Archives of Head and Neck Surgery
https://archivesheadnecksurgery.com/article/doi/10.4322/ahns.2019.0024
Archives of Head and Neck Surgery
Original Article Parathyroid diseases and tumors

Outcome of subtotal parathyroidectomy for surgical treatment of hyperparathyroidism after renal transplantation

Murilo Catafesta das Neves, Ana Beatriz Ribeiro Fonseca, Camila Akemi Yamashiro Koike, Davi Knoll Ribeiro, Mayra Messias Lera, Rodrigo Oliveira Santos

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Abstract

Introduction: Parathyroidectomy (PTX) is one of the forms to treat hyperparathyroidism (HPT) after renal transplantation (RT), but choosing the appropriate surgical technique is controversial. The option for more conservative surgeries, such as subtotal parathyroidectomy (STPX), has been expanding owing to the lower risk of definitive HPT and its effectiveness in controlling hypercalcemia. Objective: To evaluate the efficacy of STPX as a definitive treatment for hyperparathyroidism after renal transplantation (HPTRT) and determine whether there is a relationship between percentage intraoperative parathyroid hormone (ioPTH) decay levels and parathyroid hormone (PTH) values on the first postoperative day and surgical success. Methods: This retrospective study analyzed the medical records of prospectively followed patients diagnosed with HPT-RT submitted to STPX in two tertiary hospitals (Brazilian Unified Health System - SUS) for two years. Patients were allocated in two groups according to operative success (SG - normalization of ionized calcium (iCa) and PTH six months after surgery) or operative failure (FG - persistence of high iCa and PTH). The percentage ioPTH decay levels and the postoperative PTH absolute values on the first postoperative day were evaluated in both groups. Results: Of the total sample of 31 patients, surgical treatment was successful in 27 cases (87%). No statistically significant differences were observed between the groups for the percentage ioPTH decay levels (SG = 71.51% vs. FG = 70.4%), as well as for the PTH absolute values on the first postoperative day (SG = 52.69pg/ mL vs. FG = 54.55pg/mL). Conclusion: Subtotal parathyroidectomy is an effective and safe procedure for treating HPT-RT; however, the use of PTH levels remains subjective and cannot be considered as a predictor of surgical success.

Keywords

hyperparathyroidism; parathyroidectomy; renal transplantation; hypercalcemia.

References

1. Kandil E, Florman S, Alabbas H, Abdullah O, McGee J, Noureldine S, Slakey D, Zhang R. Exploring the effect of parathyroidectomy for tertiary hyperparathyroidism after kidney transplantation. Am J Med Sci. 2010;339(5):420-4. http://dx.doi.org/10.1097/MAJ.0b013e3181d8b6ff. PMid:20234299.

2. Evenepoel P, Claes K, Kuypers D, Maes B, Bammens B, Vanrenterghem Y. Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study. Nephrol Dial Transplant. 2004;19(5):1281-7. http://dx.doi.org/10.1093/ndt/gfh128. PMid:14993493.

3. Copley JB, Wüthrich RP. Therapeutic management of post-kidney transplant hyperparathyroidism. Clin Transplant. 2011;25(1):24-39. http://dx.doi.org/10.1111/j.1399-0012.2010.01287.x. PMid:20572835.

4. Dulfer RR, Franssen GJH, Hesselink DA, Hoorn EJ, van Eijck CHJ, van Ginhoven TM. Systematic review of surgical and medical treatment for tertiary hyperparathyroidism. Br J Surg. 2017;104(7):804-13. http://dx.doi.org/10.1002/bjs.10554. PMid:28518414.

5. Tominaga Y, Kakuta T, Yasunaga C, Nakamura M, Kadokura Y, Tahara H. Evaluation of Parathyroidectomy for Secondary and Tertiary Hyperparathyroidism by the Parathyroid Surgeons’ Society of Japan. Ther Apher Dial. 2016;20(1):6-11. http://dx.doi.org/10.1111/1744-9987.12352. PMid:26879490.

6. Goldsmith D, Covic A, Vervloet M, Cozzolino M, Nistor I, Cozzolino M, Vervloet M, Brandenburg V, Bover J, Covic A, Evenepoel P, Goldsmith D, Massy Z, Mazzaferro S, Urena-Torres P, Abramowicz D, Bolignano D, Cannata Andia G, Cochat P, Covic A, Delvecchio L, Drechsler C, Eckardt KU, Fouque D, Fox J, Haller M, Heimburger O, Jager KJ, Lindley E, Marti Monros AM, Nagler E, Oberbauer R, Spasovski G, Tattersall J, Van Biesen W, vander Veer S, Vanholder R, Wanner C, Wheeler D, Whithers W, Wiecek A, Zoccali C. Should patients with CKD stage 5D and biochemical evidence of secondary hyperparathyroidism be prescribed calcimimetic therapy? An ERA-EDTA position statement. Nephrol Dial Transplant. 2015;30(5):698-700. http://dx.doi.org/10.1093/ndt/gfv050. PMid:25928337.

7. Neves MCD, Rocha LAD, Cervantes O, Santos RO. Initial surgical results of 500 Parathyroidectomies for Hyperparathyroidism related to chronic kidney disease - mineral and bone disorder. J Bras Nefrol. 2018;40(4):319-25. http://dx.doi.org/10.1590/2175-8239-jbn-3924. PMid:29944161.

8. Meng C, Martins P, Frazão J, Pestana M. Parathyroidectomy in persistent posttransplantation hyperparathyroidism: single-center experience. Transplant Proc. 2017;49(4):795-8. http://dx.doi.org/10.1016/j.transproceed.2017.01.067. PMid:28457397.

9. Goldenstein PT, Elias RM, Carmo LPF, Coelho FO, Magalhães LP, Antunes GL, Custódio MR, Montenegro FL, Titan SM, Jorgetti V, Moysés RM. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PLoS One. 2013;8(8):e68870. http://dx.doi.org/10.1371/journal. pone.0068870. PMid:23940515.

10. Sampaio Ede A, Moysés RM. Parathyroidectomy in CKD. J Bras Nefrol. 2011;33(2):221-4. PMid:21789436.

11. Schlosser K, Endres N, Celik I, Fendrich V, Rothmund M, Fernández ED. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters! World J Surg. 2007;31(10):1947-53. http://dx.doi.org/10.1007/s00268-007-9187-z. PMid:17665243.

12. Neves MC, Ohe MN, Rosano M, Abrahão M, Cervantes O, Lazaretti-Castro M, Vieira JG, Kunii IS, Santos RO. A 10-year experience in intraoperative parathyroid hormone measurements for primary hyperparathyroidism: a prospective study of 91 previous unexplored patients. J Osteoporos. 2012;2012:914214. http://dx.doi.org/10.1155/2012/914214. PMid:22523718.

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