Immune Reconstitution After Total Parathyroidectomy and Forearm Transplantation in Chronic Renal Failure.

Objective: To investigate the immune reconstitution after total parathyroidectomy and forearm transplantation in chronic renal failure.

Method: Forty-three patients, accompanied with chronic renal failure and secondary hyperparathyroidism (SHPT) that hospitalized during January 2019 to 2021 and underwent total thyroidectomy and forearm transplantation were enrolled as observation group. Forty hemodialysis patients with chronic renal failure but without SHPT were selected as the hemodialysis group. In addition, fifty volunteers who underwent physical examination within the same period were chosen as a control group. The parathyroid hormone (iPTH), blood phosphorus, blood calcium, th22, Treg cells, and inflammatory factors were detected in the three groups.

Results: The preoperative iPHT, serum phosphorus, and calcium levels in the observation group were higher than those in the control group and hemodialysis group (P<0.05), and the index values of the observation group at each time point after surgery were remarkably lower than those in pre-surgery (P<0.05). The preoperative Th22 and Th22/Treg in the observation group were higher, and Treg was lower than those in the control group and hemodialysis group (P<0.05); The levels of Th22 and Th22/Treg in the observation group at each time point in post-operation were lower than those in pre-operation (P<0.05), whereas Treg cells in observation group at each time point postoperatively were higher than those prior-operation (P<0.05). The preoperative serum TNF-α, IL-6, TGF-β, and IL-22 in the observation group were notably higher than those in the control group and hemodialysis group (P<0.05); And TNF-α, IL-6, TGF-β, and IL-22 in observation group at each time point in post-operation were lower than those in pre-surgery(P<0.05).

Conclusion: For chronic renal failure patients complicated with SHPT, total parathyroidectomy and forearm transplantation can effectively improve their clinical symptoms, reduce the inflammatory state of the body, and beneficial for immune reconstruction.