title: Surgical treatment of tertiary hyperparathyroidism after renal transplantation: a 31-year experience in a single institution.
abstract: Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation.  Parathyroidectomy (PTX) is an efficient method for treatment of tHPT.  In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery.  Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5%) were identified as having tHPT and underwent PTX.  Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function.  One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX.  We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs.  Level of iPTH and serum calcium were at normal range after PTX.  Estimated GFR decreased after PTX.  Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX.  PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function.  We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Jeong
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.forename: Hang Seok
authors.initials: HS
authors.lastname: Chang
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Cheong Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D000236:Adenoma / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000503:physiopathology; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology* / Q000601:surgery*; D006996:Hypocalcemia / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010280:Parathyroid Glands / Q000503:physiopathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects