title: Current trends in surgery for renal hyperparathyroidism (RHPT)--an international survey.
abstract: OBJECTIVE
  The indications and results of preoperative localization, surgical strategy, indication for thymectomy, the application of intraoperative parathyroid hormone (PTH) monitoring, cryopreservation, and replantation of cryopreserved parathyroid tissue are not well documented in renal hyperparathyroidism (RHPT). The current trends in surgery for RHPT are to be evaluated in an international online survey.
  
  
  METHODS
  Thirty-three questions regarding preoperative localization, surgical management of RHPT, intraoperative PTH monitoring, immediate/delayed autotransplantation (AT), and parathyroid cryopreservation were sent to members of various societies of endocrine surgeons.
  
  
  RESULTS
  The data from 86 responses were analyzed, 61.6 % reported more than 50 parathyroid surgeries per year, and 62.7 % operated on less than 16 patients with RHPT per year. Subtotal or total parathyroidectomy (with/without AT) was the standard procedure in 98.8 % of the cases. Immediate AT was performed in 40.7 % (72.7 % in the forearm). In most patients, the onset of graft function was documented later than 1 week after AT. Cryopreservation was routinely performed in 27.4 %. In 10.7 %, replantation was performed in more than five patients (hypo- or aparathyroidism: n = 41; fresh graft failure: n = 13; reoperations: n = 9). Intraoperative PTH monitoring (in RHPT) was routinely used in 46.2 %. Its influence on surgical strategy was confirmed in 40 %.
  
  
  CONCLUSIONS
  The survey reflects the divergent strategies applied for AT, cryopreservation, and PTH monitoring in RHPT.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. philipp.riss@meduniwien.ac.at
authors.forename: Philipp
authors.initials: P
authors.lastname: Riss
authors.forename: Reza
authors.initials: R
authors.lastname: Asari
authors.forename: Christian
authors.initials: C
authors.lastname: Scheuba
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
mesh_terms: D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D003431:Cross-Cultural Comparison; D015925:Cryopreservation; D003625:Data Collection; D006085:Graft Survival; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000639:trends; D010280:Parathyroid Glands / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000706:statistics & numerical data / Q000639:trends*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000639:trends; D012092:Replantation / Q000639:trends; D013934:Thymectomy / Q000639:trends; D014600:Utilization Review
chemical_list: D010281:Parathyroid Hormone