Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

Jae Hyun Park, Sang Wook Kang, Jong Ju Jeong, Kee Hyun Nam, Hang Seok Chang, Woong Youn Chung, Cheong Soo Park

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient method for treatment of tHPT. In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery. Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5%) were identified as having tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function. One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX. We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs. Levels of iPTH and serum calcium were at normal range after PTX. 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. PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function. We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.

Original languageEnglish
Pages (from-to)827-833
Number of pages7
JournalEndocrine Journal
Volume58
Issue number10
DOIs
Publication statusPublished - 2011 Nov 3

Fingerprint

Hyperparathyroidism
Kidney Transplantation
Parathyroid Hormone
Glomerular Filtration Rate
Transplants
Kidney
Autologous Transplantation
Hypercalcemia
Therapeutics
Calcium
Diet Therapy
Parathyroidectomy
Secondary Hyperparathyroidism
Therapeutic Uses
Serum
Signs and Symptoms
Allografts
Reference Values

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Park, Jae Hyun ; Kang, Sang Wook ; Jeong, Jong Ju ; Nam, Kee Hyun ; Chang, Hang Seok ; Chung, Woong Youn ; Park, Cheong Soo. / Surgical treatment of tertiary hyperparathyroidism after renal transplantation : A 31-year experience in a single institution. In: Endocrine Journal. 2011 ; Vol. 58, No. 10. pp. 827-833.
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abstract = "Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient method for treatment of tHPT. In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery. Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5{\%}) were identified as having tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function. One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX. We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs. Levels of iPTH and serum calcium were at normal range after PTX. 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. PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function. We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.",
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Surgical treatment of tertiary hyperparathyroidism after renal transplantation : A 31-year experience in a single institution. / Park, Jae Hyun; Kang, Sang Wook; Jeong, Jong Ju; Nam, Kee Hyun; Chang, Hang Seok; Chung, Woong Youn; Park, Cheong Soo.

In: Endocrine Journal, Vol. 58, No. 10, 03.11.2011, p. 827-833.

Research output: Contribution to journalArticle

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