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Novosti Khirurgii
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Novosti Khirurgii
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Allotransplantation of Cultivated Parathyrocytes from a Living Unrelated Donor to a Kidney Transplant Recipient: the First Clinical Observation

Аллотрансплантация культивированных паратироцитов живого неродственного донора реципиенту с почечным трансплантатом: первое клиническое наблюдение
Authors: Khryshchanovich, V. Y.; Vershinin, P. Y.; Bolshov, A. V.; Tretyak, S. I.; Kuzmenkova, E. I.; Pisarenko, A. M.; Khodosovskaya, E. V.; +2 Authors

Allotransplantation of Cultivated Parathyrocytes from a Living Unrelated Donor to a Kidney Transplant Recipient: the First Clinical Observation

Abstract

Цель. Продемонстрировать возможность успешного лечения послеоперационного гипопаратиреоза тяжелой степени тяжести путем аллотрансплантации культивированных паратироцитов реципиенту с почечным трансплантатом. Материал и методы. Реципиентом паратиреоидного аллотрансплантата была 37-летняя женщина с почечным трансплантатом и гипопаратиреозом тяжелой степени тяжести на фоне интенсивной заместительной терапии. Симптомы тетании, высокая судорожная готовность (симптомы Труссо, Хвостека), крайне низкие показатели общего/ионизированного кальция (1,71/0,98 ммоль/л) и паратгормона (1,7 пг/мл) в периферической крови явились показанием к паратиреоидной аллотрансплантации. В толщу левой плечелучевой мышцы реципиента имплантировали 21×106 культивированных паратироцитов, полученных от живого неродственного донора (62-летней женщины) с вторичным гиперпаратиреозом. Выбор места для паратиреоидной аллотрансплантации обусловило отсутствие артериовенозной фистулы на стороне пересадки. Иммуносупрессивная терапия включала прием 150 мг/сутки циклоспорина, 720 мг/сутки микофеноловой кислоты, 6 мг/сутки метилпреднизолона. Результаты. В послеоперационном периоде осложнений вмешательства, местных и общих побочных эффектов на паратиреоидный клеточный аллотрансплантат отмечено не было. Через 1 месяц после пересадки паратироцитов наступила клинико-лабораторная компенсация гипопаратиреоза: концентрация паратгормона возросла до 14,7 пг/мл и достигла максимального значения (61,7 пг/мл) через 3,5 месяца. На протяжении 6-месячного периода наблюдения судорожный синдром не возникал, симптомы Труссо и Хвостека купировались, объем пероральной заместительной терапии существенно уменьшился, исчезла потребность в парентеральном введении солевых растворов кальция. Через 6 месяцев после пересадки пациентка ведет привычный образ жизни и принимает per os 0,5 г кальция в сутки. Заключение. Комбинированная аллотрансплантация трупной почки и культивированных паратироцитов, выделенных из гиперплазированной паратиреоидной ткани живого неродственного донора, является эффективным методом лечения перманентного гипопаратиреоза тяжелой степени тяжести у пациентов, нуждающихся в органной трансплантации с последующей иммуносупрессивной терапией.Objectives. To demonstrate the possibility of successful treatment of a severe postsurgical hypoparathyroidism by the cultured parathyrocyte allotransplantation to a kidney transplant recipient. Methods. A 37-year-old female with the kidney transplant and a severe postsurgical hypoparathyroidism on the background of intensive replacement therapy was a recipient of parathyroid allograft. The indications for parathyroid autotransplantation include symptoms of tetany, high convulsive readiness (Chvostek’s and Trousseau’s signs), extremely low rates of total/ionized calcium (1,71/0,98 mmol/L) and parathyroid hormone (1,7 pg/ml) in the peripheral blood. culture (21×106) of parathyroid cells obtained from a living unrelated donor (62-year-old female) with the secondary hyperparathyroidism was implanted into the recipients’ left brachioradialis muscle. Site selection for parathyroid allograft was conditioned by the absence of arteriovenous fistula on the side of the transplantation. Immunosuppressive therapy consisted of 150 mg/day of cyclosporine, 720 mg/day of mycophenolic acid, 6 mg/day of methylprednisolone. Results. No postoperative complications of the intervention, local and general side effects on the parathyroid cell allograft were observed. Clinical and laboratory improvement of hypoparathyroidism occurred 1 month after the transplantation: parathyroid hormone concentration increased up to 14,7 pg/ml and reached a maximum value (61,7 pg/mL) after 3,5 months. No convulsions were observed over a 6-month follow-up, Chvostek’s and Trousseau’s signs were stopped, the amount of oral substitution therapy significantly reduced, and there was no more need for parenteral administration of calcium salt solutions. Six months after transplantation a patient led a very active life and took per os 0,5 g/day of calcium. Conclusion. Combined allotransplantation of cadaveric kidneys and cultured parathyroid cells obtained from the hyperplastic parathyroid tissue of a living unrelated donor is considered to be an effective treatment of permanent severe hypoparathyroidism in patients who need the organ transplantation with subsequent immunosuppressive therapy.

Country
Belarus
Keywords

АЛЛОТРАНСПЛАНТАЦИЯ ПАРАТИРОЦИТОВ,ПОЧЕЧНЫЙ ТРАНСПЛАНТАТ,ИНТЕНСИВНАЯ ЗАМЕСТИТЕЛЬНАЯ ТЕРАПИЯ,ПОСЛЕОПЕРАЦИОННЫЙ ГИПОПАРАТИРЕОЗ,ГИПЕРПЛАЗИРОВАННАЯ ПАРАТИРЕОИДНАЯ ТКАНЬ,ИММУНОСУПРЕССИВНАЯ ТЕРАПИЯ,ПОСЛЕОПЕРАЦИОННЫЕ ОСЛОЖНЕНИЯ,PARATHYROID CELLS ALLOTRANSPLANTATION,KIDNEY TRANSPLANT,INTENSIVE SUBSTITUTION THERAPY,SURGICAL HYPOPARATHYROIDISM,HYPERPLASTIC PARATHYROID TISSUE,IMMUNOSUPPRESSIVE THERAPY,POSTOPERATIVE COMPLICATIONS

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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