SUBTOTAL PARATHYROIDECTOMY IN DIALYSIS-DEPENDENT AND POSTRENAL TRANSPLANT PATIENTS - A 25-YEAR SINGLE-CENTER EXPERIENCE

Objective: To determine long-term results and durability of parathyroi dectomy in patients with chronic renal failure and renal transplant re cipients. Design: Retrospective chart review and structured telephone interviews. Setting: Tertiary-care academic medical center. Patients: Ninety-one consecutive patients (80 undergoing long-term dialysis, 11 with posttransplant hyperparathyroidism). Mean follow-up was 8 years ( minimum follow-up, 2 years; longest follow-up, 25 years). The most com mon indications for operation were bone pain (70% [56/80]) and weaknes s (46% [37/80]) in patients with renal failure and hypercalcemia (91% [10/11]) in renal transplant recipients. Intervention: Subtotal parath yroidectomy without remnant gland implantation. Main Outcome Measures: Postoperative morbidity and mortality, relief and recurrence of sympt oms. Results: Symptoms were successfully ameliorated in 95% (86/91) of patients. Clinically significant complications occurred in 5% (5/91) of patients (one patient each with wound hematoma, wound infection, an d permanent recurrent laryngeal nerve paralysis and two patients with permanent hypoparathyroidism). Recurrence occurred in five (5%) of 91 patients. Two of these patients required four operations each to eradi cate all hyperfunctioning accessory glands. The other three recurrence s were caused by hyperplasia of the remnant gland left in the neck. Th ese were easily treated by simple excision, with no morbidity. The act uarial rate of recurrent hyperparathyroidism was 4.1% at 1 year and 11 .7% at 20 years. Overall hospital mortality was 3% (3/91). None of the deaths was directly attributable to parathyroidectomy. Conclusions: W e recommend subtotal parathyroidectomy without remnant implantation as a safe and durable intervention for hyperparathyroidism associated wi th renal failure and following renal transplantation. This interventio n is associated with an acceptably low recurrence rate over extremely long periods of follow-up.