Tumour-like growth of parathyroid autografts in uraemic patients.

Total parathyroidectomy with autotransplantation of parathyroid tissue into the forearm musculature has been recommended as surgical treatment for renal hyperparathyroidism. Five of 41 patients, in whom this procedure was performed, developed hyperparathyroidism 7 to 33 months after surgery due to graft hyperplasia. Grafts had to be removed. Whereas about 20--25mg were implanted, the removed grafts weighed 0.9--3.1g. Morphological examination showed signs of accelerated growth, infiltration of adjacent structures and invasion of blood vessels. For total removal, repeated and extensive surgery was necessary. Conservative treatment failed to prevent tumour-like growth of autografts. We no longer recommend parathyroidectomy with autotransplantation of parathyroid tissue as the method of choice for the surgical treatment of renal hyperparathyroidism.