Year 2014 Vol. 22 No 5

TRANSPLANTOLOGY

A.M. PISARENKO1,2, Y.E. DEMIDCHIK1, O.V. ILYINCHYK1,3, V.Y.KHRYSHCHANOVICH4, A.N. KOZLOVSKAYA2,4, D.G. BALASHOVA4, O.I. KENDENKOV4

SURGICAL TREATMENT RESULTS OF SECONDARY HYPERPARATHYROIDISM WITH PARATHYROID AUTOTRANSPLANTATION APPLICATION

SEE Belarusian Medical Academy of Post-graduate Education 1,
ME Minsk City Clinical Ontological Dispensary 2,
ME The 1st City Clinical Hospital3, Minsk,
EE Belarusian State Medical University4, Minsk,
The Republic of Belarus

Objectives. To study the effectiveness of surgical treatment of the secondary hyperparathyroidism with parathyroid autotransplantation application.
Methods. A retrospective data analysis of 39 patients receiving the renal replacement therapy in hemodialysis department of ME The 1st Clinical Hospital and suffering from the secondary hyperparathyroidism; they were subjected to parathyroidectomy (PTE) with autotransplantation of the parathyroid tissue on the basis of the head and neck tumors department of ME Minsk City Clinical Oncologic Dispensary. Patients average age was 50 [44-55] years. Parathyroid autograft was stored in sterile cold NaCl solution, grinded and implanted into brachioradialis muscle of the forearm. Serum levels of calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase have been evaluated in the postoperative period.
Results. Postoperative follow-up period made up 21 [12-24] months. Transient hypocalcaemia has developed in 5 patients. The recurrence of hyperparathyroidism was observed in two cases and reoperation was carried out. During follow-up period we observed the stable and statistically significant (P≤0,01) reduction of serum PTH, calcium and phosphate in comparison with initial levels, wherein differences in the level of PTH in 1 month and 24 months after PTE was unreliable (p<0,8). Sensitivity of US and scintigraphy of the parathyroid glands with Tc-99m-MIB I in regard to the nature of parathyroid pathology was 79.9%.
Conclusion. Total PTE with autologous parathyroid tissue transplantation in the forearm muscles is considered to be a highly effective and pathogenetic reasonable method of treatment of severe secondary renal hyperparathyroidism in dialysis patients. Along with safety, a small number of complications and the lack of lethality, the developed technology allowed reducing the recurrence rate of hyperparathyroidism, preventing the development of postoperative hypoparathyroidism, achieving a good cosmetic effect, shortening the time of hospitalization.

Keywords: chronic renal insufficiency, secondary hyperparathyroidism, surgical treatment, autotransplantation
p. 582-588 of the original issue
References
  1. Cohen EP, Moulder JE.Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery? Nephron. 2001 Nov;89(3):27173.
  2. Albright F, Baird PC, Cope O, Bloomberg E. Studies on the physiology of parathyroid glands. IV. Renal complications of hyperparathyroidism. Am. J. Med. Sci. 1934;187(1):4964.
  3. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK.Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001 Oct;12(10):213138.
  4. Raggi P, Boulay A, Chasan-Taber S, Amin N, Dillon M, Burke SK, Chertow GM.Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol. 2002 Feb 20;39(4):695701.
  5. Llach F.Secondary hyperparathyroidism in renal failure: the trade-off hypothesis revisited. Am J Kidney Dis. 1995 May;25(5):66379.
  6. Fournier A, Moriniere PH, Oprisiu R, Yverneau-Hardy P, Westeel PF, Mazouz H, el Esper N, Ghazali A, Boudailliez B.1-alpha-Hydroxyvitamin D3 derivatives in the treatment of renal bone diseases: justification and optimal modalities of administration. Nephron. 1995;71(3):25483.
  7. Gourgiotis S, Moustafellos P, Stratopoulos C, Vougas V, Drakopoulos S, Hadjiyannakis E.Total parathyroidectomy with autotransplantation in patients with renal hyperparathyroidism: indications and surgical approach. Hormones (Athens). 2006 Oct-Dec;5(4):27075.
  8. Salem MM.Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis. 1997 Jun;29(6):86265.
  9. Chang CW, Tsue TT, Hermreck AS, Baxter KG, Hoover LA.Efficacy of preoperative dual-phase sestamibi scanning in hyperparathyroidism. Am J Otolaryngol. 2000 Nov-Dec;21(6):35559.
  10. Takagi H, Tominaga Y, Uchida K, Yamada N, Morimoto T, Yasue M.Image diagnosis of parathyroid glands in chronic renal failure. Ann Surg. 1983 Jul;198(1):7479.
  11. Takagi H, Tominaga Y, Uchida K, Yamada N, Kawai M, Kano T, Funahashi H, Mizuno S.Evaluation of image-diagnosing methods of enlarged parathyroid glands in chronic renal failure. World J Surg. 1986 Aug;10(4):60511.
  12. Numano M, Tominaga Y, Uchida K, Orihara A, Tanaka Y, Takagi H. Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg. 1998 Oct;22(10):1098102; discussion 1103.
  13. Yueming Sun, Huihua Cai, Jianfeng Bai, Hanlin Zhao, and Yi Miao Endoscopic Total Parathyroidectomy and Partial Parathyroid Tissue Autotransplantation for Patients with Secondary Hyperparathyroidism: A New Surgical Approach. World J Surg. Aug 2009; 33(8): 16741679.
  14. Chou F-F, Chi S-Y, Hsieh K-C. Hypoparathyroidism after total parathyroidectomy plus subcutaneous autotransplantation for secondary hyperparathyroidism any side effects? World J. Surg. 2010:34(10):235054.
  15. Sohal AS, Gangji AS, Crowther MA, Treleaven D.Uremic bleeding: pathophysiology and clinical risk factors. Thromb Res. 2006;118(3):41722.
  16. Chapelle T, Meuris K, Roeyen G, De Greef K, Van Beeumen G, Bosmans JL, Ysebaert D.Simultaneous kidney-parathyroid allotransplantation from a single donor after 20 years of tetany: a case report. Transplant Proc. 2009 Mar;41(2):599600.
  17. Tonelli M, Klarenbach S, Rose C, Wiebe N, Gill J.Access to kidney transplantation among remote- and rural-dwelling patients with kidney failure in the United States. JAMA. 2009 Apr 22;301(16):168190.
Address for correspondence:
220116 Respublika Belarus,
g. Minsk, prospekt Dzerzhinskogo, d. 83,
UO Belorusskiy gosudarstvennyiy meditsinskiy universitet,
2-ya kafedra hirurgicheskih bolezney,
tel. office: 375 17 287-86-52,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Yanovich
Information about the authors:
Pisarenko A.M. Head of the head and neck tumors unit of ME Minsk City Clinical Oncologic Dispensary.
Demidchik Y.E. MD, professor, corresponding member of NAS RB, Rector of SEE Belarusian Medical Academy of Post-graduate Training.
Ilyinchyk O.V. A nephrologists, head of the hemodialysis department with the unit of peritoneal dialysis of ME The 1st City Clinical Hospital.
Khryshchanovich V.Y. PhD, associate professor of the 2nd surgical diseases chair of EE Belarusian State Medical University.
Kozlovskaya A.N. PhD, an assistant of the oncology chair of EE Belarusian State Medical University.
Kendenkov O.I. A 6-year student of EE Belarusian State Medical University.
Balashova D.G. A 6-year student of EE Belarusian State Medical University.
Contacts | ©Vitebsk State Medical University, 2007-2023