Transpl Int. 2007; published online ahead of print
Percutaneous ethanol injection therapy (PEIT) is a useful and safe treatment alternative for patients with persistent post-transplant secondary hyperparathyroidism, researchers in Argentina report.
Walter G. Douthat, MD, and his colleagues at the Hospital Privado-Centro Médico de Córdoba, performed PEIT under ultrasonographic guidance and local anesthesia in eight renal transplant patients with secondary hyperparathyroidism in whom medical therapy failed. The patients had high intact parathyroid hormone (iPTH) levels with hypercalcemia, hypophosphatemia, osteopenia, and/or bone pain.
All patients had at least one visible parathyroid nodule by ultrasonography. Seven patients had hypercalcemia at baseline (calcium levels above 10.5 mg/dL). A total of 1.38 nodules were injected with a mean of 1.38 sessions per patient. The mean ethanol volume used per patient was 3.15 cm3. One patient did not complete PEIT because of technical difficulties.
Immediately after PEIT, mean serum iPTH levels dropped from 286.9 to 154.6 pg/mL and mean serum calcium levels decreased from 11.4 to 10.3 mg/dL. The decrease in both markers persisted eight months after PEIT: the mean iPTH and calcium levels were 146.4 pg/mL and 10.3 mg/dL, respectively. The response correlated significantly with the amount of ethanol injected. Hypercalcemia disappeared in six patients. The researchers observed no changes in renal function related to treatment.
The authors observed that PEIT offers the advantage of low cost and it can be performed on an outpatient basis, avoiding parathyroidectomy.
PEIT has been used successful to control moderate to severe secondary hyperparathyroidism in dialysis patients, but its use has not been described in patients following renal transplantation, the authors noted.