Long-term functionality of cryopreserved parathyroid autografts: A 13-year prospective analysis

Mark S. Cohen, William G. Dilley, Samuel A. Wells, Jeffrey F. Moley, Gerard M. Doherty, Gregorio A. Sicard, Michael A. Skinner, Jeffrey A. Norton, Mary K. DeBenedetti, Terry C. Lairmore, Clive Grant, Ashok R. Shaha, Andrew Saxe, Bradford K. Mitchell, Michael J. Demeure, Steven K. Libutti, Antonio Sitges-Serra

Research output: Contribution to journalArticle

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Abstract

Background. The functional results of cryopreserved heterotopic parathyroid autotransplantation (CHPA) are not well defined. The authors evaluated the outcomes of delayed CHPA for the treatment of surgically induced hypoparathyroidism. Methods. Since November 1991, 448 parathyroid samples from 436 patients were cryopreserved at our institution. Of these, 29 patients underwent 34 CHPA procedures, with placement of 20 to 25 pieces of parathyroid tissue (approximately 50 to 75 mg) into the forearm. Outcomes were determined based on peripheral parathyroid hormone (PTH) levels and, where available, PTH gradients between grafted and nongrafted arms. Graft function results were defined as completely functional (patients with normal PTH and calcium levels off all calcium/vitamin D supplementation), partially functional (normal PTH levels and mild hypocalcemia on calcium supplementation), or nonfunctional (low PTH levels and dependent on calcium/vitamin D supplementation). Results. Of the 29 patients with CHPA, prospective data were available for 26 patients undergoing 30 CHPA procedures (9 patients with MEN 1, 4 with MEN 2A, 1 with MEN 2B, and 12 with sporadic hyperparathyroidism). The mean follow-up interval was 2 years. Twelve of 26 patients (46%) had completely functional grafts, 6 patients (23%) had partially functional grafts, and the remaining 8 patients (31%) had nonfunctional grafts. No patient with CHPA had graft-dependent recurrent hyperparathyroidism. Of the 14 patients (15 autografts) with MEN, 7 patients (50%) had fully functional grafts, and 2 patients (14%) had partially functional grafts. The mean cryopreservation period was 7.9 months (range, 1 week to 22 months) for functional autografts and 15.3 months (range, 2 weeks to 106 months) for nonfunctional autografts (P < .01). Conclusions. Based on these data and those in previous studies, approximately 60% of delayed, cryopreserved parathyroid autografts are functional. In this study 40% autografts (46% of patients) achieved full competency off supplements. Some patients have evidence of graft function with normal PTH levels but are not normocalcemic. Results were similar for patients with MEN and nonhereditary hyperparathyroidism. The duration of cryopreservation was a significant indicator of graft failure, and no functional autograft was observed beyond 22 months of preservation. CHPA is a useful treatment modality for patients with postoperative hypocalcemia after thyroid or parathyroid surgery, who do not respond to immediate parathyroid autotransplantation.

Original languageEnglish (US)
Pages (from-to)1033-1041
Number of pages9
JournalSurgery
Volume138
Issue number6
DOIs
StatePublished - Dec 2005

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Autografts
Autologous Transplantation
Parathyroid Hormone
Transplants
Hyperparathyroidism
Calcium
Multiple Endocrine Neoplasia Type 1
Hypocalcemia
Cryopreservation
Vitamin D
Multiple Endocrine Neoplasia Type 2b
Multiple Endocrine Neoplasia Type 2a
Hypoparathyroidism
Forearm

ASJC Scopus subject areas

  • Surgery

Cite this

Cohen, M. S., Dilley, W. G., Wells, S. A., Moley, J. F., Doherty, G. M., Sicard, G. A., ... Sitges-Serra, A. (2005). Long-term functionality of cryopreserved parathyroid autografts: A 13-year prospective analysis. Surgery, 138(6), 1033-1041. https://doi.org/10.1016/j.surg.2005.09.029

Long-term functionality of cryopreserved parathyroid autografts : A 13-year prospective analysis. / Cohen, Mark S.; Dilley, William G.; Wells, Samuel A.; Moley, Jeffrey F.; Doherty, Gerard M.; Sicard, Gregorio A.; Skinner, Michael A.; Norton, Jeffrey A.; DeBenedetti, Mary K.; Lairmore, Terry C.; Grant, Clive; Shaha, Ashok R.; Saxe, Andrew; Mitchell, Bradford K.; Demeure, Michael J.; Libutti, Steven K.; Sitges-Serra, Antonio.

In: Surgery, Vol. 138, No. 6, 12.2005, p. 1033-1041.

