title: Presence of small parathyroid glands in renal transplant patients supports less-than-total parathyroidectomy to treat hypercalcemic hyperparathyroidism.
abstract: BACKGROUND
  Parathyroid glands (PG) are rarely analyzed in renal transplant (RTX) patients. This study analyzes comparatively PG of RTX and end-stage renal disease (ESRD) patients. The clinical part of the study evaluates if total parathyroidectomy with autotransplantation (TPT+AT) treats appropriately hypercalcemic hyperparathyroidism in RTX patients.
  
  
  METHODS
  TPT+AT was performed in 15 of 23 RTX and 21 of 27 ESRD patients. Remaining patients underwent less-than-total PT. Volume and stage of hyperplasia were determined from 86 PG of RTX and 109 PG of ESRD patients. Patients were categorized according to the presence of small PG (volume < 100 mm(3)). Calcium homeostasis and hyperparathyroidism were evaluated 2 years after PT in RTX patients.
  
  
  RESULTS
  PG of RTX patients were significantly smaller, but similar hyperplastic in comparison to PG of ESRD patients. Small PG were more frequent in RTX than in ESRD patients (19% vs 6%) and mainly graded normal or diffuse hyperplastic (94%). Forty-seven percent of RTX, but only 14% of ESRD, patients receiving a total PT possessed ≥1 small PG (P < .05). Overall, PT treated successfully hypercalcemic hyperparathyroidism. However, TPT+AT caused permanent hypocalcemia in 50% of RTX patients without small PG and even in 83% of RTX patients with small PG. All RTX patients receiving less-than-total PT were normocalcemic at 2-year follow-up. Logistic regression revealed a 10.7 times greater risk of permanent hypocalcemia in RTX patients with small PG receiving TPT+AT compared with RTX patients without small PG receiving TPT+AT or RTX patients undergoing less-than-total PT.
  
  
  CONCLUSIONS
  Surgeons performing PT should be aware of the high frequency of small and less diseased PG in RTX patients. In this context, TPT+AT might overtreat hypercalcemic hyperparathyroidism in RTX patients, especially when small PG are present.
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany. Electronic address: jaeger.mark@mh-hannover.de.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Jäger
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Emmanouilidis
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Steffan
authors.initials: S
authors.lastname: Jackobs
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Kespohl
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Hett
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Denis
authors.initials: D
authors.lastname: Musatkin
authors.affiliation: Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tränkenschuh
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Georg F W
authors.initials: GF
authors.lastname: Scheumann
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006961:Hyperparathyroidism / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006965:Hyperplasia; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010280:Parathyroid Glands / Q000473:pathology* / Q000637:transplantation; D016105:Parathyroidectomy; D016896:Treatment Outcome; D055815:Young Adult