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      Short- and Long-Term Outcome of Total Parathyroidectomy with Immediate Autografting versus Subtotal Parathyroidectomy in Patients with End-Stage Renal Disease

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          A retrospective study was performed in 36 patients with end-stage renal disease (ESRD) comparing total parathyroidectomy followed by immediate autografting into the forearm (total PTX + IA) with parathyroidectomy (subtotal PTX) over a five-year period. Twenty-eight patients underwent subtotal PTX and 8 had total PTX + IA. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, perioperative morbidity, and the incidence of recurrent hyperparathyroidism. Eleven patients in total (30.6%) developed recurrent hyperparathyroidism; 2/8 (25%) in the total PTX + IA group compared to 9/28 (32.1%) in the subtotal PTX group (p = 0.699). The median time to recurrence was longer in the total PTX + IA group (39 vs. 16 months), and the median long-term postoperative PTH value was lower (81 vs. 199 ng/l), but these differences did not reach statistical significance. In conclusion, the incidence of recurrent hyperparathyroidism is high regardless of surgical modality. However, total PTX + IA may produce more favorable results with respect to median postoperative PTH level and time to recurrence.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          October 1999
          26 November 1999
          : 19
          : 5
          : 559-564
          Divisions of aNephrology, bGeneral Surgery, and cEndocrinology and Metabolism, University of Calgary, Calgary, Alta., Canada
          13520 Am J Nephrol 1999;19:559–564
          © 1999 S. Karger AG, Basel

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          Tables: 3, References: 22, Pages: 6
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