Research output: Contribution to journalArticle

Cohen, MS, Dilley, WG, Wells, SA, Moley, JF, Doherty, GM, Sicard, GA, Skinner, MA, Norton, JA, DeBenedetti, MK, Lairmore, TC, Grant, C, Shaha, AR, Saxe, A, Mitchell, BK, Demeure, MJ, Libutti, SK & Sitges-Serra, A 2005, 'Long-term functionality of cryopreserved parathyroid autografts: A 13-year prospective analysis', Surgery, vol. 138, no. 6, pp. 1033-1041. https://doi.org/10.1016/j.surg.2005.09.029
Cohen MS, Dilley WG, Wells SA, Moley JF, Doherty GM, Sicard GA et al. Long-term functionality of cryopreserved parathyroid autografts: A 13-year prospective analysis. Surgery. 2005 Dec;138(6):1033-1041. https://doi.org/10.1016/j.surg.2005.09.029
Cohen, Mark S. ; Dilley, William G. ; Wells, Samuel A. ; Moley, Jeffrey F. ; Doherty, Gerard M. ; Sicard, Gregorio A. ; Skinner, Michael A. ; Norton, Jeffrey A. ; DeBenedetti, Mary K. ; Lairmore, Terry C. ; Grant, Clive ; Shaha, Ashok R. ; Saxe, Andrew ; Mitchell, Bradford K. ; Demeure, Michael J. ; Libutti, Steven K. ; Sitges-Serra, Antonio. / Long-term functionality of cryopreserved parathyroid autografts : A 13-year prospective analysis. In: Surgery. 2005 ; Vol. 138, No. 6. pp. 1033-1041.
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abstract = "Background. The functional results of cryopreserved heterotopic parathyroid autotransplantation (CHPA) are not well defined. The authors evaluated the outcomes of delayed CHPA for the treatment of surgically induced hypoparathyroidism. Methods. Since November 1991, 448 parathyroid samples from 436 patients were cryopreserved at our institution. Of these, 29 patients underwent 34 CHPA procedures, with placement of 20 to 25 pieces of parathyroid tissue (approximately 50 to 75 mg) into the forearm. Outcomes were determined based on peripheral parathyroid hormone (PTH) levels and, where available, PTH gradients between grafted and nongrafted arms. Graft function results were defined as completely functional (patients with normal PTH and calcium levels off all calcium/vitamin D supplementation), partially functional (normal PTH levels and mild hypocalcemia on calcium supplementation), or nonfunctional (low PTH levels and dependent on calcium/vitamin D supplementation). Results. Of the 29 patients with CHPA, prospective data were available for 26 patients undergoing 30 CHPA procedures (9 patients with MEN 1, 4 with MEN 2A, 1 with MEN 2B, and 12 with sporadic hyperparathyroidism). The mean follow-up interval was 2 years. Twelve of 26 patients (46{\%}) had completely functional grafts, 6 patients (23{\%}) had partially functional grafts, and the remaining 8 patients (31{\%}) had nonfunctional grafts. No patient with CHPA had graft-dependent recurrent hyperparathyroidism. Of the 14 patients (15 autografts) with MEN, 7 patients (50{\%}) had fully functional grafts, and 2 patients (14{\%}) had partially functional grafts. The mean cryopreservation period was 7.9 months (range, 1 week to 22 months) for functional autografts and 15.3 months (range, 2 weeks to 106 months) for nonfunctional autografts (P < .01). Conclusions. Based on these data and those in previous studies, approximately 60{\%} of delayed, cryopreserved parathyroid autografts are functional. In this study 40{\%} autografts (46{\%} of patients) achieved full competency off supplements. Some patients have evidence of graft function with normal PTH levels but are not normocalcemic. Results were similar for patients with MEN and nonhereditary hyperparathyroidism. The duration of cryopreservation was a significant indicator of graft failure, and no functional autograft was observed beyond 22 months of preservation. CHPA is a useful treatment modality for patients with postoperative hypocalcemia after thyroid or parathyroid surgery, who do not respond to immediate parathyroid autotransplantation.",
author = "Cohen, {Mark S.} and Dilley, {William G.} and Wells, {Samuel A.} and Moley, {Jeffrey F.} and Doherty, {Gerard M.} and Sicard, {Gregorio A.} and Skinner, {Michael A.} and Norton, {Jeffrey A.} and DeBenedetti, {Mary K.} and Lairmore, {Terry C.} and Clive Grant and Shaha, {Ashok R.} and Andrew Saxe and Mitchell, {Bradford K.} and Demeure, {Michael J.} and Libutti, {Steven K.} and Antonio Sitges-Serra",
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T1 - Long-term functionality of cryopreserved parathyroid autografts

T2 - A 13-year prospective analysis

AU - Cohen, Mark S.

AU - Dilley, William G.

AU - Wells, Samuel A.

AU - Moley, Jeffrey F.

AU - Doherty, Gerard M.

AU - Sicard, Gregorio A.

AU - Skinner, Michael A.

AU - Norton, Jeffrey A.

AU - DeBenedetti, Mary K.

AU - Lairmore, Terry C.

AU - Grant, Clive

AU - Shaha, Ashok R.

AU - Saxe, Andrew

AU - Mitchell, Bradford K.

AU - Demeure, Michael J.

AU - Libutti, Steven K.

AU - Sitges-Serra, Antonio

PY - 2005/12

Y1 - 2005/12

N2 - Background. The functional results of cryopreserved heterotopic parathyroid autotransplantation (CHPA) are not well defined. The authors evaluated the outcomes of delayed CHPA for the treatment of surgically induced hypoparathyroidism. Methods. Since November 1991, 448 parathyroid samples from 436 patients were cryopreserved at our institution. Of these, 29 patients underwent 34 CHPA procedures, with placement of 20 to 25 pieces of parathyroid tissue (approximately 50 to 75 mg) into the forearm. Outcomes were determined based on peripheral parathyroid hormone (PTH) levels and, where available, PTH gradients between grafted and nongrafted arms. Graft function results were defined as completely functional (patients with normal PTH and calcium levels off all calcium/vitamin D supplementation), partially functional (normal PTH levels and mild hypocalcemia on calcium supplementation), or nonfunctional (low PTH levels and dependent on calcium/vitamin D supplementation). Results. Of the 29 patients with CHPA, prospective data were available for 26 patients undergoing 30 CHPA procedures (9 patients with MEN 1, 4 with MEN 2A, 1 with MEN 2B, and 12 with sporadic hyperparathyroidism). The mean follow-up interval was 2 years. Twelve of 26 patients (46%) had completely functional grafts, 6 patients (23%) had partially functional grafts, and the remaining 8 patients (31%) had nonfunctional grafts. No patient with CHPA had graft-dependent recurrent hyperparathyroidism. Of the 14 patients (15 autografts) with MEN, 7 patients (50%) had fully functional grafts, and 2 patients (14%) had partially functional grafts. The mean cryopreservation period was 7.9 months (range, 1 week to 22 months) for functional autografts and 15.3 months (range, 2 weeks to 106 months) for nonfunctional autografts (P < .01). Conclusions. Based on these data and those in previous studies, approximately 60% of delayed, cryopreserved parathyroid autografts are functional. In this study 40% autografts (46% of patients) achieved full competency off supplements. Some patients have evidence of graft function with normal PTH levels but are not normocalcemic. Results were similar for patients with MEN and nonhereditary hyperparathyroidism. The duration of cryopreservation was a significant indicator of graft failure, and no functional autograft was observed beyond 22 months of preservation. CHPA is a useful treatment modality for patients with postoperative hypocalcemia after thyroid or parathyroid surgery, who do not respond to immediate parathyroid autotransplantation.

AB - Background. The functional results of cryopreserved heterotopic parathyroid autotransplantation (CHPA) are not well defined. The authors evaluated the outcomes of delayed CHPA for the treatment of surgically induced hypoparathyroidism. Methods. Since November 1991, 448 parathyroid samples from 436 patients were cryopreserved at our institution. Of these, 29 patients underwent 34 CHPA procedures, with placement of 20 to 25 pieces of parathyroid tissue (approximately 50 to 75 mg) into the forearm. Outcomes were determined based on peripheral parathyroid hormone (PTH) levels and, where available, PTH gradients between grafted and nongrafted arms. Graft function results were defined as completely functional (patients with normal PTH and calcium levels off all calcium/vitamin D supplementation), partially functional (normal PTH levels and mild hypocalcemia on calcium supplementation), or nonfunctional (low PTH levels and dependent on calcium/vitamin D supplementation). Results. Of the 29 patients with CHPA, prospective data were available for 26 patients undergoing 30 CHPA procedures (9 patients with MEN 1, 4 with MEN 2A, 1 with MEN 2B, and 12 with sporadic hyperparathyroidism). The mean follow-up interval was 2 years. Twelve of 26 patients (46%) had completely functional grafts, 6 patients (23%) had partially functional grafts, and the remaining 8 patients (31%) had nonfunctional grafts. No patient with CHPA had graft-dependent recurrent hyperparathyroidism. Of the 14 patients (15 autografts) with MEN, 7 patients (50%) had fully functional grafts, and 2 patients (14%) had partially functional grafts. The mean cryopreservation period was 7.9 months (range, 1 week to 22 months) for functional autografts and 15.3 months (range, 2 weeks to 106 months) for nonfunctional autografts (P < .01). Conclusions. Based on these data and those in previous studies, approximately 60% of delayed, cryopreserved parathyroid autografts are functional. In this study 40% autografts (46% of patients) achieved full competency off supplements. Some patients have evidence of graft function with normal PTH levels but are not normocalcemic. Results were similar for patients with MEN and nonhereditary hyperparathyroidism. The duration of cryopreservation was a significant indicator of graft failure, and no functional autograft was observed beyond 22 months of preservation. CHPA is a useful treatment modality for patients with postoperative hypocalcemia after thyroid or parathyroid surgery, who do not respond to immediate parathyroid autotransplantation.

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