title: Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation.
abstract: BACKGROUND
  The optimal surgical approach for tertiary hyperparathyroidism (HPT) after kidney transplantation is unknown. Existing studies are limited by small sample size, lack of adjustment for kidney function, and no long-term follow-up.
  
  
  METHODS
  We retrospectively analyzed 74 patients with tertiary HPT who underwent parathyroidectomy at two centers since 1978. Persistent HPT was defined as parathyroid hormone (PTH) concentrations in excess of the K/DOQI target range for the corresponding estimated creatinine clearance (eCrCl).
  
  
  RESULTS
  Seventy-four patients had 83 operations (72 subtotal and 11 less-than-subtotal parathyroidectomies). Mean follow-up time was 5.4 +/- 4.7 years. Calcium concentrations decreased significantly after parathyroidectomy (2.83 vs 2.28 mmol/L, P < 0.001), as did eCrCl (54.5 vs 44.9 mL/min, P < 0.001) and PTH (382 vs 132 pg/mL, P < 0.001). In the multivariable regression analysis, only the type of operation and postoperative eCrCl were significantly correlated with PTH at follow-up. A limited parathyroidectomy was associated with a fivefold increase in risk of persistent or recurrent hyperparathyroidism.
  
  
  CONCLUSIONS
  The use of limited parathyroidectomy for tertiary HPT after kidney transplantation has a higher risk of persistent/recurrent HPT. Subtotal parathyroidectomy is recommended for patients with tertiary HPT.
authors.affiliation: Division of Endocrine Surgical Oncology, University of California at San Francisco, San Francisco, CA, USA. frederic.triponez@hcuge.ch
authors.forename: Frederic
authors.initials: F
authors.lastname: Triponez
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: David
authors.initials: D
authors.lastname: Dosseh
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Marc
authors.initials: M
authors.lastname: Hazzan
authors.forename: Christian
authors.initials: C
authors.lastname: Noel
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: François
authors.initials: F
authors.lastname: Wambergue
authors.forename: Dominique
authors.initials: D
authors.lastname: Fleury
authors.forename: Vincent
authors.initials: V
authors.lastname: Lemaitre
authors.forename: Charles A G
authors.initials: CA
authors.lastname: Proye
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000652:urine; D023381:Endpoint Determination; D005060:Europe; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology* / Q000601:surgery*; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010281:Parathyroid Hormone; D003404:Creatinine