Parathyroid allotransplantation for the treatment of permanent hypoparathyroidism: A systematic review

Eric, Kim; Ramonell, Kimberly M.; Mayfield, Nicolas; Lindeman, Brenessa

doi:10.1016/j.amjsurg.2021.07.025

Cited by 8 publications

(10 citation statements)

References 39 publications

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“…Because of this, we constructed our own success criterion aimed to filter for quality and to promote uniformity in the definition of transplantation success. We hoped this would present a more realistic representation of the treatment efficacy in comparison to other systematic reviews on the same topic that did not set a filter [ 43 , 44 ]. As expected, our calculated success was decreased in respect to that of Kim et al [ 43 ]: we calculated a 47% success rate with a median FU of 24 months as supposed to their 73.3% with a mean FU duration of 18.6 ± 14.3 months for transient immunosuppression, and our 67% success rate with a median FU of 9.5 months as supposed to their 87.5% survival with a median FU of 11.5 months for permanent immunosuppression (Parameswaran et al [ 44 ] had an incomparable outcome).…”

Section: Discussionmentioning

confidence: 99%

“…We hoped this would present a more realistic representation of the treatment efficacy in comparison to other systematic reviews on the same topic that did not set a filter [ 43 , 44 ]. As expected, our calculated success was decreased in respect to that of Kim et al [ 43 ]: we calculated a 47% success rate with a median FU of 24 months as supposed to their 73.3% with a mean FU duration of 18.6 ± 14.3 months for transient immunosuppression, and our 67% success rate with a median FU of 9.5 months as supposed to their 87.5% survival with a median FU of 11.5 months for permanent immunosuppression (Parameswaran et al [ 44 ] had an incomparable outcome). In summary, the suspected biases combined with the neglect of providing essential information about transplantation characteristics lead to the suspicion of the calculated success rate, most likely still overestimating the true effectiveness of this treatment modality in its current state.…”

Section: Discussionmentioning

confidence: 99%

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Parathyroid Allotransplantation: A Systematic Review

2022

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Background: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by design is a one-time cure through its restoration of the parathyroid function and, therefore, could be the solution. A systematic literature review is conducted in the present paper, with the aim of outlining the possibilities of parathyroid allotransplantation and to calculate its efficacy. Additionally, various transplantation characteristics are linked to success. Methods: This review is carried out according to the PRISMA statement and checklist. Relevant articles were searched for in medical databases with the most recent literature search performed on 9 December 2021. Results: In total, 24 articles involving 22 unique patient cohorts were identified with 203 transplantations performed on 148 patients. Numerous types of (exploratory) interventions were carried out with virtually no protocols that were alike: there was the use of (non-) cryopreserved parathyroid tissue combined with direct transplantation or pretreatment using in vitro techniques, such as culturing cells and macro-/microencapsulation. The variability increased further when considering immunosuppression, graft histology, and donor–recipient compatibility, but this was found to be reported in its entirety by exception. As a result of the large heterogeneity among studies, we constructed our own criterium for transplantation success. With only the studies eligible for our assessment, the pooled success rate for parathyroid allotransplantation emerged to be 46% (13/28 transplantations) with a median follow-up duration of 12 months (Q1–Q3: 8–24 months). Conclusions: Manifold possibilities have been explored around parathyroid allotransplantation but are presented as a double-edged sword due to high clinical diverseness, low expertise in carrying out the procedure, and unsatisfactory study quality. Transplantations carried out with permanent immunosuppression seem to be the most promising, but, in its current state, little could be said about the treatment efficacy with a high quality of evidence. Of foremost importance in pursuing the answer whether parathyroid allotransplantation is a suitable treatment for hypoparathyroidism, a standardized definition of transplantation success must be established with a high-quality trial.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Parathyroid Allotransplantation: A Systematic Review

2022

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“…Permanent functional hypoparathyroidism is defined by the need for oral calcium administration to a patient with apparently normal PTH levels (E. Kim, Ramonell, Mayfield, & Lindeman, 2021;Sitges-Serra, 2021). Obiarinze et al, (2021) believes that there may be normalization of parathyroid function up to two years after thyroidectomy (Obiarinze, Fazendin, Iyer, Lindeman, & Chen, 2021).…”

