The Importance of Cryopreserved Parathyroid Tissue Autotransplantation in the Hypoparathyroidism Treatment after Secondary Hyperparathyroidism Surgery

Abstract

Introduction: Severe hypocalcemia is a rare but serious complication of secondary hyperparathyroidism (SH) surgery. Continuous intravenous calcium replacement is required and patients are not discharged. Cryopreserved parathyroid autotransplantation (CPA) is the most effective and lasting treatment option for severe hypocalcemia. However, a cryopreservation laboratory is necessary for this procedure. Methods: Subtotal parathyroidectomy performed 150 SH cases (age range: 26-69 years, mean age: 39.5 years, men/women: 2/1) were retrospectively evaluated. Severe hypocalcemia (serum calcium level of <6.5 mg/dL) was developed in 7 (4.6%) cases. CPA was performed and cases were observed in a minimum of 18 months. Results: After transplantation in five cases, intravenous and oral calcium replacement was ceased and cases were discharged. Transplantation failed in two cases, thus second time CPA. After the second CPA, intravenous calcium is ceased and cases were discharged. Any side effects or complications were not seen during the observation period. Conclusion: CPA is the most effective and lasting treatment option for severe hypocalcemia. CPA is not difficult to perform but a cryopreservation laboratory and experienced laboratory team are necessary for this procedure. The presence of this laboratory in SH surgery performed centers reduces the risk of mortality and morbidity.