Parathyroid Transplantation

Yeditepe University Hospitals Parathyroid Transplantation Clinic is one of the rare clinics in the world where parathyroid transplantation is performed.

It is the ONLY multidisciplinary center performing parathyroid transplantation in the world.

Parathyroid transplantation, which is used in the treatment of patients with permanent hypoparathyroidism and is included in the organ transplant classification, is a treatment method that provides fast results and has no side effects. It is an extremely important treatment option because it is cost effective and can be effective for years (sometimes for life). However, the use of drugs that suppress the body’s defense system is not required after other organ transplants.

Yeditepe University Hospitals Parathyroid Transplantation Clinic, which continues its studies under the leadership of Prof. Erhan Ayşan, the pioneer of parathyroid transplantation in Turkey and is licensed by the Ministry of Health, serves with its multidisciplinary structure and academic staff.

What is a parathyroid transplant?

Parathyroid transplant is an organ transplant procedure. However, since the size of the parathyroid glands is small, the transplant procedure has some distinct differences.

There are two basic techniques in parathyroid transplantation:

1. The tissue is transplanted in its original form without damaging the anatomical structure. This is called “tissue type transplant”.
2. Tissue is broken down by a suitable method and separated into its cells. It is placed in a special liquid and transported. This is called “cell type transplant”.

Who may undergo parathyroid transplantation?

Parathyroid transplantation is performed only for people diagnosed with “permanent hypoparathyroidism”.

What is permanent hypoparathyroidism?

It is the case of low parathyroid hormone (PTH) and calcium levels in the blood for at least six months, resulting in complaints (muscle contraction, inability to move, tremor, weakness, fatigue, etc.).

Is there no other treatment for permanent hypoparathyroidism other than transplantation?

There are two treatment options for this disease other than transplantation:

1. Calcium and vitamin D supplements called conventional therapy: It is a lifelong treatment. When calcium pills are used for a long time, they can cause ulcers (wounds) in the stomach and duodenum, accumulate in the kidneys and cause kidney damage. Moreover, this approach does not cure the disease itself, it only provides a temporary increase in the low calcium in the blood.
2. Recombinant parathormone therapy: It is a form of parathyroid hormone (PTH), which is the only hormone produced by the parathyroid glands, produced under laboratory conditions and turned into a drug. It is administered as subcutaneous injection with small needles; just like diabetes patients’ insulin application! It is more effective than conventional treatment, has a lower potential for side effects, but is an expensive option. Moreover, these drugs are not produced in Turkey and provided from abroad in various ways and be reimbursed by SSI.

What is the relationship between thyroid (goiter) surgery and parathyroid transplantation?

Thyroid (goiter) surgery is the most common endocrine gland operation in the world and in Turkey. The thyroid gland is a very bloody organ, and since this organ is very close to serious anatomical structures (vocal nerves, parathyroid glands, carotid artery), goiter surgery is a serious and difficult surgery category and requires careful work during surgery. Since the parathyroid glands are behind the thyroid gland, attached to it and are very small, they can be removed or damaged unnoticed in thyroid surgeries. This is a rare complication, but when it occurs the condition is serious and unfortunately, there is no permanent treatment other than either lifelong medication or parathyroid transplantation.

Who can be a parathyroid donor?

Three groups of people can be parathyroid donors:

• People who have brain death but have donated organs and have no health problems (infectious diseases, cancer, etc.) that prevent organ donation. These are also called cadaver donors.
• Persons who have excessive parathyroid hyperplasia requiring surgery due to kidney failure and who do not have health problems (infectious diseases, cancer, etc.) that prevent organ donation.
• People who have the appropriate blood and tissue group and do not have any health problems (infectious disease, cancer, etc.).

Will the donor suffer any harm?

This is not the case for people with brain death. When it comes to hyperplasia cases due to kidney failure; These patients benefit from the surgery, not harmed. Because the parathyroid glands work very hard in these patients and as a result, bone loss and calcification occur in the vessels. All these problems are either reduced or eliminated by surgery.

Is there a certain age limit for people to be transplanted?

No there is not. If the patient is diagnosed with permanent hypoparathyroidism, transplantation can be performed at any age.

How is parathyroid transplant performed?

We have previously stated that parathyroid transplantation is of two types (tissue type transplant and cell type transplant). These tissues or cells are given to the patient in two basic ways; intramuscular injection and injection into the omentum:

Parathyroid transplant is an intramuscular injection. The patient does not enter the operating room, does not receive anesthesia, no incision is made on his body, no stitches. The parathyroid cells previously taken from the donor. The cells are prepared for transplantation under special and sterile laboratory conditions. Cells put into a standard injector in a special liquid of 2ml and injected into the patient’s arm or abdominal muscles. This application is performed at the patient’s bedside not in the operation room and takes only a few seconds. After the procedure, the patient is observed for a few hours and then discharged. There is no need to stay in the hospital for night. Drugs that suppress the body’s defense system (immunosuppressant drugs) are not used after the transplantation.

What should the patient pay attention after the transplant?

After the transplant, you stay in the hospital for two days and intravenous cortisone is administered during these days. In the morning of the third day, intravenous cortisone administration is stopped and the patient is discharged. In this process, there is no special diet and no restrictions are made, except that the patient does not overuse himself. It may take several months for the transplanted cells to function and get rid of the medications used by the patient. Therefore, the patient is followed up by having a blood test every 10 days in the post-transplant period. Drugs used before transplantation are released gradually.

What is the transplantation success rate? Is the patient harmed in unsuccessful transplants?

There is no 100% success rate of any organ transplant in the world. Moreover, the success of each organ transplant varies depending on many factors. These rules also apply to parathyroid transplantation. Many factors such as the age of the donor and recipient, the amount and variety of surface antigens of the transplanted cells, the strength of the recipient’s defense system, the functional capacity of the cells, and the correct application of laboratory techniques are effective in the success of the transplant.

In other organ transplants (kidney, liver, etc.), when the transplant is not successful, the transplanted organ must be removed from the body. This means a new surgical procedure. This is not the case in parathyroid transplantation. If the transplant is unsuccessful, this means that the transplanted cells are destroyed by the defense system of the recipient’s body, so no surgical intervention is required and no side effects occur.

Can a person undergo transplantation more than once?

Yes, it can be done. These patients can be transplanted again, whether the first transplant is successful and the cells have lost their functionality over the years, or the first transplant is unsuccessful.