Section: Classification Of Hypocalcemiamentioning

confidence: 99%

“…According to Kim et al, (2021) and others, performing two PTH measurements (intraoperative and immediate postoperative), found that PTH values greater than 10.0 pg/ml and an increase in postoperative PTH compared to intraoperatively indicate low risk of hypocalcemia (Daskalaki et al, 2022;D. H. Kim et al, 2021;Rahman, 2021).…”

Section: Hyperparathyroidismmentioning

confidence: 99%

Post-thyroidectomy hypocalcemia and related complications

Al-Roubaie

2022

ijhs

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The incidence of post-thyroidectomy hypocalcemia is high while the factors involved include age (> 50 years), type of operation, operative time, neck dissection, histology of the surgical specimen and vocal fold paralysis. Low ionic calcium concentrations are indicative of the presence of symptoms of hypocalcemia and the need for oral calcium. Progression to definitive hypoparathyroidism occurs only in patients with clinical manifestations of post-thyroidectomy hypocalcemia. In general, the problem with post-surgical hypoparathyroidism resides in the surgical procedure itself. The most common are related to neuronal hyperexcitability, which explains the paresthesias, cramps and numbness, which usually start in the perioral region and on the fingertips. Muscle spasms and muscle stiffness are also common. When severe, hypocalcemia can lead to life-threatening spastic tetany, laryngospasm, and seizures. The current manuscript aimed to present a review of the bibliography on thyroidectomy and negative impact of its complications on human health, mainly because of a higher risk for developing hypocalcemia. To achieve the study goal, this review covered most recent published articles from 2017 onward.

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“…A wide range of case reports and methodologies have been described dating back to the 1950s with relative success. 8,9 The most common source of viable parathyroid tissue for allotransplantation has come from hyperplastic glands of living donor patients with secondary hyperparathyroidism triggered by chronic renal failure. 9 These glands were most often cryopreserved or cultured before transplantation, leading to a large degree of variance in allotransplantation strategies and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Procurement of Deceased Donor Parathyroid Glands With the Aid of Near-infrared Autofluorescence Imaging

Ward

Kelly

Syed

et al. 2022

Transplantation Direct

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Background. Parathyroid allotransplantation is a burgeoning treatment for severe hypoparathyroidism. Deceased donor parathyroid gland (PTG) procurement can be technically challenging due to lack of normal intraoperative landmarks and exposure constraints in the neck of organ donors. In this study, we assessed standard 4-gland exposure in situ and en bloc surgical techniques for PTG procurement and ex vivo near-infrared autofluorescence (NIRAF) imaging for identification of PTGs during organ recovery. Methods. Research tissue consent was obtained from organ donors or donor families for PTG procurement. All donors were normocalcemic, brain-dead, solid organ donors between 18 and 65 y of age. PTGs were procured initially using a standard 4-gland exposure technique in situ and subsequently using a novel en bloc resection technique after systemic organ preservation flushing. Parathyroid tissue was stored at 4 °C in the University of Wisconsin solution up to 48 h post-procurement. Fluoptics Fluobeam NIRAF camera and Image J software were utilized for quantification of NIRAF signal. Results. Thirty-one brain-dead deceased donor PTG procurements were performed by abdominal transplant surgeons. In the initial 8 deceased donors, a mean of 1.75 glands (±1.48 glands SD) per donor were recovered using the 4-gland in situ technique. Implementation of combined en bloc resection with ex vivo NIRAF imaging in 23 consecutive donors yielded a mean of 3.60 glands (±0.4 SD) recovered per donor (P < 0.0001). Quantification of NIRAF integrated density signal demonstrated >1-fold log difference in PTG (2.13 × 105 pixels) versus surrounding anterior neck structures (1.9 × 104 pixels; P < 0.0001). PTGs maintain distinct NIRAF signal from the time of recovery (1.88 × 105 pixels) up to 48 h post-procurement (1.55 × 105 pixels) in organ preservation cold storage (P = 0.34). Conclusions. The use of an en bloc surgical technique with ex vivo NIRAF imaging significantly enhances the identification and recovery of PTG from deceased donors.

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Parathyroid allotransplantation for the treatment of permanent hypoparathyroidism: A systematic review

Cited by 8 publications

References 39 publications

Parathyroid Allotransplantation: A Systematic Review

Parathyroid Allotransplantation: A Systematic Review

Post-thyroidectomy hypocalcemia and related complications

Procurement of Deceased Donor Parathyroid Glands With the Aid of Near-infrared Autofluorescence Imaging

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