Parathyroidectomy after renal transplantation.

Among 569 patients treated with renal transplantation during a 12-year period in Gothenburg, eleven patients were subjected to subtotal parathyroidectomy after successful transplantation. All patients had comparatively long histories of advanced renal failure and/or long-lasting haemodialysis treatment before transplantation. Signs of hyperfunctioning parathyroid glands (elevated total serum calcium with or without clinical symptoms) appeared within the first few months after transplantation in eight cases, and after 1-3 years in three cases. Four patients had symptoms of bone disease and/or soft tissue calcium deposits whereas renal functional impairment was not noted in any patient. The remaining seven patients were operated upon because of persistently elevated serum calcium levels only, in order to prevent such complications. In spite of our extremely restrictive policy concerning parathyroidectomy in patients awaiting renal transplantation and, conversely, a liberal attitude to this operation after transplantation, parathyroidectomy was a rare event among our patients. The rationale for surgical treatment of mild hyperparathyroidism following renal transplantation is questioned, as is the need for sophisticated diagnostic procedures to detect more cases of asymptomatic hyperparathyroidism.