Surgical treatment of persistent hyperparathyroidism after renal transplantation.
OBJECTIVE
To provide a review on current knowledge about the pathogenesis, epidemiology, and clinical complications of persistent hyperparathyroidism after kidney transplantation (3HPT) and to discuss the surgical approaches.


BACKGROUND
3HPT usually regresses within the first months after transplantation. Parathyroidectomy for 3HPT is therefore not usually needed. Consequently, few studies have been published regarding the best medical management for 3HPT and indications for parathyroidectomy.


METHODS
Medical literature databases were searched for studies on the surgical treatment of 3HPT published in English.


RESULTS
Forty-one studies were identified and included in this review.


CONCLUSIONS
3HPT most commonly occurs in patients who have severe secondary hyperparathyroidism at the time of transplantation. Indications for parathyroidectomy in patients with 3HPT include persistent severe hypercalcemia, defined as a serum calcium level greater than 11.5 mg/dl, unexplained renal function deterioration, or progressive bone mineral density loss. Published studies suggest that the best surgical approach for patients with 3HPT is subtotal parathyroidectomy or total parathyroidectomy with autotransplantation. 3HPT poses important health risks, particularly concerning bone density and the cardiovascular system. Because spontaneous improvement of parathyroid function is uncommon after 3 months of transplantation, waiting for more than 6 months before parathyroidectomy should be discouraged.
Triponez
Frédéric
F
Department of Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland. frederic.triponez@hcuge.ch
Clark
Orlo H
OH
Vanrenthergem
Yves
Y
Evenepoel
Pieter
P
D000069449:Cinacalcet; D015925:Cryopreservation; D003952:Diagnostic Imaging; D018450:Disease Progression; D006801:Humans; D006934:Hypercalcemia / Q000150:complications; D006961:Hyperparathyroidism / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017674:Hypophosphatemia / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism; D016030:Kidney Transplantation; D016343:Monitoring, Intraoperative; D009281:Naphthalenes / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000032:analysis; D016105:Parathyroidectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D013934:Thymectomy
D009281:Naphthalenes; D010281:Parathyroid Hormone; D000069449:Cinacalcet