Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation

Surgery. 2006 Dec;140(6):990-7; discussion 997-9. doi: 10.1016/j.surg.2006.06.039.

Abstract

Background: The optimal surgical approach for tertiary hyperparathyroidism (HPT) after kidney transplantation is unknown. Existing studies are limited by small sample size, lack of adjustment for kidney function, and no long-term follow-up.

Methods: We retrospectively analyzed 74 patients with tertiary HPT who underwent parathyroidectomy at two centers since 1978. Persistent HPT was defined as parathyroid hormone (PTH) concentrations in excess of the K/DOQI target range for the corresponding estimated creatinine clearance (eCrCl).

Results: Seventy-four patients had 83 operations (72 subtotal and 11 less-than-subtotal parathyroidectomies). Mean follow-up time was 5.4 +/- 4.7 years. Calcium concentrations decreased significantly after parathyroidectomy (2.83 vs 2.28 mmol/L, P < 0.001), as did eCrCl (54.5 vs 44.9 mL/min, P < 0.001) and PTH (382 vs 132 pg/mL, P < 0.001). In the multivariable regression analysis, only the type of operation and postoperative eCrCl were significantly correlated with PTH at follow-up. A limited parathyroidectomy was associated with a fivefold increase in risk of persistent or recurrent hyperparathyroidism.

Conclusions: The use of limited parathyroidectomy for tertiary HPT after kidney transplantation has a higher risk of persistent/recurrent HPT. Subtotal parathyroidectomy is recommended for patients with tertiary HPT.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Creatinine / urine
  • Endpoint Determination
  • Europe
  • Female
  • Humans
  • Hyperparathyroidism / blood
  • Hyperparathyroidism / etiology*
  • Hyperparathyroidism / surgery*
  • Kidney / physiology
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Parathyroidectomy / methods*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • United States

Substances

  • Parathyroid Hormone
  • Creatinine