Indications and late results of subtotal parathyroidectomy for hyperparathyroidism after renal transplantation

Abstract

In view of the current controversy about the relative merits of subtotal versus total parathyroidectomy plus autograft for the treatment of parathyroid hyperplasia, we reviewed the results of subtotal parathyroidectomy in 6 patients with hyperparathyroidism after successful renal transplantation. All had normal renal function and hypercalcemia (mean 11.4 mg/100 ml). The time elapsed between renal transplantation and parathyroidectomy ranged from 3 months to 10 years (mean 42 months). The indications for subtotal parathyroidectomy were: severe acute hypercalcemia after transplantation (1 case), persistent asymptomatic hypercalcemia (2 cases), allograft iithiasis (2 cases), and bone disease (1 case). Subtotal parathyroidectomy was performed, aiming to leave about 30-50 mg of parathyroid tissue, and included a routine transcervical thymectomy. The weight of resected tissue ranged between 0.6 and 2.4 g per patient (mean 1.58 g). Immediate control of hypercalcemia was achieved in all cases. No patient needed replacement therapy with calcium and/or vitamin D after the operation. The 6 patients were followed from 8 months to 4.5 years (mean 34 months) and all had normal calcium, phosphate, and alkaline phosphatase serum values at the time of their last visit. A reappraisal of the surgical indications for hypercalcemia after renal transplantation is needed because severe longterm complications (allograft lithiasis) may develop in patients with minimal hypercalcemia. Subtotal parathyroidectomy is a good operation for treating hyperparathyroidism in patients with functioning renal allografts.

Subtotal parathyroidectomy with thymectomy for autonomous hyperparathyroidism after renal transplantation

“…These treatments can be broadly divided into systematic subtotal parathyroid reduction surgery (total parathyroidectomy with thymectomy and autotransplantation, or subtotal parathyroidectomy with thymectomy), regardless of preoperative and intraoperative findings, as classically indicated in secondary HPT7, 8, 11, and a more conservative approach, tailored to the macroscopically (or ultrasonographically) enlarged glands12, 13, 18. Surgical series using these various approaches have all reported long‐term success rates greater than 70 per cent, although different criteria were used to define postoperative hypoparathyroidism and recurrent HPT7, 12, 13, 19–23. None of the published series has presented the long‐term results in patients who had surgery in the presence of a functioning graft but who returned to dialysis or predialysis after parathyroidectomy.…”

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

“…tHPT can cause serious problems, including hypercalcaemia, osteitis fibrosa cystica, osteoporosis leading to increased risk of fracture, soft tissue calcification, bone pain, myopathy with muscular weakness, tendon rupture, anaemia (refractory to erythropoietin), arterial hypertension, and hypercalciuria that increases the risk of kidney stone disease, which is particularly deleterious in a renal graft [4,[6][7][8][9][10][11][12].…”

Serum calcium as an early indicator for surgical treatment of hyperparathyroidism after renal transplantation

“…None of the study group patients had symptoms suggestive of graft lithiasis, but formation of calculi in the graft could not be properly investigated because of the retrospective nature of the study. Lithiasis appears to be an uncommon complication of HRT, but it can occur many years after transplantation even in patients with borderline hypercalcemia [5,10]. We found that hypercalciuria is nearly always present in HRT [5] and this may predispose to the formation of stones as in primary hyperparathyroidism.…”

“…Lithiasis appears to be an uncommon complication of HRT, but it can occur many years after transplantation even in patients with borderline hypercalcemia [5,10]. We found that hypercalciuria is nearly always present in HRT [5] and this may predispose to the formation of stones as in primary hyperparathyroidism.…”