J Korean Soc Transplant.  2007 Dec;21(2):250-256.

Surgical Treatment of Tertiary Hyperparathyroidism after Renal Transplantation

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. yukim@yumc.yonsei.ac.kr
  • 2Research Institute for Tansplantation, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery.
METHODS
Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function.
RESULTS
One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX.
CONCLUSION
PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.

Keyword

Tertiary hyperparathyroidism; Parathyroidectomy; Renal transplantation

MeSH Terms

Allografts
Autografts
Calcium
Creatinine
Diet
Humans
Hypercalcemia
Hyperparathyroidism*
Hyperparathyroidism, Secondary
Kidney
Kidney Transplantation*
Parathyroid Hormone
Parathyroidectomy
Reference Values
Transplants
Calcium
Creatinine
Parathyroid Hormone
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