G Conzo1, C Della Pietra2, E Tartaglia3, C Gambardella4, C Mauriello5, A Palazzo6, L Santini7, L Fei8, G Rossetti9, G Docimo10, A Perna11. 1. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: giovanni.conzo@unina2.it. 2. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: c.della.pietra@alice.it. 3. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: ernestart@msn.com. 4. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: claudiog86@tin.it. 5. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: claudio.mauriello@live.it. 6. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: antonietta.palazzo@unina2.it. 7. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: luigi.santini@unina2.it. 8. Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: landino.fei@unina2.it. 9. Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy. Electronic address: gianluca.rossetti@unina2.it. 10. Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. Electronic address: giovanni.docimo@unina2.it. 11. Department of Cardio-thoracic and Respiratory Sciences First Division of Nephrology, Second University of Naples, Italy. Electronic address: alessandra.perna@unina2.it.
Abstract
INTRODUCTION: Parathyroidectomy (PTx) is recommended in patients affected by secondary hyperparathyroidism (2HPT) of chronic kidney disease-mineral bone disorders (CKD-MBD), resistant to medical treatment. Analyzing total parathyroidectomy with muscular or subcutaneous autoimplantation (TPai) outcomes in hemodialysis (HD) 2HPT patients, and monitoring intact parathyroid hormone (iPTH) levels, we evaluated long-term functional results of subcutaneous parathyroid glandular tissue autoimplantation. METHODS: 40 HD 2HPT patients, resistant to medical treatment, and awaiting for renal transplantation, underwent total parathyroidectomy with subcutaneous autoimplantation of 9-12 fragments of not nodular hyperplasia parathyroid tissue in not dominant forearm. iPTH were analyzed 24 h, and 3-6-12-24 months after surgery. The 1.08-6.99 pmol/L range was taken as reference of normal iPTH level based on which eu- (1.08-6.99), hypo- (<1.08), aparathyroidism (0) and persistence or relapse (>6.99) of disease were determined. RESULTS: In every case PTai determined an extraordinary improvement of quality of life, associated with a notable reduction of iPTH serum level. Immediate normalization of iPTH was achieved in 50% of cases; hypoparathyroidism in 25% of cases and persistence of disease in 25% were observed. Long term follow-up showed a reduction of hypoparathyroidism and an increase of relapse rate up to 20%. Grafting resection was never performed. DISCUSSION: Subcutaneous autotrasplantation is a very simple and fast surgical technique. Nevertheless, similar success and recurrence rates were reported following muscular or subcutaneous grafting, as confirmed in our experience. CONCLUSIONS: Subcutaneous grafting was effective as muscular implantation, with comparable functional results, but avoiding its potential complications.
INTRODUCTION: Parathyroidectomy (PTx) is recommended in patients affected by secondary hyperparathyroidism (2HPT) of chronic kidney disease-mineral bone disorders (CKD-MBD), resistant to medical treatment. Analyzing total parathyroidectomy with muscular or subcutaneous autoimplantation (TPai) outcomes in hemodialysis (HD) 2HPTpatients, and monitoring intact parathyroid hormone (iPTH) levels, we evaluated long-term functional results of subcutaneous parathyroid glandular tissue autoimplantation. METHODS: 40 HD2HPTpatients, resistant to medical treatment, and awaiting for renal transplantation, underwent total parathyroidectomy with subcutaneous autoimplantation of 9-12 fragments of not nodular hyperplasia parathyroid tissue in not dominant forearm. iPTH were analyzed 24 h, and 3-6-12-24 months after surgery. The 1.08-6.99 pmol/L range was taken as reference of normal iPTH level based on which eu- (1.08-6.99), hypo- (<1.08), aparathyroidism (0) and persistence or relapse (>6.99) of disease were determined. RESULTS: In every case PTai determined an extraordinary improvement of quality of life, associated with a notable reduction of iPTH serum level. Immediate normalization of iPTH was achieved in 50% of cases; hypoparathyroidism in 25% of cases and persistence of disease in 25% were observed. Long term follow-up showed a reduction of hypoparathyroidism and an increase of relapse rate up to 20%. Grafting resection was never performed. DISCUSSION: Subcutaneous autotrasplantation is a very simple and fast surgical technique. Nevertheless, similar success and recurrence rates were reported following muscular or subcutaneous grafting, as confirmed in our experience. CONCLUSIONS: Subcutaneous grafting was effective as muscular implantation, with comparable functional results, but avoiding its potential complications.