Short- and long-term outcome of total parathyroidectomy with immediate autografting versus subtotal parathyroidectomy in patients with end-stage renal disease.
A retrospective study was performed in 36 patients with end-stage renal disease (ESRD) comparing total parathyroidectomy followed by immediate autografting into the forearm (total PTX + IA) with parathyroidectomy (subtotal PTX) over a five-year period. Twenty-eight patients underwent subtotal PTX and 8 had total PTX + IA. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, perioperative morbidity, and the incidence of recurrent hyperparathyroidism. Eleven patients in total (30.6%) developed recurrent hyperparathyroidism; 2/8 (25%) in the total PTX + IA group compared to 9/28 (32.1%) in the subtotal PTX group (p = 0.699). The median time to recurrence was longer in the total PTX + IA group (39 vs. 16 months), and the median long-term postoperative PTH value was lower (81 vs. 199 ng/l), but these differences did not reach statistical significance. In conclusion, the incidence of recurrent hyperparathyroidism is high regardless of surgical modality. However, total PTX + IA may produce more favorable results with respect to median postoperative PTH level and time to recurrence.
Hargrove
G M
GM
Division of Nephrology, University of Calgary, Calgary, Alta., Canada.
Pasieka
J L
JL
Hanley
D A
DA
Murphy
M B
MB
D000469:Alkaline Phosphatase / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D010280:Parathyroid Glands / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D012008:Recurrence; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D000469:Alkaline Phosphatase