Parathyroid autografts--morphology and function: six years' experience with parathyroid autotransplantation in uremic patients.

Abstract

AbstractRecurrence of hyperparathyroidism (HPT) following total parathyroidectomy and autotransplantation (APTX) has been reported before. However, no data about the time interval between grafting and relapse and about morphology were given. Only 1 case of primary hyperparathyroidism with APTX has been extensively analyzed.We have performed autotransplantation in 42 patients with HPT due to chronic renal failure. Implanted parathyroid tissue showed typical chief cell hyperplasia. Within 4–33 months, 6 patients developed recurrent HPT with serum iPTH levels being highest in venous blood of the grafted arm. Grafts had to be removed. Although only 20–40 mg of parathyroid tissue had been implanted, removed grafts weighed from 0.9 to 3.1 g. Explanted grafts were examined by light and electron microscopy. The size and DNA content of nuclei were determined. In all cases the explanted material showed a distinct invasive growth into the adjacent connective tissue and muscles and in 2 cases mitotic figures were demonstrated, a finding resembling malignant neoplasia of the parathyroid.From our clinical and morphological observations we draw the following conclusions: Surgical treatment of renal hyperparathyroidism by PTX + Auto‐TX unforeseeably may result in very accelerated growth of grafted tissue. Because of invasive growth there exists the risk of uncontrolled spread of parathyroid tissue. Graft removal may turn out to be difficult and possibly necessitate repeated and extensive surgery. Before the observed phenomenon is totally understood, we no longer recommend PTX + Auto‐TX as an alternative to subtotal PTX in the surgical treatment of renal hyperparathyroidism.