[Parathyroid autotransplantation in hemodialysed chronic renal failure. Attempts to modulate secretion. First results apropos of 45 cases].

The authors report their experience of parathyroid autotransplantation in 45 cases of renal insufficiency undergoing hemodialysis. The operation, carried out by two teams, reduces to the minimum the time during which the grafts are exposed to environmental factors likely to impair their function. An immediate anatomopathological examination is necessary to determine the degree of hyperplasia in each gland and the corresponding choice of grafts. The tissue to be implanted must be raised in the least hyperplastic gland and the size of the graft, always difficult to specify, is dictated by the intensity of the hyperplasia. This technique ultimately permits and almost permanent modulation of the parathyroid secretion by action on the secreting tissue. In the event of post-operative persistent hypoparathyroidism, a second operation is desirable, using cryopreserved fragments for the implant. Conversely, in the event of clinical and biological recurrence, the ablation of a precise volume of grafted tissue can be performed without difficulty, under local anaesthetic.