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Clinical and operative management of persistent hyperparathyroidism after renal transplantation: A single‐center experience
Author(s) -
Gilat Hanna,
Feinmesser Raphael,
Vinkler Yanush,
Morgenstern Sara,
Shvero Jacob,
Bachar Gideon,
Shpitzer Thomas
Publication year - 2007
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.20628
Subject(s) - medicine , parathyroidectomy , transplantation , surgery , hyperparathyroidism , tertiary hyperparathyroidism , nephrology , hyperplasia , kidney transplantation , single center , perioperative , parathyroid gland , parathyroid hormone , calcium
Abstract Background. Persistent (tertiary) hyperparathyroidism (TH) after renal transplantation may cause considerable morbidity and necessitate parathyroidectomy. This study investigated the characteristics of this patient subgroup. Methods. The medical data and pathology specimens of 20 kidney transplant recipients who underwent parathyroidectomy for TH in 2001 to 2004 were reviewed. Results. Treatment consisted of subtotal resection of 3.5 glands in 13 patients, resection of 3 to 3.5 glands under intraoperative parathyroid hormone monitoring (iPTH) in 5 patients, and selective resection in 2 patients with markedly asymmetric gland enlargement. Eighteen patients had hyperplasia—diffuse in 10, nodular in 4, or both in 2; 2 patients had 1 large nodule in every gland. Six patients had postoperative complications. Follow‐up of 2 years revealed recurrent hypercalcemia in 1 patient and a high level of PTH (>60 pg/mL) in 12. Conclusion. Subtotal resection for TH may be insufficient. The use of iPTH monitoring is recommended. Renal transplant recipients have distinctive characteristics and require special perioperative attention. © 2007 Wiley Periodicals, Inc. Head Neck, 2007