Subtotal parathyroidectomy in dialysis-dependent and post-renal transplant patients. A 25-year single-center experience.
OBJECTIVE
To determine long-term results and durability of parathyroidectomy in patients with chronic renal failure and renal transplant recipients.


METHODS
Retrospective chart review and structured telephone interviews.


METHODS
Tertiary-care academic medical center.


METHODS
Ninety-one consecutive patients (80 undergoing long-term dialysis, 11 with posttransplant hyperparathyroidism). Mean follow-up was 8 years (minimum follow-up, 2 years; longest follow-up, 25 years). The most common indications for operation were bone pain (70% [56/80]) and weakness (46% [37/80]) in patients with renal failure and hypercalcemia (91% [10/11]) in renal transplant recipients.


METHODS
Subtotal parathyroidectomy without remnant gland implantation.


METHODS
Postoperative morbidity and mortality, relief and recurrence of symptoms.


RESULTS
Symptoms were successfully ameliorated in 95% (86/91) of patients. Clinically significant complications occurred in 5% (5/91) of patients (one patient each with wound hematoma, wound infection, and permanent recurrent laryngeal nerve paralysis and two patients with permanent hypoparathyroidism). Recurrence occurred in five (5%) of 91 patients. Two of these patients required four operations each to eradicate all hyperfunctioning accessory glands. The other three recurrences were caused by hyperplasia of the remnant gland left in the neck. These were easily treated by simple excision, with no morbidity. The actuarial rate of recurrent hyperparathyroidism was 4.1% at 1 year and 11.7% at 20 years. Overall hospital mortality was 3% (3/91). None of the deaths was directly attributable to parathyroidectomy.


CONCLUSIONS
We recommend subtotal parathyroidectomy without remnant implantation as a safe and durable intervention for hyperparathyroidism associated with renal failure and following renal transplantation. This intervention is associated with an acceptably low recurrence rate over extremely long periods of follow-up.
Punch
J D
JD
Department of Surgery, University of Michigan Medical School, Ann Arbor, USA.
Thompson
N W
NW
Merion
R M
RM
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies