Long-term Results of Subtotal vs Total Parathyroidectomy Without Autotransplantation in Kidney Transplant Recipients

Rayes, Nada; Seehofer, Daniel; Schindler, Ralf; Reinke, Petra; Kahl, Andreas; Ulrich, Frank; Neuhaus, P.; Nüssler, Natascha C.

doi:10.1001/archsurg.143.8.756

Cited by 48 publications

(40 citation statements)

References 20 publications

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“…The correlation between pain and calcium showed a weak positive correlation, which is in concordance with a study by Rayes et al [63], who found a reduction of bone pain when calcium levels dropped to the normal range. A positive correlation between bone pain and osteocalcin was described in a long-term study by Hampl et al [64], where an increased physical activity and endurance was interpreted as a reduction of bone pain.…”

Section: Discussionsupporting

confidence: 91%

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

et al. 2018

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Background: After parathyroidectomy (PTX), hungry bone syndrome leads to hypocalcemia due to bone remineralization. The aim of this pilot study was to analyze changes in markers of bone metabolism in patients with secondary hyperparathyroidism (sHPT) after PTX and to correlate these markers with bone pain measured with a validated questionnaire. Materials and Methods: All patients who underwent PTX for sHPT between March 2010 and February 2012 at out institution were included in this prospective observational pilot study. At the day before surgery and on the 3rd day thereafter, levels of parathyroid hormone (PTH), calcium, osteocalcin, alkaline phosphatase (AP), bone-specific AP (BAP), tartrate-resistant acid phosphatase 5b (TRAP5b), osteoprotegerin (OPG), sclerostin, fibroblast growth factor 23, and Klotho were measured. Additionally, all patients were requested to answer the Brief Pain Inventory preoperatively and on the 5th postoperative day. Results: A total of 35 patients with a mean age of 49.8 years were analyzed. A significant difference between the pre- and postoperative values could be detected in PTH, calcium, BAP, TRAP5b, and sclerostin. The highest correlation of laboratory markers with bone pain was found for preoperative PTH (r = 0.3), postoperative OPG (r = 0.4), postoperative BAP (r = –0.4), and postoperative Klotho (r = –0.4). Conclusions: The present study revealed significant perioperative changes in PTH, BAP, sclerostin, and TRAP5b after PTX. These markers may serve as laboratory markers to monitor bone metabolism in patients with sHPT. PTH, OPG, and sclerostin were the parameters with the closest correlation to bone pain. However, larger prospective trials with a longer follow-up are required to confirm these results.

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Section: Discussionsupporting

confidence: 91%

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

et al. 2018

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“…It is also well worth noting that all recurrences occurred in patients who were receiving dialysis treatment (26,27). Therefore, the most important reason for recurrence was related not to the surgical approach itself but rather to the effects of longstanding renal disease, given that no recurrence was observed among patients who received renal transplantation, even throughout a long follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Sakman¹,

Parsak²,

Balal³

et al. 2014

Balkan Med J

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Secondary hyperparathyroidism (sHPT) is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events (1). Parathyroidectomy (PTX) is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years (2, 3).When medical treatment fails, subtotal parathyroidectomy (subtotal PTX) with a cervical remnant and total parathyroidectomy with autotransplantation (total PTX+AT) are the standard procedures, although both are associated with high recurrence rates (4-7). A considerable quantity of functioning parathyroid tissue is left after each of these operations in order to prevent possible hypoparathyroidism and the need for longBackground: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. Conclusion: Total parathroidectomy with auto...

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“…Until very recently, the recommended surgical procedure for patients with HPT after renal transplantation was similar to that for patients with renal HPT under dialysis, a form of subtotal resection of all parathyroid tissue (usually subtotal PTX or total PTX+AT), because of the increased risk of recurrence if more parathyroid tissue is left in place [34,116] However, despite recent reports suggesting that hypoparathyroidism, even if definitive, is manageable in patients with a good renal function [66,[137][138][139], it seems that the current trend is to be less aggressive for three main reasons:…”

Section: Extent Of Surgery In Persistent Hpt After Renal Transplantationmentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

105

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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Long-term Results of Subtotal vs Total Parathyroidectomy Without Autotransplantation in Kidney Transplant Recipients

Cited by 48 publications

References 20 publications

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

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