UHN’s Ajmera Transplant Centre performed a groundbreaking parathyroid transplant

The Ajmera Transplant Centre at University Health Network (UHN) has performed a groundbreaking parathyroid transplant, in 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 a 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.

Patient Dawn Ethier, a police officer with the City of Ottawa and mother of four, suffered for a decade with uncontrolled levels of PTH – hormone produced by parathyroid glands. She was frequently hospitalized, 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.

Dawn'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 from the surgery.

In this groundbreaking transplant, a total of four parathyroid glands from a deceased donor were implanted to Dawn's right forearm, in a surgery with local anesthesia. 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, Dr. Devon and the team at the Ajmera Transplant Centre are working to study further and expand parathyroid transplant as treatment for severe hypoparathyroidism.

About parathyroid glands and hypoparathyroidism

• Humans have four parathyroid glands, which are about the size of grains of rice and are located around the thyroid.

• Their function is completely unrelated to the thyroid's.

• Parathyroid glands produce PTH, a hormone that controls calcium levels in the body. It regulates essential functions such as muscle and nerve function, bone health, with long-term impacts on cardiovascular and mental health.

• Current treatment options for hypoparathyroidism include oral and intravenous supplementation of vitamin D, calcium, and other minerals and PTH replacement, but for severe cases like Dawn Ethier's these strategies alone may not provide the best outcomes.

• The prevalence of hypoparathyroidism is an estimated 37 per 100,000 people per year in the United States .

Quotes

"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." – Dawn Ethier, patient

"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." – Dr. Karen Devon, an endocrine surgeon at UHN's Sprott Department of Surgery and associate professor, University of Toronto

"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." – Dr. Kathryn Tinckam, transplant nephrologist, Ajmera Transplant Centre, consultant to the HLA Lab and Physician-in-Chief at UHN, associate professor at U of T.

"Innovation is in our DNA at the Ajmera Transplant Centre and UHN. We never shy away from trying something new, especially when patients look to us for life-saving and life-altering procedures. We are very happy to see such positive results, as this opens an exciting new opportunity to treat patients with severe hypoparathyroidism." – Dr. Atul Humar, Director, Ajmera Transplant Centre at UHN, and professor, University of Toronto.

"Ontario Health (Trillium Gift of Life Network) was proud to lead the collaboration with UHN to develop the criteria, resources and education required to facilitate a successful transplant. Thanks to the commitment and dedication of all our partners, more patients will be able to enjoy vastly improved lives as a result of this innovative work. Ground-breaking medical advances in organ and tissue donation and transplant are only possible through the generosity of donors and their families. Every Ontarian can play a part by registering to donate at BeADonor.ca. Together, we will continue to serve those who are waiting for their lives to be saved or changed through transplant." – Rebecca Cooper, Vice President, Ontario Health (Trillium Gift of Life Network and Ontario Renal Network)