Total Parathyroidectomy with Autograft in Persistent Hyperparathyroidism After Renal Transplantation. (July 2018)

• Record Type: Journal Article
• Authors: Okada, Manabu; Minami, Masato; Futamura, Kenta; Tsujita, Makoto; Hiramitsu, Takahisa; Goto, Norihiko; Narumi, Shunji; Watarai, Yoshihiko; Ichimori, Toshihiro; Tominaga, Yoshihiro
• Is Part Of: Transplantation. Volume 102(2018)Supplement 7S-1
• Publication Date: 2018-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/01.tp.0000543431.25986.d1
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Introduction: Hyperparathyroidism (HPT) is a common and serious complication which may result in bone loss, renal dysfunction and cardiovascular events in patients with chronic kidney disease. After successful renal transplantation, some patients require parathyroidectomy due to persistent hyperparathyroidism. Detailed information regarding clinical course after total parathyroidectomy with autograft (total PTx-AT) in renal transplant patients is limited. We aimed to analyze the long-term effect of total PTx-AT on calcium, phosphorus, parathyroid hormone (PTH) levels and renal function. Materials and Methods: Fifty three renal transplant patients with persistent HPT received total PTx-AT between January 2000 and May 2017. Total PTx-AT was indicated for the cases in which persistent hypercalcemia (serum calcium ≥ 11.0mg/dL) or symptoms related to HPT existed. Most patients had hypercalcemia and 11 (20.8%) patients were receiving cinacalcet before surgery. We retrospectively investigated patient's characteristics and laboratory data. Results: There was a significant decrease in serum calcium and PTH levels (11.3 mg/dL vs 9.0 mg/dL, P<0.001; 185 pg/mL vs 47.5 pg/mL, P<0.001) 1 year after surgery. Serum phosphorus and creatinine levels increased significantly (2.4 mg/dL vs 3.6 mg/dL, P<0.001; 1.16 mg/dL vs 1.20 mg/dL, P<0.001). There were no graft loss or death associated with surgery. In 52 (98.1%) patients, hypercalcemia was corrected. However, 16 (30.2%) patients had persistent hypocalcemia. There were no reoperative parathyroidectomy at the end of follow-up. Discussion: In most cases, HPT was successfully treated with total PTx-AT without severe complication in renal transplant patients. However, persistent hypocalcemia observed in one third of patients suggested insufficiency of parathyroid function after surgery. Conclusion: Total PTx-AT seemed effective and safe to resolve persistent HPT in renal transplant patients. However, long-term hypocalcemia due to persistent hypoparathyroidism after surgery is an important issue which should be resolved in future.