甲状旁腺自体移植冷冻保存的结果：一项回顾性多中心研究。

Results of cryopreserved parathyroid autografts: a retrospective multicenter study.

机构信息

Endocrinology Department, University Hospital, Besançon, France.

出版信息

Surgery. 2010 Apr;147(4):529-35. doi: 10.1016/j.surg.2009.10.010. Epub 2010 Feb 12.

DOI:10.1016/j.surg.2009.10.010

PMID:20153007

Abstract

BACKGROUND

The functionality of cryopreserved parathyroid autotransplantation (CPAT) has been evaluated in few studies, mostly conducted by experienced single-institution centers that have reported different success rates ranging from 17% to 83%. In France, CPAT are rare and their functionality has never been evaluated. Moreover, French tissue banks are facing an accumulation of ungrafted samples. The aim of our work was to evaluate the implantation rate of cryopreserved parathyroid samples and the functionality of CPAT in a multicenter study.

METHODS

Data from 9 French tissue banks were analyzed. CPAT functionality was defined as fully functional (normal parathyroid hormone [PTH] and calcium levels without treatment), partially functional (normal PTH levels but need for treatment to maintain normocalcemia), and nonfunctional (low PTH levels and need for treatment). For dialyzed patients, CPAT was considered nonfunctional if the PTH level in the nongrafted arm was less than 20 pg/mL, partially functional if the PTH level was between 20 and 50 pg/mL, and fully functional if the PTH level was between 50 and 300 pg/mL.

RESULTS

The 9 centers had cryopreserved 1376 samples of parathyroid tissue and only 22 (1.6%) had been autografted in 20 patients (65% renal hyperparathyroidism, 20% multiple endocrine neoplasia type 1, 15% "other") by 12 different surgical teams. The median duration of storage was 11.1 months (range, 0.4-28.5). Only 2 autografts (10%) were fully functional, 2 (10%) were partially functional, and 17 (80%) were nonfunctional at 26 months median follow-up.

CONCLUSION

The reimplantation rate is low, and the functionality of CPAT is less than those published by experienced centers. Logistical and technical problems occurring in less experienced centers are probably the main reasons for nonfunctioning implants. Considering the results of this study, we suggest that cryopreservation of parathyroid glands should be abandoned when not performed in very large experimented centers, that CPAT should be used only for patients with hyperplasic parathyroid tissue, and that tissue samples should be systematically destroyed when patients do not have hypoparathyroidism or after 1 year of storage.

摘要

背景

冷冻保存甲状旁腺自体移植（CPAT）的功能已在少数研究中进行了评估，这些研究主要由经验丰富的单一机构中心进行，这些中心报告的成功率从 17%到 83%不等。在法国，CPAT 很少见，其功能从未得到过评估。此外，法国组织库正面临未移植样本的堆积。我们的工作目的是在一项多中心研究中评估冷冻保存甲状旁腺样本的植入率和 CPAT 的功能。

方法

分析了 9 家法国组织库的数据。CPAT 的功能被定义为完全功能（正常甲状旁腺激素[PTH]和钙水平，无需治疗）、部分功能（正常 PTH 水平但需要治疗以维持正常钙血症）和无功能（低 PTH 水平和需要治疗）。对于透析患者，如果非移植臂的 PTH 水平低于 20pg/mL，则认为 CPAT 无功能，如果 PTH 水平在 20 至 50pg/mL 之间，则部分功能，如果 PTH 水平在 50 至 300pg/mL 之间，则完全功能。

结果

9 个中心共冷冻保存了 1376 个甲状旁腺组织样本，仅在 20 名患者（65%为肾性甲状旁腺功能亢进症，20%为多发性内分泌肿瘤 1 型，15%为“其他”）中进行了 22 次自体移植（12 名不同手术团队）。冷冻保存的中位时间为 11.1 个月（范围为 0.4-28.5）。在 26 个月的中位随访中，仅 2 例（10%）自体移植完全功能，2 例（10%）部分功能，17 例（80%）无功能。

结论

再植入率较低，CPAT 的功能低于经验丰富的中心报告的功能。在经验较少的中心，发生的后勤和技术问题可能是植入物功能丧失的主要原因。考虑到这项研究的结果，我们建议在没有在非常大的经验丰富的中心进行的情况下，应放弃甲状旁腺的冷冻保存，CPAT 仅应用于增生性甲状旁腺组织的患者，并且当患者没有甲状旁腺功能减退或在储存 1 年后，应系统地破坏组织样本。