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Removal of Autografted Parathyroid Tissue for Recurrent Renal Hyperparathyroidism in Hemodialysis Patients

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Abstract

Background

Recurrent renal hyperparathyroidism (HPT) is a serious problem after parathyroidectomy (PTx). We evaluated the frequency of graft-dependent recurrent HPT and the clinical outcomes after removal of the autograft.

Methods

Between March 1980 and January 2009, 2660 patients underwent total PTx with forearm autograft. After resection of all parathyroid glands, 30 pieces of 1 × 1 × 3 mm parathyroid tissue from diffuse hyperplasia, if possible, were autografted into brachioradial muscle. Graft-dependent recurrence of HPT was diagnosed by a high PTH gradient and detection of swollen autografts by palpation and/or MRI or US.

Results

In 248/2660 (9.3%) patients, removal of the graft was required a total of 327 times (53 patients required removal of the autograft several times). The cumulative frequency of graft-dependent recurrent HPT was 17.4% ten years after the initial PTx. Thirty-two patients underwent both resection of missed glands located in the neck or mediastinum and removal of the graft. En-bloc resection of autograft with surrounding muscle was required to avoid reoperation. When the intact PTH level dropped under 300 pg/ml, in the majority of patients renal HPT could be medically managed after the operation. The mean weight of the resected parathyroid tissue was 1583.7 mg. No specimen had histopathologically malignant features. Three patients suffered from hematoma in the wound.

Conclusions

Graft-dependent recurrent renal HPT is not negligible. However, in the majority of patients, renal HPT can be controlled by removal of the autograft noninvasively. Total PTx with forearm autograft is preferable for hemodialysis patients, especially when long-term survival is expected.

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Acknowledgments

We thank Professor Henry Johansson, Department of Surgery, Uppsala University Hospital, Sweden, for his kind advice on the manuscript.

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Authors and Affiliations

  1. Department of Transplant and Endocrine Surgery, Nagoya Second Red Cross Hospital, 2–9, Myoken-cho, Showa-ku, Nagoya, 4668650, Japan

    Yoshihiro Tominaga, Susumu Matsuoka, Nobuaki Uno, Takahisa Hiramitsu, Norihiko Goto, Takaharu Nagasaka, Yoshihiko Watarai & Kazuharu Uchida

  2. Department of Pathology, Nagoya Second Red Cross Hospital, Nagoya, Japan

    Toyonori Tsuzuki

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  1. Yoshihiro Tominaga
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  2. Susumu Matsuoka
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Correspondence to Yoshihiro Tominaga.

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Tominaga, Y., Matsuoka, S., Uno, N. et al. Removal of Autografted Parathyroid Tissue for Recurrent Renal Hyperparathyroidism in Hemodialysis Patients. World J Surg 34, 1312–1317 (2010). https://doi.org/10.1007/s00268-010-0412-9

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  • DOI: https://doi.org/10.1007/s00268-010-0412-9

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