*Purpose: Hypoparathyroidism (hypoPTH) is a clinical condition characterized by an abnormal mineral homeostasis determined by inadequate secretion of parathyroid hormone. It can be secondary to non-surgical causes, mostly genetic (previously referred as idiopathic) or, more commonly, result of complications of neck surgery. In cases refractory to medical management, parathyroid allo-transplant offers promising results. We report our experience on 3 patients with follow up between 1-4 years.

*Methods: Retrospective analysis of 3 patients with iatrogenic hypoPTH and severe complications despite medical management, treated with parathyroid allo-transplantation from living unrelated donors. All donors underwent subtotal parathyroidectomy for symptomatic secondary hyperparathyroidism. The immunosuppressive protocol consisted in Methylprednisolone 500 mg and Basiliximab 20 mg at induction and Tacrolimus 0.1 mg/kg PO daily (The protocol was approved by the Institutional Review Board (IRB) and the operations were performed at the University of Illinois Hospital).

*Results: All 3 patients experienced immediate improvement of symptoms with stable levels of ionized calcium and PTH at 6 months follow up. The first patient experienced recurrent hypoPTH 2 years after the first parathyroid allotransplant; successfully retransplanted 6 months ago with PTH ranging between 40-60 pg/mL and normal calcium levels. The second patient had extraordinary improvement of symptoms after the first transplant, failed after 3 years; the second transplant failed immediately due to wound infection; the third transplant worked very well for 1 year then eventually failed. The third patient experienced side effects from immunosuppression despite being switched from tacrolimus to cyclosporine, after discontinuation of therapy she maintained measurable PTH levels (5-10 pg/mL) and stable calcium levels for 3 years.

*Conclusions: In our experience parathyroid allo-transplantation proved to be a safe and effective strategy in the treatment of patients with hypoparathyroidism refractory to medical management. Further studies involving larger number of patients and longer follow up are needed to validate its efficacy.

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