5 TO 10 YEARS FOLLOW-UP AFTER TOTAL PARATHYROIDECTOMY AND AUTOTRANSPLANTATION OF PARATHYROID TISSUE - EVALUATION OF PARATHYROID FUNCTION BYUSE OF ISCHEMIC BLOCKADE MANEUVER

The aim of the present study was to assess the long-term function of a utotransplanted parathyroid tissue in patients with chronic renal dise ase. We examined the medical records of a consecutive series of 21 pat ients with chronic renal failure, who had undergone total parathyroide ctomy with autotransplantation. During the time of follow-up, on avera ge 79 months, one patient developed graft-dependent recurrent hyperpar athyroidism and one patient suffered from persistent hypoparathyroidis m. Nine of the patients were available for a clinical study. In these patients we measured the plasma concentration of intact PTH in blood f rom the arm contralateral to the graft-bearing arm at rest and during a short-lasting ischaemic blockade of the graft site from the circulat ing blood. At rest all nine patients had parathyroid hormone (PTH) val ues within the normal range. The ischaemic blockade produced a marked reduction in the plasma concentration of intact PTH in eight of the pa tients indicating well functioning autografts. Prior to the examinatio n the patient with recurrent hyperparathyroidism had undergone resecti on of the autograft. In this patient, ischaemia of the former graft si te did not cause any change in the concentration of PTH indicating nor mally functioning residual parathyroid tissue in the neck. Thus, the i schaemic blockade manoeuvre seems suitable for the assessment of autog rafted parathyroid tissue. Our results indicate that total parathyroid ectomy with autotransplantation provides a rational alternative to the surgical treatment of secondary hyperparathyroidism.