Total parathyroidectomy with autotransplantation in patients with renal hyperparathyroidism: indications and surgical approach.
OBJECTIVE
renal hyperparathyroidism (rH) is one of the most serious complications in long-term hemodialysis patients. the purpose of this retrospective study was the evaluation of the surgical indications, parathyroid histology, and the results of total parathyroidectomy with autotransplantation (Ptx+At) in patients with rH.


METHODS
the study included 36 patients with rH in whom Ptx+At was carried out at the First surgical Department of the Evangelismos Hospital over a 5-year period. Indications for Ptx+At were high levels of parathyroid hormone (PtH >800 ng/L) associated with hypercalcemia and/or hyperphosphatemia, that were refractory to medical treatment, as well as clinical effects of rH, including pruritus, bone and joints pain, muscle weakness, progression of soft tissue calcification, and spontaneous fractures. Ultrasonography, (99m)Tc sestamibi scan and computed tomography were used to evaluate the thyroid and parathyroids.


RESULTS
there was no mortality related to surgery. Preoperative symptoms, serum PtH, serum alkaline phosphatace, hyperphosphatemia, and hypercalcemia were improved or normalised in most patients. recurrence was observed in one case; this autotransplanted patient required resection of transplanted tissue from his forearm. Hypoparathyroidism was not recorded.


CONCLUSIONS
Ptx+At is a safe option for the treatment of rH that is accompanied by low morbidity, mortality, and recurrence rate. It is important to identify all parathyroid glands at surgery and to choose adequate parathyroid tissue for autograft.
Gourgiotis
Stavros
S
First Surgical Department Organ Transplant Unit, Evangelismos General Hospital, Athens, Greece. drsgourgiotis@tiscali.co.uk
Moustafellos
Panagiotis
P
Stratopoulos
Charalabos
C
Vougas
Vasilis
V
Drakopoulos
Spiros
S
Hadjiyannakis
Evangelos
E
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000378:metabolism / Q000473:pathology / Q000637:transplantation*; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D010710:Phosphates / Q000097:blood; D012189:Retrospective Studies; D055502:Secondary Prevention; D014182:Transplantation, Autologous / Q000379:methods
D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium