Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease
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Background: Subtotal parathyroidectomy (SP) and total parathyroidectomy (TP) with autotransplantation (TPai) are the most commonly adopted operations for the treatment of secondary hyperparathyroidism (2HPT). TP without autotransplantation had previously been confined to patients with advanced dialytic vintage, not eligible for kidney transplantation. Over the years, the procedure has gained more widespread use, but there is no precise knowledge on the immediate and long-term effects. Methods: The authors analyzed the immediate and long-term results of TP without autotransplantation, that is after the systematic removal of at least four glands in 20 patients operated for 2HPT, which were compared with results from TPai in an equal number of cases. Results: An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact PTH (iPTH) serum levels was achieved. Immediate normalization of iPTH level was observed in 11/20 TP cases, hypoparathyroidism in 4/20 and persistent HPT in 5/20 cases. One year of follow-up showed a slight increase in hypoparathyroidism, with 1/20 (5%) recurrence of the disease. One-year TPai results showed a similar percentage of euparathyroidism, as well as a higher long-term recurrence rate (4/20, 20%), although values do not reach statistical significance. Conclusions: TP may still be considered the operation of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation, because of its low recurrence rate (5%). Post-operative aparathyroidism is rare, while hypoparathyroidism and hypocalcemia can be well controled by medical treatment.
Key-wordsAutotransplantation chronic kidney disease parathyroidectomy secondary hyperparathyroidism
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- 1.Schlosser K, Veit JA, Witte S, et al. Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidectomy: TOPAR PlLOT-Trial. Trials 2007, 8: 22.PubMedCentralPubMedCrossRefGoogle Scholar
- 2.Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009, (113): S1–130.Google Scholar
- 4.National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003, 42 (4 Suppl 3): S127–9.Google Scholar
- 6.Fassbinder W, Brunner FP, Brynger H, et al. Combined report on regular dialysis and transplantation in Europe, XX, 1989. Nephrol Dial Transplant 1991, 6(Suppl 1): 5–35.Google Scholar
- 10.Malberti F, Marcelli D, Conte F, Limido A, Spotti D, Locatelli F. Parathyroidectomy in patients on renal replacement therapy: an epidemiologic study. J Am Soc Nephral 2001, 12: 1242–8.Google Scholar
- 15.Gasparri G, Camandona M, Mengozzi G, et al. Qu’est-ce que l’introduction du dosage peroperatoire de la PTH a changé dans les strategies chirurgicales des hyperparathyrodismes?. e-memoires de l’Académie Nationale de Chirurgie 2004, 3: 26–9.Google Scholar