Parathyroid Tissue Cryopreservation: Does the Storage Time Affect Viability and Functionality?

Aiti, Annalisa; Rossi, Martina; Alviano, Francesco; Morara, Barbara; Burgio, Luca; Cioccoloni, Eleonora; Cavicchi, Ottavio; Pasquinelli, Gianandrea; Bonsi, Laura; Buzzi, Marina

doi:10.1089/bio.2018.0140

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…The alternative is parathyroid cryopreservation [ 131 ]. Cryopreservation preserves cellular function (up to 5 years) and allows the storage of parathyroid tissue for potential reimplantation in patients who develop hypoparathyroidism [ 132 ].…”

Section: Introductionmentioning

confidence: 99%

A roadmap to parathyroidectomy for kidney transplant candidates

Cianciolo

Tondolo

Barbuto

et al. 2022

Clinical Kidney Journal

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Chronic kidney disease Mineral and Bone Disorder may persist after successful kidney transplantation. Persistent hyperparathyroidism has been identified in up to 80% of patients throughout the first year after kidney transplantation. International Guidelines lack strict recommendations about the management of persistent hyperparathyroidism. However, it is associated with adverse graft and patients’ outcomes such as higher fracture risk and an increased risk of all-cause mortality and allograft loss. Secondary hyperparathyroidism may be treated medically (vitamin D, phosphate binders and calcimimetics) or surgically (parathyroidectomy). Guideline recommendations suggest medical therapy first but do not clarify optimal PTH targets or indications and timing of parathyroidectomy. There are no clear guidelines or long-term studies about the impact of hyperparathyroidism therapy. Parathyroidectomy is more effective than medical treatment although associated to increased short term risks. Ideally, parathyroidectomy should be performed before kidney transplantation to prevent persistent hyperparathyroidism and improve graft outcomes. We now propose a roadmap for the management of secondary hyperparathyroidism in patients eligible for kidney transplantation that includes the indications and timing (pre- or post-kidney transplantation) of parathyroidectomy, the evaluation of parathyroid gland size and the integration of parathyroid gland size in the decision-making process by a multidisciplinary team of nephrologists, radiologists and surgeons.

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Section: Introductionmentioning

confidence: 99%

A roadmap to parathyroidectomy for kidney transplant candidates

Cianciolo

Tondolo

Barbuto

et al. 2022

Clinical Kidney Journal

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“…Autotransplantation and cryopreservation should be considered when hypoparathyroidism occurs after parathyroidectomy or when the target parathyroid in reoperation is the only viable parathyroid tissue remaining[ 78 ].…”

Section: Intraoperative Tools For Parathyroid Identificationmentioning

confidence: 99%

Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Pavlidis¹,

Pavlidis²

2023

World J Clin Cases

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Primary hyperparathyroidism (pHPT) is the third most common endocrine disease. The surgical procedure aims for permanent cure, but recurrence has been reported in 4%-10% of pHPT patients. Preoperative localization imaging is highly valuable. It includes ultrasound, computed tomography (CT), single-photon-emission CT, sestamibi scintigraphy and magnetic resonance imaging. The operation has been defined as successful when postoperative continuous eucalcemia exists for more than the first six months. Ongoing hypercalcemia during this period is defined as persistence, and recurrence is defined as hypercalcemia after six months of normocalcemia. Vitamin D is a crucial factor for a good outcome. Intraoperative parathyroid hormone (PTH) monitoring can safely predict the outcomes and should be suggested. PTH ≤ 40 pg/mL or the traditional decrease ≥ 50% from baseline minimizes the likelihood of persistence. Risk factors for persistence are hyperplasia and normal parathyroid tissue on histopathology. Risk factors for recurrence are cardiac history, obesity, endoscopic approach and low-volume center (at least 31 cases/year). Cases with double adenomas or four-gland hyperplasia have a greater likelihood of persistence/ recurrence. A 6-mo calcium > 9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 mo may be associated with recurrence necessitating long-term follow-up. 18F-fluorocholine positron emission tomography and 4-dimensional CT in persistent and recurrent cases can be valuable before reoperation. With these novel advances in preoperative imaging and localization as well as intraoperative PTH measurement, the recurrence rate has dropped to 2.5%-5%. Six-month serum calcium ≥ 9.8 mg/dL and parathyroid hormone ≥ 80 pg/mL indicate a risk of recurrence. Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels are predictors of multiglandular disease, which brings an increased risk of persistence and recurrence. Bilateral neck exploration was considered the gold-standard diagnostic method. Minimally invasive parathyroidectomy and neck exploration are both effective surgical techniques. Multidisciplinary diagnostic and surgical management is required to prevent persistence and recurrence. Long-term follow-up, even up to 10 years, is necessary.

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“…In relation to these observations, although a large amount of excess parathyroid tissue is usually frozen for future grafting, it is mandatory to know the quantity of parathyroid tissue sample required for a good outcome without risking complications after parathyroid allotransplantation. Regarding the cryopreservation method, several researchers described a standard method of tissue manipulation and gradual preparation for freezing and storing in liquid nitrogen, which have not changed significantly over time [ 73 , 74 , 75 , 81 , 82 ].…”

Section: Transplantation Technologies and Hypoptmentioning

confidence: 99%

Hypoparathyroidism: State of the Art on Cell and Tissue Therapies

Miglietta

Palmini

Giusti

et al. 2021

IJMS

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Hypoparathyroidism is an endocrine disorder characterized by low serum calcium levels, high serum phosphorus levels, and by inappropriate or absent secretion of the parathyroid hormone (PTH). The most common therapeutic strategy to treat this condition is hormone replacement therapy with calcium and vitamin D but, unfortunately, in the long term this treatment may not be sufficient to compensate for the loss of endocrine function. Glandular autotransplantation is considered the most effective technique in place of replacement therapy. Although it leads to excellent results in most cases, autotransplantation is not always possible. Allograft is a good way to treat patients who have not been able to undergo autograft, but this technique has limited success due to side effects related to tissue rejection. This therapy is supported by systemic immunosuppression, which leads to the onset of serious side effects in patients, with a risk of endocrine toxicity. Today, research on endocrine disorders is focused on discovering alternative graft therapies that can allow optimal results with the fewest possible side effects. In this review, we will make an update on the current state of the art about the cell and tissue therapy as treatment for hypoparathyroidism, to identify which type of therapeutic strategy could be valid for a future clinical use.

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Parathyroid Tissue Cryopreservation: Does the Storage Time Affect Viability and Functionality?

Cited by 6 publications

References 25 publications

A roadmap to parathyroidectomy for kidney transplant candidates

A roadmap to parathyroidectomy for kidney transplant candidates

Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Hypoparathyroidism: State of the Art on Cell and Tissue Therapies

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