AUTOTRANSPLANTATION OF PARATHYROID-GLANDS INTO SUBCUTANEOUS FOREARM TISSUE FOR RENAL HYPERPARATHYROIDISM

Background. Autotransplantation of diseased parathyroid glands into su bcutaneous adipose tissue has been mentioned previously, but as far as we know there is no previous systemic study concerning parathyroid fu nction after subcutaneous autotransplantation. Methods. From January 1 993 to June 1996, total parathyroidectomy and autotransplantation were carried out in 46 patients with renal hyperparathyroidism. The sympto ms and signs before operation were intractable pruritus in 29 patients (63%), bone pain in 27 patients (58. 7%), general weakness in 17 pati ents (37%), soft tissue calcification in 15 patients (32. 6%), bone fr acture in one patient, and failure to thrive in one patient. Twenty-fo ur patients (group A) underwent autotransplantation GO mg of a diffuse hyperplastic parathyroid gland into subcutaneous forearm tissue, and 22 patients (group B) underwent autotransplantation of 15 pieces (60 m g) of 1 mm(3) tissue into forearm muscles, as mentioned previously. Fo ur patients in group A and one in group B who had high levels of intac t parathyroid hormone (I-PTH) immediately after operation were exclude d. After the operation, calcium carbonate, 1.5 to 16 gm daily, and cal citriol, 0.25 to 1.5 mu g/daily, were prescribed according to the pati ents' calcium levels. Results. After 6 months, all patients in both gr oups were given calcium carbonate, 1 gm/day, and calcitrol, 0. 25 mu g /day, for parathyroid suppression, and none had to take more medicine to maintain calcium levels. There were no significant differences betw een the two groups regarding serum calcium, phosphorous, alkaline phos phatase, and I-PTH levels 1 week, 3 to 6 months, and 1 year after oper ation. Eighteen patients in group A and 19 patients in group B had nor mal levels of I-PTH 1 year after operation. In the follow-up period fr om 1 to 3 1/2 years, only one patient in group A had a subnormal I-PTH level and one in group B had graft-dependent hyperparathyroidism. Con clusions. We therefore suggest that autotransplantation of a parathyro id gland into forearm subcutaneous tissue for renal hyperparathyroidis m is as effective as autotransplantation into forearm muscles and can be done easier.