SURGICAL-TREATMENT OF SECONDARY HYPERPARA THYROIDISM IN CHRONIC-RENAL-FAILURE - RESULTS OF TOTAL PARATHYROIDECTOMY WITH PARATHYROID AUTOGRAFT

Between 1978 and 1990, 68 patients, operated on for secondary hyperpar athyroidism (HPT), received a forearm intramuscular free autologous pa rathyroid graft (37 women and 31 men - mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same lime as t he total parathyroidectomy and the remaining parathyroid material afte r surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respec tively 3 or 5,5 years later, depending of the realisation of a renal t ransplantation (n = 27) or not. Four patients were lost to follow-up a nd 4 died post-operatively, including a wrong diagnosis (60 patients e valuated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had t o be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong di agnosis: 1 cervical gland left over and 1 aluminium intoxication). Sec ond cervicotomy was performed in 3 cases (5%) for remaining cervical p arathyroid gland (2 cases) and false-positive Tallium- Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.