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Procurement of Parathyroid Glands from Living Donor Pigs and Ex Vivo Identification
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Parathyroid Allotransplantation: A Systematic Review.

Jaimie L H Zhang1, Natasha M Appelman-Dijkstra2, Abbey Schepers1

  • 1Department of Surgery, Leiden University Medical Center, 2333 Leiden, The Netherlands.

Medical Sciences (Basel, Switzerland)
|March 24, 2022
PubMed
Summary

Parathyroid allotransplantation shows potential for hypoparathyroidism, but its efficacy is hampered by diverse methods and low-quality studies. Establishing a standardized definition of success is crucial for future high-quality trials.

Keywords:
cell transplantationhypoparathyroidismimmunosuppressionmacro-encapsulationmicroencapsulationparathyroid allotransplantation

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Area of Science:

  • Endocrinology and Metabolic Diseases
  • Transplantation Immunology
  • Regenerative Medicine

Background:

  • Hypoparathyroidism lacks effective treatments, with patients often refractory to calcium and vitamin D supplementation.
  • Parathyroid allotransplantation offers a potential one-time cure by restoring parathyroid function.

Purpose of the Study:

  • To systematically review and outline possibilities of parathyroid allotransplantation.
  • To calculate the efficacy of parathyroid allotransplantation.
  • To identify transplantation characteristics associated with successful outcomes.

Main Methods:

  • Systematic literature review adhering to PRISMA guidelines.
  • Searched medical databases with the last search on December 9, 2021.
  • Identified 24 articles detailing 203 transplantations in 148 patients.

Main Results:

  • High heterogeneity observed in transplantation techniques, cryopreservation, in vitro processing, immunosuppression, and graft histology.
  • A pooled success rate of 46% (13/28 transplantations) was calculated using a self-defined criterion.
  • Median follow-up duration was 12 months (Q1-Q3: 8-24 months).

Conclusions:

  • Parathyroid allotransplantation presents diverse approaches but faces challenges due to clinical variability, limited expertise, and poor study quality.
  • Transplantations with permanent immunosuppression appear promising, but evidence quality is low.
  • A standardized definition of transplantation success and high-quality trials are essential to determine efficacy for hypoparathyroidism.