Fate of long-term parathyroid autografts in patients with chronic renal failure treated by parathyroidectomy: a histopathological study of autografts, parathyroid glands and bone.

The aims of the study were to (1) determine the histopathology of parathyroid autografts in patients with renal failure treated by parathyroidectomy, (2) relate this to any evidence of hyperfunction, such as histological osteitis fibrosa and (3) determine whether there were any features in the donor parathyroid glands which correlated with autograft behaviour. Fourteen patients were studied; 106 implanted parathyroid fragments were identified in nine at necropsy and in the remaining five patients multiple fragments were obtained at the time of autograft surgical reduction. Of the patients studied at necropsy, in two the autografts were small and hypofunctional and in one of these the implants appeared partially involuted. In neither was there osteitis fibrosa. In the others there were varying degrees of hyperplasia and osteitis fibrosa. Four of the surgically excised autografts were markedly hyperplastic but there was no unequivocal evidence of malignancy. In one case, requiring repeated reduction of rapidly growing autograft tissue, there were frequent mitoses in the donor parathyroid gland and in the autograft. The presence of atypical cellular features and frequent mitoses in intraoperative frozen sections of a parathyroid gland militate against its use for implantation.