Long-term results of subtotal vs total parathyroidectomy without autotransplantation in kidney transplant recipients.
OBJECTIVE
Total parathyroidectomy without autotransplantation in kidney transplant recipients leads to reduced recurrence rates and similar improvement of clinical symptoms compared with subtotal parathyroidectomy.


METHODS
A retrospective cohort study.


METHODS
University clinic.


METHODS
Thirty-three patients with functioning renal grafts who underwent primary total (n = 17; group 1) or subtotal (n = 16; group 2) parathyroidectomy for renal hyperparathyroidism.


METHODS
Long-term levels of intact parathyroid hormone, serum calcium, phosphate, alkaline phosphatase, creatinine, and vitamin D; bone pain; use of medication; and incidence of persistent or recurrent hyperparathyroidism.


RESULTS
The mean length of follow-up was 31 months in group 1 and 41 months in group 2. In all patients, postoperative serum calcium and phosphate levels normalized and bone pain markedly decreased. Persistent hypocalcemia was not observed. Serum creatinine levels intermittently increased in both groups but returned to preoperative levels in most of the patients. In group 1, all patients had undetectable intact parathyroid hormone levels throughout the study period. In group 2, 2 patients had persistent and 3 patients developed recurrent hyperparathyroidism (31%) that required therapy with cinacalcet hydrochloride in 3 cases. In 4 of these 5 patients, intact parathyroid hormone levels were greater than 54 ng/L directly after operation. In all, 27 of 33 patients (82%) received cholecalciferol therapy. Additional calcium supplementation was used by 12 group 1 patients (71%) and 3 group 2 patients (19%).


CONCLUSIONS
Total parathyroidectomy in kidney transplant recipients appears to be safe and protective against persistent and recurrent disease. If subtotal parathyroidectomy is performed, the remnant should be small.
Rayes
Nada
N
Department of General, Visceral and Transplant Surgery, Charité Campus Virchow Clinic, Augustenburger Platz 1, 13344 Berlin, Germany. nada.rayes@charite.de
Seehofer
Daniel
D
Schindler
Ralf
R
Reinke
Petra
P
Kahl
Andreas
A
Ulrich
Frank
F
Neuhaus
Peter
P
Nüssler
Natascha C
NC
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation*; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome