The current role of parathyroid cryopreservation and autotransplantation in parathyroid surgery: An institutional experience

Abstract

Background. Hypoparathyroidism after cervical exploration is a rare but problematic complication. Cryopreservation and subsequent autotransplantation of parathyroid tissue are infrequently used to combat this problem; effective usage of this surgical adjunct remains variable. Methods. From 1981 through 1995 we performed 3080 cervical explorations for hyperparathyroidism. Cryopreservation was performed in 112 (3.6%) patients. This review evaluates our indications and usage of cryopreservation and autotransplantation and the eventual outcome after autotransplantation. Results. Of 81 women and 31 men, 106 (95%) had undergone previous exploration for hyperparathyroidism or thyroid disease. The primary indication for cryopreservation was uncertainty about the viability and number of remaining parathyroid glands. After operation 23 patients (20%) were permanently hypocalcemic and became autotransplantation candidates. Thirteen patients underwent a total of 15 autotransplantations (median postoperative interval, 7 months). Although 6 of 15 grafts (40%) were shown to secrete parathyroid hormone, only three patients (23%) were normocalcemic without supplemental therapy. Conclusions. Cryopreservation with autotransplantation is in theory a sound but difficult practice to correct postexploration hypocalcemia. The principal indication for cryopreservation is the uncertainty regarding the status of remaining normal parathyroid tissue. Because we cannot predict postexploration hypocalcemia, cryopreservation plays a small but sometimes integral role in parathyroid surgery. Indications for cryopreservation in our practice are rare, and the rate of cryopreservation tissue usage is low.