US-guided microwave ablation for secondary hyperparathyroidism in patients after renal transplantation: a pilot study

Abstract

Objective: To assess the safety and efficacy of ultrasound-guided microwave ablation (MWA) in the treatment of patients who develop secondary hyperparathyroidism (SHPT) after renal transplantation (RT). Methods: In total, nine patients, each with symptomatic SHPT caused by RT and at least one enlarged parathyroid gland, underwent MWA via hydrodissection. Intact parathyroid hormone (i-PTH), serum calcium, serum phosphorus, creatinine and blood urea nitrogen concentrations, before and after MWA, were assessed and compared. Results: Complete ablation was achieved in all patients for a total of 14 ablated parathyroid glands. The mean follow-up time was 17.2 ± 1.7 months post-operation. The mean maximum diameter of the parathyroid glands was 1.3 ± 0.4 cm (range: 0.4-2.0 cm). The ablation power implemented was 30 W and the mean time for each parathyroid gland to achieve complete ablation was 287.5 ± 83.4 s. The mean i-PTH, serum calcium and phosphorus concentrations at one day post-MWA (69.6 pg/mL, 2.23 ± 0.29 mmol/L, 1.2 2 ± 0.48 mmol/L, respectively) were significantly lower than those before MWA (780.0 pg/mL, 2.62 ± 0.32 mmol/L, 1.39 ± 0.61 mmol/L, respectively; p < .01), whereas the creatinine and blood urea nitrogen concentrations before and after MWA did not differ significantly from each other (p > .05). No significant differences were found between the biomarker concentrations observed at one day post-MWA and at the follow-ups (p > .05). No major operation-related complications occurred. Conclusion: Ultrasound-guided MWA is a safe and effective technique for destroying parathyroid gland tissue in patients who develop SHPT after RT and its clinical effects are long-lasting.

Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis

“…The studies covered a period !8 years, from 2009 to 2017. Two were retrospective cohort studies [26,27], and six were retrospective self-control studies [28][29][30][31][32][33]. The mean follow-up period ranged from six to 23 months, and the sample size ranged from 9-56 patients.…”

“…The PTH levels at one day after MWA were significantly lower than those measured before MWA (WMD: 890.314, 95% CI: 767.121-1013.506, p < 0.01; Figure 2(A)). Four articles reported PTH levels at one week [26,27,29,30] and one month [26,27,29,31] Figure 2(B,C)). Two articles reported PTH measurements obtained 6 months after MWA [29,33].…”

“…All studies included in the meta-analysis reported calcium measurements obtained before MWA. Five articles reported calcium levels as measured one day after MWA [27,28,[30][31][32].…”

“…Data about phosphorus measurements obtained before MWA were reported in all articles. Five articles reported phosphorus measurements obtained one day after MWA [27,28,[30][31][32]. The heterogeneity among studies was not significant (p ¼ 0.242, I 2 ¼ 26.9%), so the fixed-effects model was used for the analysis.…”

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

“…Among the treatments for parathyroid hyperplastic glands in chronic renal failure patients with HPT, RFA, LA and ethanol ablation could achieve similar clinical efficiency compared with that of MWA [18,25,35,[38][39][40]. Although the prominent advantage of MWA is the higher thermal efficiency which could achieve larger ablation with less time used, it is with less manipulative for smaller lesions compared with that of RFA and LA.…”