title: Effect of incomplete parathyroidectomy preserving entire parathyroid glands on renal graft function.
abstract: OBJECTIVE
  Parathyroidectomy (PT) corrects tertiary hyperparathyroidism in patients who have received renal grafts but can result in deterioration of renal function.
  
  
  OBJECTIVE
  To compare different surgical procedures for their effect on renal function and efficacy to cure tertiary hyperparathyroidism.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  University clinic.
  
  
  METHODS
  Eighty-three patients with functioning renal grafts receiving PT for the first time.
  
  
  METHODS
  Group 1 received an incomplete PT, with at least 1 entire parathyroid gland (PG) remaining in situ (n = 12). Group 2 received an incomplete PT, with the most morphologically conserved PG partially resected (n = 22). Group 3 received a complete PT, with autotransplantation of PG tissue (n = 49).
  
  
  METHODS
  The primary end point was the postoperative change in glomerular filtration rate. Secondary end points were rates of redialysis, hypercalcemia, and hyperparathyroidism within 5 years.
  
  
  RESULTS
  A decrease in glomerular filtration rate occurred postoperatively in 75 patients (90%) and correlated significantly with the extent of PG resection. Recovery of renal function at month 6 was observed in group 1, but not in groups 2 and 3 (P < .001). Seven patients (8%) needed permanent dialysis (1 in group 2 and 6 in group 3). Hypercalcemia was abrogated in 78 patients (94%), without significant differences among the groups. Assessment of parathyroid hormone levels in accordance with target ranges from the Kidney Disease Outcomes Quality Initiative guidelines did not reveal significant differences in the rates of recurrent hyperparathyroidism.
  
  
  CONCLUSIONS
  Incomplete PT preserving at least 1 entire PG does not cause deterioration of renal graft function and provides long-term correction of hypercalcemia and tertiary hyperparathyroidism.
authors.affiliation: Klinik fuer Allgemein-, Viszeral-, und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany. jaeger.mark@mh-hannover.de
authors.forename: Mark D
authors.initials: MD
authors.lastname: Jäger
authors.forename: Stephan
authors.initials: S
authors.lastname: Kaaden
authors.forename: Nikos
authors.initials: N
authors.lastname: Emmanouilidis
authors.forename: Rainer
authors.initials: R
authors.lastname: Lück
authors.forename: Jan H
authors.initials: JH
authors.lastname: Beckmann
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Güner
authors.forename: Holger
authors.initials: H
authors.lastname: Kespohl
authors.forename: Kristina
authors.initials: K
authors.lastname: Glockzin
authors.forename: Heiko
authors.initials: H
authors.lastname: Aselmann
authors.forename: Christian P
authors.initials: CP
authors.lastname: Kaudel
authors.forename: Anke
authors.initials: A
authors.lastname: Schwarz
authors.forename: Antonia
authors.initials: A
authors.lastname: Zapf
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Georg F W
authors.initials: GF
authors.lastname: Scheumann
mesh_terms: D005919:Glomerular Filtration Rate; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*
chemical_list: D010281:Parathyroid Hormone