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

Abstract

AbstractIn 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 lithiasis (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.