Total parathyroidectomy without autotransplantation in dialysis patients and renal transplant recipients, long-term follow-up evaluation.
BACKGROUND
Persistent secondary hyperparathyroidism not responding to medication is treated successfully with surgical excision of parathyroid glands (total parathyroidectomy [PTX]). PTX without autotransplantation of parathyroid glands excludes the risk for recurrence of hyperparathyroidism.


METHODS
During the years 2002 to 2005, 36 total parathyroidectomies were performed in 33 patients: 21 dialysis patients because of end-stage renal disease and 12 renal transplant recipients.


RESULTS
PTX without autotransplantation was performed successfully in 33 patients, whereas 3 patients were reoperated for remaining parathyroid glands. Immediate improvement of clinical symptoms and a decrease of serum calcium and parathormone levels were observed after surgical procedures. Oral replacement treatment with vitamin D (1a-calcidiol) and calcium was commenced and long-term follow-up evaluation (23.5 +/- 7.6 mo) showed that calcium homeostasis was controlled adequately.


CONCLUSIONS
PTX without autotransplantation is a safe and effective surgical procedure for the treatment of resistant secondary hyperparathyroidism with immediate response of clinical symptoms. Replacement treatment with vitamin D and calcium provides satisfactory coverage of individual needs.
Drakopoulos
Spiros
S
Transplant Unit, Evangelismos General Hospital of Athens, 45-47 Ipsilantou Street, Athens 10676, Greece.
Koukoulaki
Maria
M
Apostolou
Theofanis
T
Pistolas
Dimitrios
D
Balaska
Katerina
K
Gavriil
Stylianos
S
Hadjiconstantinou
Valsamakis
V
D000469:Alkaline Phosphatase / Q000097:blood; D018771:Arthralgia / Q000209:etiology; D002114:Calcinosis / Q000209:etiology; D002118:Calcium / Q000097:blood; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010758:Phosphorus / Q000097:blood; D011537:Pruritus / Q000209:etiology; D006435:Renal Dialysis
D010281:Parathyroid Hormone; D010758:Phosphorus; D000469:Alkaline Phosphatase; D002118:Calcium