Parathyroid graft function after presternal subcutaneous autotransplantation for renal hyperparathyroidism

HYPOTHESIS: Presternal subcutaneous autotransplantation of parathyroid tissue after total parathyroidectomy for renal hyperparathyroidism could be at least as effective as intramuscular grafting, without its complications. DESIGN: Prospective study of a postoperative diagnostic method of monitoring intact parathyroid hormone (iPTH) levels among a cohort of surgical patients, without loss to follow-up. SETTING: Hemodialysis unit in a university hospital. PATIENTS: Twenty-five patients (17 women and 8 men) underwent total parathyroidectomy and presternal subcutaneous autotransplantation for renal hyperparathyroidism at Donostia Hospital, San Sebastián, Spain, between January 1, 2002, and June 30, 2004. MAIN OUTCOME MEASURES: Evaluation of parathyroid graft function by measurement of serum iPTH levels at admission and 24 hours and 1, 3, 5, 15, 30, and 60 weeks after surgery. RESULTS: The mean +/- SD preoperative serum iPTH level was 1302 +/- 425 pg/mL; the iPTH level was undetectable in all patients 24 hours after surgery. Subsequent mean +/- SD iPTH levels obtained were 14 +/- 10 pg/mL after 1 week, 54 +/- 1 pg/mL after 5 weeks, 64 +/- 9 pg/mL after 15 weeks, 77 +/- 8 pg/mL after 30 weeks, and 106 +/- 21 pg/mL after 60 weeks. Autotransplanted parathyroid tissue appears to be adequately functional at week 5 (criterion level of adequate functioning, 50 pg/mL). CONCLUSIONS: Presternal subcutaneous autotransplantation after total parathyroidectomy for renal hyperparathyroidism may be an alternative to avoid musculus brachialis grafting and its complications. Our functional results compare favorably with the published data on other surgical techniques for the treatment of renal hyperparathyroidism. Long-term follow-up of this series is planned.