 ]. We showed a nonsignificant difference between the two groups in the recurrence of secondary hyperparathyroidism after parathyroidectomy (only in 3 patients), while Hsu and Hung [ 37 ] showed a significant difference between the two groups; this difference could be due to the low size of the sample (7.8%).…”