Jäger Mark D, Kaaden Stephan, Emmanouilidis Nikos, Lück Rainer, Beckmann Jan H, Güner Zeynep, Kespohl Holger, Glockzin Kristina, Aselmann Heiko, Kaudel Christian P, Schwarz Anke, Zapf Antonia, Klempnauer Jürgen, Scheumann Georg F W
Klinik fuer Allgemein-, Viszeral-, und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Arch Surg. 2011 Jun;146(6):704-10. doi: 10.1001/archsurg.2011.138.
Parathyroidectomy (PT) corrects tertiary hyperparathyroidism in patients who have received renal grafts but can result in deterioration of renal function.
To compare different surgical procedures for their effect on renal function and efficacy to cure tertiary hyperparathyroidism.
A retrospective cohort study.
University clinic.
Eighty-three patients with functioning renal grafts receiving PT for the first time.
Group 1 received an incomplete PT, with at least 1 entire parathyroid gland (PG) remaining in situ (n = 12). Group 2 received an incomplete PT, with the most morphologically conserved PG partially resected (n = 22). Group 3 received a complete PT, with autotransplantation of PG tissue (n = 49).
The primary end point was the postoperative change in glomerular filtration rate. Secondary end points were rates of redialysis, hypercalcemia, and hyperparathyroidism within 5 years.
A decrease in glomerular filtration rate occurred postoperatively in 75 patients (90%) and correlated significantly with the extent of PG resection. Recovery of renal function at month 6 was observed in group 1, but not in groups 2 and 3 (P < .001). Seven patients (8%) needed permanent dialysis (1 in group 2 and 6 in group 3). Hypercalcemia was abrogated in 78 patients (94%), without significant differences among the groups. Assessment of parathyroid hormone levels in accordance with target ranges from the Kidney Disease Outcomes Quality Initiative guidelines did not reveal significant differences in the rates of recurrent hyperparathyroidism.
Incomplete PT preserving at least 1 entire PG does not cause deterioration of renal graft function and provides long-term correction of hypercalcemia and tertiary hyperparathyroidism.
