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2017 г. №1 Том 25

ТРАHСПЛАHТОЛОГИЯ

DOI: https://dx.doi.org/10.18484/2305-0047.2017.1.44   |  

V.Y. KHRYSHCHANOVICH1, P.Y. VERSHININ2,
A.V. BOLSHOV1, S.I. TRETYAK1, E.I. KUZMENKOVA3, A.M. PISARENKO4, E.V. KHODOSOVSKAYA, T.S. KOLESNIKOVA1, O.O. RUMMO2

Allotransplantation of cultivated parathyroid cells of a living unrelated donor to recipient with renal transplant: first clinical observation

EE "Belarusian State Medical University"1,
ME "The 9th City Clinical Hospital", Minsk 2,
SE "Republican Center of Medical Rehabilitation and Balneotherapy"3,
ME "Minsk City Clinical Oncologic Dispensary"4,
Minsk,
The Republic of Belarus

Objectives. To demonstrate the possibility of successful treatment of a severe postsurgical hypoparathyroidism by the cultured parathyrocyte allotransplantation to a kidney transplant recipient.
Methods. A 37-year-old female with the kidney transplant and a severe postsurgical hypoparathyroidism on the background of intensive replacement therapy was a recipient of parathyroid allograft. The indications for parathyroid autotransplantation include symptoms of tetany, high convulsive readiness (Chvostek’s and Trousseau’s signs), extremely low rates of total/ionized calcium (1,71/0,98 mmol/L) and parathyroid hormone (1,7 pg/ml) in the peripheral blood. Culture (21×106) of parathyroid cells obtained from a living unrelated donor (62-year-old female) with the secondary hyperparathyroidism was implanted into the recipients’ left brachioradialis muscle. Site selection for parathyroid allograft was conditioned by the absence of arteriovenous fistula on the side of the transplantation. Immunosuppressive therapy consisted of 150 mg/day of cyclosporine, 720 mg/day of mycophenolic acid, 6 mg/day of methylprednisolone.
Results. No postoperative complications of the intervention, local and general side effects on the parathyroid cell allograft were observed. Clinical and laboratory improvement of hypoparathyroidism occurred 1 month after the transplantation: parathyroid hormone concentration increased up to 14,7 pg/ml and reached a maximum value (61,7 pg/mL) after 3,5 months. No convulsions were observed over a 6-month follow-up, Chvostek’s and Trousseau’s signs were stopped, the amount of oral substitution therapy significantly reduced, and there was no more need for parenteral administration of calcium salt solutions. Six months after transplantation a patient led a very active life and took per os 0,5 g/day of calcium.
Conclusion. Combined allotransplantation of cadaveric kidneys and cultured parathyroid cells obtained from the hyperplastic parathyroid tissue of a living unrelated donor is considered to be an effective treatment of permanent severe hypoparathyroidism in patients who need the organ transplantation with subsequent immunosuppressive therapy.

Ключевые слова: parathyroid cells allotransplantation, kidney transplant, intensive substitution therapy, surgical hypoparathyroidism, hyperplastic parathyroid tissue, immunosuppressive therapy, postoperative complications
с. 44-52 оригинального издания
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Адрес для корреспонденции:
220116, Republic of Belarus, Minsk,
Dzerzhinsky Av., 83,
EE "Belarusian State Medical University",
Department N2 of surgical diseases.
Tel.: 375 17 287-86-52
fax: 375 17 201-91-60
e-mail: vladimirkh77@mail.ru
Khryshchanovich Vladimir Yanovich
Cведения об авторах:
Khryshchanovich V.Y. MD, Ass. Professor of department N2 of surgical diseases, EE "Belarusian State Medical University".
Vershinin P.Y. Head of the nephrology and hemodyalysis unit, ME "The 9th City Clinical Hospital".
Bolshov A.V. PhD, Ass. Professor of department N2 of surgical diseases, EE "Belarusian State Medical University".
Tretyak S.I. Honored Worker of Science of the Republic of Belarus, MD, Professor, Corresponding Member of NAS of Belarus, Head of department N2 of surgical diseases, EE "Belarusian State Medical University".
Kuzmenkova E.I. Head of the endocrinology unit of SE "Republican Center of Medical Rehabilitation and Balneotherapy".
Pisarenko A.M. Head of the department of head and neck tumors of ME "Minsk City Clinical Oncologic Dispensary".
Khodosovskaya E.V. Senior researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Kolesnikova T.S. Senior researcher of the laboratory of biochemical methods of investigation, EE "Belarusian State Medical University".
Rummo O.O. Honored Worker of Science of the Republic of Belarus, MD, professor, Deputy Chief of surgery, ME "The 9th City Clinical Hospital", Minsk, Chief Freelance transplantologist of the Ministry of Health of the Republic of Belarus.
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