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Nada Rayes, MD; Daniel Seehofer, MD; Ralf Schindler, PhD; Petra Reinke, PhD; Andreas Kahl, MD; Frank Ulrich, MD; Peter Neuhaus, PhD; Natascha C. Nüssler, MD

Arch Surg. 2008;143(8):756-761.

Hypothesis  Total parathyroidectomy without autotransplantation in kidney transplant recipients leads to reduced recurrence rates and similar improvement of clinical symptoms compared with subtotal parathyroidectomy.

Design  A retrospective cohort study.

Setting  University clinic.

Patients  Thirty-three patients with functioning renal grafts who underwent primary total (n = 17; group 1) or subtotal (n = 16; group 2) parathyroidectomy for renal hyperparathyroidism.

Main Outcome Measures  Long-term levels of intact parathyroid hormone, serum calcium, phosphate, alkaline phosphatase, creatinine, and vitamin D; bone pain; use of medication; and incidence of persistent or recurrent hyperparathyroidism.

Results  The mean length of follow-up was 31 months in group 1 and 41 months in group 2. In all patients, postoperative serum calcium and phosphate levels normalized and bone pain markedly decreased. Persistent hypocalcemia was not observed. Serum creatinine levels intermittently increased in both groups but returned to preoperative levels in most of the patients. In group 1, all patients had undetectable intact parathyroid hormone levels throughout the study period. In group 2, 2 patients had persistent and 3 patients developed recurrent hyperparathyroidism (31%) that required therapy with cinacalcet hydrochloride in 3 cases. In 4 of these 5 patients, intact parathyroid hormone levels were greater than 54 ng/L directly after operation. In all, 27 of 33 patients (82%) received cholecalciferol therapy. Additional calcium supplementation was used by 12 group 1 patients (71%) and 3 group 2 patients (19%).

Conclusions  Total parathyroidectomy in kidney transplant recipients appears to be safe and protective against persistent and recurrent disease. If subtotal parathyroidectomy is performed, the remnant should be small.

Author Affiliations: Departments of General, Visceral, and Transplant Surgery (Drs Rayes, Seehofer, Ulrich, Neuhaus, and Nüssler) and Nephrology and Intensive Care Medicine (Drs Schindler, Reinke, and Kahl), Charité Campus Virchow Clinic, Berlin, Germany.

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Long-term Results of Subtotal vs Total Parathyroidectomy Without Autotransplantation in Kidney Transplant Recipients—Invited Critique
Clive S. Grant
Arch Surg. 2008;143(8):761.
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