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. 2021 May 1;21(1):226.
doi: 10.1186/s12893-021-01222-2.

Total parathyroidectomy with forearm autotransplantation in secondary hyperparathyroidism patients: analysis of muscle, subcutaneous and muscle + subcutaneous method

Bin Zhou #  1   2 , Lei Zhu #  2 , Cheng Xiang  1 , Feng Cheng  2 , Xi Zhu  2 , Yi Zhou  2 , Yong Wang  3
Affiliations

Total parathyroidectomy with forearm autotransplantation in secondary hyperparathyroidism patients: analysis of muscle, subcutaneous and muscle + subcutaneous method

Bin Zhou et al. BMC Surg. .

Abstract

Background: Forearm autotransplantation after parathyroidectomy has turned into the standard method for secondary hyperparathyroidism (SHPT) treatment in chronic kidney disease patients. Our study aimed to explore the effects of three methods including muscle, subcutaneous and muscle + subcutaneous transplant methods on SHPT.

Methods: Seventy five SHPT patients were enrolled and assigned into the muscle + subcutaneous (M + S) (n = 26), muscle (M) (n = 35), and subcutaneous (S) (n = 14) groups. The operation efficacy evaluation included preoperative and postoperative biological characteristics such as parathyroid hormone (PTH), serum phosphorus, serum calcium and alkaline phosphatase (ALP). The data were recorded from pre-operation time point to 1, 2, 3, 6, 12, 18, 24 month (mo) postoperation periods. After operation, short-form health survey (SF-36) scores was made for life quality identification at 1, 2, 3, 6, 12, 24 time points. Symptoms about SHPT including bone pain, fracture, pruritus, and coronary artery calcification were followed-up based on the scale.

Results: Compared with the preoperative record, all the M + S, M, and S groups showed postoperative decreased levels of PTH, serum phosphorus, serum calcium, calcium-phosphorus. In M + S group, the PTH and serum calcium level kept more steady compared with the M and S groups during a 24 mo duration observation. After this, a SF-36 score scale which represents the life quality show M + S group got more scores at 3, 6, 12, 18 and 24 mo points. At last, the incidence of SHPT associated symptoms including Bone pain, Fracture, Pruritus, and Coronary artery calcification in M + S group were decreased compared with M and S groups at 1, 3, 6, 12 and 24 mo post-operation time points.

Conclusion: M + S seems to be an efficient method for medical treatment of SHPT patients in the control of PTH and serum calcium. This mixed transplant strategy improves the biochemical characterizes compared with M and S groups in SHPT patients. Furthermore, the M + S method make beneficial on clinical outcomes and life quality of patients.

Keywords: Forearm autotransplantation; Muscle and subcutaneous transplantation; Secondary hyperparathyroidism.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
SF-36 scores in M + S, M and S groups
Fig. 2
Fig. 2
Parathyroid pieces preparation. a Four Parathyroid glands were confirmed and dissected b One parathyroid gland was cut into 15 1 × 1 mm pieces
Fig. 3
Fig. 3
Parathyroid transplant procedure. a M group b S group c M + S group
See this image and copyright information in PMC

References

    1. Ivarsson KM, Akaberi S, Isaksson E, Reihner E, Rylance R, Prutz KG, Clyne N, Almquist M. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant. 2015;30(12):2027–2033. - PMC - PubMed
    1. Ketteler M, Martin KJ, Cozzolino M, Goldsmith D, Sharma A, Khan S, Dumas E, Amdahl M, Marx S, Audhya P. Paricalcitol versus cinacalcet plus low-dose vitamin D for the treatment of secondary hyperparathyroidism in patients receiving haemodialysis: study design and baseline characteristics of the IMPACT SHPT study. Nephrol Dial Transplant. 2012;27(5):1942–1949. - PMC - PubMed
    1. Sayar H, Sahin M, Dogan PO, Karabulut S, Seringec N, Oguz A. Immunohistochemical expression of Insulin-like growth factor-1, Transforming growth factor-beta1, and Vascular endothelial growth factor in parathyroid adenoma and hyperplasia. Indian J Pathol Microbiol. 2014;57(4):549–552. - PubMed
    1. Ho LC, Hung SY, Wang HH, Kuo TH, Chang YT, Tseng CC, Wu JL, Li CY, Wang JD, Tsai YS, Sung JM, STainan RDSg. Parathyroidectomy associates with reduced mortality in Taiwanese dialysis patients with hyperparathyroidism: evidence for the controversy of current guidelines. Sci Rep. 2016;6:19150. - PMC - PubMed
    1. Behets GJ, Spasovski G, Sterling LR, Goodman WG, Spiegel DM, De Broe ME, D'Haese PC. Bone histomorphometry before and after long-term treatment with cinacalcet in dialysis patients with secondary hyperparathyroidism. Kidney Int. 2015;87(4):846–856. - PMC - PubMed

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