Nephrology Dialysis Transplantation, Vol 12, Issue 11 2393-2396, Copyright © 1997 by Oxford University Press
T Schmid, P Muller and F Spelsberg
Background: Advanced hyperparathyroidism refractory to
active vitamin D continues to be a problem and frequently forces the
nephrologist to resort to parathyroidectomy. One particular aspect is
persisting advanced hyperparathyroidsim after renal transplantation.
Published information on this point is fragmentary.
Design: Retrospective analysis.
Patients: Between 1983 and 1995 a total of 456
patients with renal secondary hyperparathyroidism were subjected to
parathyroidectomy (PTX) of whom 103 were transplanted or had at least a
history of renal transplantation. The present analysis concerns 37 patients
who had a functional renal graft at the time of PTX and were followed for
up to 13 years. PTX was performed after an average of 36.7 months after
renal transplantation. Outcome: Thirteen patients
experienced rejection and became dialysis-dependent. Twenty-four patients
had stable function of the renal graft. Seven patients died during
follow-up. Hypoparathyroidism post-PTX developed in 4/37 patients, but
could be overcome by replantation of cryoconserved parathyroid tissue.
Frequency estimate: A total of 2632 renal transplants
were performed in the catchment area. As a minimum estimate 3.91% of
patients with a functional graft required PTX.
Recommendation: Parathyroidectomy should be considered
early in cases with advanced secondary renal hyperparathyroidism, since
renal transplantation does not necessarily guarantee reversibility of
parathyroid overactivity. Key words:
hyperparathyroidism; parathyroidectomy; renal transplantation;
hypercalcaemia
ORIGINAL ARTICLES
Parathyroidectomy after renal transplantation: a retrospective analysis of long-term outcome
Department Surgery, Martha-Maria Hospital, Wolfratshauserstrasse 109, D-81479 Munchen, Germany; Corresponding author
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