Surgical Treatment of Tertiary Hyperparathyroidism after Renal Transplantation.
- Author:
Woong Youn CHUNG
1
;
Jong Ju JEONG
;
Ji Sup YUN
;
Yong Sang LEE
;
Kee Hyun NAM
;
Hang Seok CHANG
;
Myoung Soo KIM
;
Soon Il KIM
;
Yu Seun KIM
;
Cheong Soo PARK
Author Information
1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. yukim@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Tertiary hyperparathyroidism;
Parathyroidectomy;
Renal transplantation
- MeSH:
Allografts;
Autografts;
Calcium;
Creatinine;
Diet;
Humans;
Hypercalcemia;
Hyperparathyroidism*;
Hyperparathyroidism, Secondary;
Kidney;
Kidney Transplantation*;
Parathyroid Hormone;
Parathyroidectomy;
Reference Values;
Transplants
- From:The Journal of the Korean Society for Transplantation
2007;21(2):250-256
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery. METHODS: Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function. RESULTS: One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. CONCLUSION: PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.
