American Association of Endocrine SurgeonsLess-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation
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Patients, surgical treatment, and follow-up
We retrospectively analyzed the medical records of all consecutive patients with tertiary HPT who underwent parathyroidectomy at two major referral centers for endocrine surgery between 1978-2002 (70 patients at the University Hospital of Lille, Lille, France9) and 1982-2003 (34 patients at the University of California, San Francisco, Calif10) (n = 104).
Tertiary HPT was defined here as secondary HPT that did not resolve after successful renal transplantation. The criteria for surgery were
Results
One hundred four patients underwent parathyroidectomy for tertiary HPT after kidney transplantation from January 1978 to December 2003 in Lille, France, and San Francisco, Calif.9, 10 Ten (9.6%) patients died during follow-up, 12 (11.5%) did not have PTH values at follow-up, and 8 (7.7%) were lost to follow-up.
Preoperative and postoperative characteristics of the 74 patients with PTH levels at follow-up are summarized in Table I. Nine patients had 2 operations: 8 after an initial
Discussion
In this retrospective study of patients with tertiary HPT after kidney transplantation at two major referral centers, we sought to determine factors that predicted elevated PTH levels after parathyroidectomy. We found that limited parathyroidectomy and decreased kidney function at follow-up are significantly associated with increased PTH levels at follow-up, and that limited parathyroidectomy increases the risk of persistent or recurrent HPT, as defined by PTH level.
The “cure” rate in this
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Challenges and controversies in the surgical management of uremic hyperparathyroidism: A systematic review
2018, American Journal of SurgeryCitation Excerpt :Currently, choice of procedure for PTX is up to the individual surgeon, given the similar cure rates observed between techniques.52 Further, the optimal gland remnant weight in the case of SPTX remains a subject of debate.71–73 One must weigh factors such as ease of reoperation, the risk for remnant gland failure, the risk of bleeding, and patient comorbidities during surgical planning.
Parathyroidectomy for tertiary hyperparathyroidism: A systematic review
2017, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :In general, these were defined as removal of one or two parathyroid glands [1,22,34]. Among these, results were mixed regarding whether the more limited parathyroidectomy was associated with a higher recurrence rate [22,29] or showed no difference [1,3,34]. There was a trend toward a higher incidence of complications with greater extent of resection.
Parathyroidectomy in Persistent Post-transplantation Hyperparathyroidism — Single-center Experience
2017, Transplantation ProceedingsCitation Excerpt :Because evidence-recommended guidelines regarding the optimal type of parathyroidectomy are lacking, the surgical strategy was defined by our dedicated endocrine surgical team, according to pre-operative imaging studies (ultrasound or scintigraphy) and intraoperative findings; if parathyroid enlargement was markedly asymmetrical, only the macroscopically diseased glands were removed. This strategy has also been reported by other authors [10,11], although more recently, there has been a preference towards performing subtotal PTX, as it is believed to improve the rate of recurrence [12,13]. The median time of hospitalization was 6 days (IQR 3–10) and there was no surgery-related mortality.
Does the Parathyroidectomy Endanger the Transplanted Kidney?
2016, Transplantation ProceedingsCitation Excerpt :The statistically significant decrease in eGFR occurred only in patients after sPTX; the decrease in the <sPTX group was insignificant. There are some concerns about an operation less than than subtotal resection as an ineffectual method [16–18]. In this study group, all patients who underwent surgery reached normocalcemic levels.
Frederic Triponez was supported by a grant from the University Hospital of Geneva for his fellowships in Lille and San Francisco. The authors have not had any involvements that might raise the question of bias in the work reported or in the conclusions or opinions stated herein.
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Current address: Frederic Triponez, MD, Thoracic and Endocrine Surgery, University Hospital of Geneva, Geneva, Switzerland.