Parathyroid Allotransplantation: A Systematic Review
<b>Background</b>: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by design is a one-time cure through its restoration of the parathyroid function and, therefore, could be...
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| פורמט: | Article |
| שפה: | English |
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MDPI AG
2022-03-01
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| סדרה: | Medical Sciences |
| נושאים: | |
| גישה מקוונת: | https://www.mdpi.com/2076-3271/10/1/19 |
| _version_ | 1827627937644412928 |
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| author | Jaimie L. H. Zhang Natasha M. Appelman-Dijkstra Abbey Schepers |
| author_facet | Jaimie L. H. Zhang Natasha M. Appelman-Dijkstra Abbey Schepers |
| author_sort | Jaimie L. H. Zhang |
| collection | DOAJ |
| description | <b>Background</b>: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by design is a one-time cure through its restoration of the parathyroid function and, therefore, could be the solution. A systematic literature review is conducted in the present paper, with the aim of outlining the possibilities of parathyroid allotransplantation and to calculate its efficacy. Additionally, various transplantation characteristics are linked to success. <b>Methods:</b> This review is carried out according to the PRISMA statement and checklist. Relevant articles were searched for in medical databases with the most recent literature search performed on 9 December 2021. <b>Results:</b> In total, 24 articles involving 22 unique patient cohorts were identified with 203 transplantations performed on 148 patients. Numerous types of (exploratory) interventions were carried out with virtually no protocols that were alike: there was the use of (non-) cryopreserved parathyroid tissue combined with direct transplantation or pretreatment using in vitro techniques, such as culturing cells and macro-/microencapsulation. The variability increased further when considering immunosuppression, graft histology, and donor–recipient compatibility, but this was found to be reported in its entirety by exception. As a result of the large heterogeneity among studies, we constructed our own criterium for transplantation success. With only the studies eligible for our assessment, the pooled success rate for parathyroid allotransplantation emerged to be 46% (13/28 transplantations) with a median follow-up duration of 12 months (Q1–Q3: 8–24 months). <b>Conclusions:</b> Manifold possibilities have been explored around parathyroid allotransplantation but are presented as a double-edged sword due to high clinical diverseness, low expertise in carrying out the procedure, and unsatisfactory study quality. Transplantations carried out with permanent immunosuppression seem to be the most promising, but, in its current state, little could be said about the treatment efficacy with a high quality of evidence. Of foremost importance in pursuing the answer whether parathyroid allotransplantation is a suitable treatment for hypoparathyroidism, a standardized definition of transplantation success must be established with a high-quality trial. |
| first_indexed | 2024-03-09T13:22:49Z |
| format | Article |
| id | doaj.art-db7b94eaf3524beeb6227c3d1defcd3b |
| institution | Directory Open Access Journal |
| issn | 2076-3271 |
| language | English |
| last_indexed | 2024-03-09T13:22:49Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medical Sciences |
| spelling | doaj.art-db7b94eaf3524beeb6227c3d1defcd3b2023-11-30T21:27:43ZengMDPI AGMedical Sciences2076-32712022-03-011011910.3390/medsci10010019Parathyroid Allotransplantation: A Systematic ReviewJaimie L. H. Zhang0Natasha M. Appelman-Dijkstra1Abbey Schepers2Department of Surgery, Leiden University Medical Center, 2333 Leiden, The NetherlandsDepartment of Internal Medicine, Division Endocrinology, Leiden University Medical Center, 2333 Leiden, The NetherlandsDepartment of Surgery, Leiden University Medical Center, 2333 Leiden, The Netherlands<b>Background</b>: To date, there is no satisfactory treatment for patients with calcium and vitamin D supplementation refractive hypoparathyroidism. Parathyroid allotransplantation by design is a one-time cure through its restoration of the parathyroid function and, therefore, could be the solution. A systematic literature review is conducted in the present paper, with the aim of outlining the possibilities of parathyroid allotransplantation and to calculate its efficacy. Additionally, various transplantation characteristics are linked to success. <b>Methods:</b> This review is carried out according to the PRISMA statement and checklist. Relevant articles were searched for in medical databases with the most recent literature search performed on 9 December 2021. <b>Results:</b> In total, 24 articles involving 22 unique patient cohorts were identified with 203 transplantations performed on 148 patients. Numerous types of (exploratory) interventions were carried out with virtually no protocols that were alike: there was the use of (non-) cryopreserved parathyroid tissue combined with direct transplantation or pretreatment using in vitro techniques, such as culturing cells and macro-/microencapsulation. The variability increased further when considering immunosuppression, graft histology, and donor–recipient compatibility, but this was found to be reported in its entirety by exception. As a result of the large heterogeneity among studies, we constructed our own criterium for transplantation success. With only the studies eligible for our assessment, the pooled success rate for parathyroid allotransplantation emerged to be 46% (13/28 transplantations) with a median follow-up duration of 12 months (Q1–Q3: 8–24 months). <b>Conclusions:</b> Manifold possibilities have been explored around parathyroid allotransplantation but are presented as a double-edged sword due to high clinical diverseness, low expertise in carrying out the procedure, and unsatisfactory study quality. Transplantations carried out with permanent immunosuppression seem to be the most promising, but, in its current state, little could be said about the treatment efficacy with a high quality of evidence. Of foremost importance in pursuing the answer whether parathyroid allotransplantation is a suitable treatment for hypoparathyroidism, a standardized definition of transplantation success must be established with a high-quality trial.https://www.mdpi.com/2076-3271/10/1/19hypoparathyroidismparathyroid allotransplantationimmunosuppressionmicroencapsulationmacro-encapsulationcell transplantation |
| spellingShingle | Jaimie L. H. Zhang Natasha M. Appelman-Dijkstra Abbey Schepers Parathyroid Allotransplantation: A Systematic Review Medical Sciences hypoparathyroidism parathyroid allotransplantation immunosuppression microencapsulation macro-encapsulation cell transplantation |
| title | Parathyroid Allotransplantation: A Systematic Review |
| title_full | Parathyroid Allotransplantation: A Systematic Review |
| title_fullStr | Parathyroid Allotransplantation: A Systematic Review |
| title_full_unstemmed | Parathyroid Allotransplantation: A Systematic Review |
| title_short | Parathyroid Allotransplantation: A Systematic Review |
| title_sort | parathyroid allotransplantation a systematic review |
| topic | hypoparathyroidism parathyroid allotransplantation immunosuppression microencapsulation macro-encapsulation cell transplantation |
| url | https://www.mdpi.com/2076-3271/10/1/19 |
| work_keys_str_mv | AT jaimielhzhang parathyroidallotransplantationasystematicreview AT natashamappelmandijkstra parathyroidallotransplantationasystematicreview AT abbeyschepers parathyroidallotransplantationasystematicreview |