Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation.
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.
Triponez
Frederic
F
Division of Endocrine Surgical Oncology, University of California at San Francisco, San Francisco, CA, USA. frederic.triponez@hcuge.ch
Kebebew
Electron
E
Dosseh
David
D
Duh
Quan-Yang
QY
Hazzan
Marc
M
Noel
Christian
C
Chertow
Glenn M
GM
Wambergue
François
F
Fleury
Dominique
D
Lemaitre
Vincent
V
Proye
Charles A G
CA
Clark
Orlo H
OH
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
D010281:Parathyroid Hormone; D003404:Creatinine