A first-of-its-kind in North America parathyroid transplant has been declared a success by the physicians responsible
The Ajmera Transplant Centre at University Health Network (UHN) has performed a groundbreaking parathyroid transplant on a patient who suffered from a severe form of hypoparathyroidism – when there is little or no parathyroid function.
There are only a few cases of parathyroid transplant reported in scientific literature, and this case is believed to be the first of its kind in North America.
Dr Karen Devon, an endocrine surgeon at UHN’s Sprott Department of Surgery, and team were able to successfully perform the transplant at Toronto General Hospital on their second try, which happened on May 19. Enough time has passed, and the team can consider it as a success.
Devon, who is also an associate professor at the University of Toronto, said: “I was apprehensive of bringing this idea forward to leadership at the Ajmera Transplant Centre, and I was extremely pleasantly surprised with the response, which was to tell me that we have an obligation to help this patient. That was very motivating for me.”
Patient Dawn Ethier, a police officer with the City of Ottawa and mother of four, suffered for a decade with uncontrolled levels of PTH – a hormone produced by parathyroid glands. She was frequently hospitalised, tried different therapies, and at one point took almost 100 pills per day to manage symptoms. Symptoms ranged from cardiac episodes, loss of muscle control on her limbs and face, seizures, pulmonary embolisms, to long-term impacts to her mental health.
Ethier’s hypoparathyroidism resulted from a complication after a surgical intervention to treat thyroid cancer. The cancer was cured with removal of her thyroid, but she suffered with hypoparathyroidism as a complication of the surgery.
In this groundbreaking transplant, a total of four parathyroid glands from a deceased donor were implanted in Ethier’s right forearm, in a surgery with local anaesthesia. A few weeks after the successful transplant, the parathyroid glands were fully functional and she was able to come off all her medications for hypoparathyroidism, with great improvement to her quality of life.
This transplant was possible due to unwavering support from leadership at the Ajmera Transplant Centre and UHN, and from Ontario Health (Trillium Gift of Life Network), who supported logistics for this innovative treatment, including the creation of deceased donor listing for parathyroid glands.
It was also made possible with collaboration from the team at Histocompatibility Lab at UHN, who did the tests for matching donor and recipient, and thanks to generous donors to UHN Foundation.
After this successful first case, Devon and the team at the Ajmera Transplant Centre are working to study further and expand parathyroid transplant as treatment for severe hypoparathyroidism.
Dr Kathryn Tinckam, transplant nephrologist, Ajmera Transplant Centre, consultant to the HLA Lab and physician-in-chief at UHN, as well as associate professor at the University of Toronto added: “This was truly a team effort. It is always exciting to be part of something new, and we were thrilled to witness the success of this case.”
Ethier said: “This transplant saved my life, it changed everything. My mood, my personality is coming through.
“I’m no longer exhausted, I’m able to spend more time with my children. I can see a future now. This is not going to end up being something that will take me.”
Image: Dr Karen Devon shows a parathyroid prior to transplant © UHN.