title: Clinical and operative management of persistent hyperparathyroidism after renal transplantation: a single-center experience.
abstract: BACKGROUND
  Persistent (tertiary) hyperparathyroidism (TH) after renal transplantation may cause considerable morbidity and necessitate parathyroidectomy. This study investigated the characteristics of this patient subgroup.
  
  
  METHODS
  The medical data and pathology specimens of 20 kidney transplant recipients who underwent parathyroidectomy for TH in 2001 to 2004 were reviewed.
  
  
  RESULTS
  Treatment consisted of subtotal resection of 3.5 glands in 13 patients, resection of 3 to 3.5 glands under intraoperative parathyroid hormone monitoring (iPTH) in 5 patients, and selective resection in 2 patients with markedly asymmetric gland enlargement. Eighteen patients had hyperplasia-diffuse in 10, nodular in 4, or both in 2; 2 patients had 1 large nodule in every gland. Six patients had postoperative complications. Follow-up of 2 years revealed recurrent hypercalcemia in 1 patient and a high level of PTH (>60 pg/mL) in 12.
  
  
  CONCLUSIONS
  Subtotal resection for TH may be insufficient. The use of iPTH monitoring is recommended. Renal transplant recipients have distinctive characteristics and require special perioperative attention.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Gilat
authors.forename: Raphael
authors.initials: R
authors.lastname: Feinmesser
authors.forename: Yanush
authors.initials: Y
authors.lastname: Vinkler
authors.forename: Sara
authors.initials: S
authors.lastname: Morgenstern
authors.forename: Jacob
authors.initials: J
authors.lastname: Shvero
authors.forename: Gideon
authors.initials: G
authors.lastname: Bachar
authors.forename: Thomas
authors.initials: T
authors.lastname: Shpitzer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D007165:Immunosuppression Therapy; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D012189:Retrospective Studies; D016896:Treatment Outcome